What to Do When Your Insurance Claim Is Denied After a Car Accident
A serious car accident can leave you with medical bills, vehicle damage, and lost time. When your insurance claim is denied, the stress increases. Insurance companies may reject claims for missing documents, disputed fault, or policy exclusions. In Georgia, you have the right to question that denial and take action.
In this blog, you will learn why insurance claims get denied, what immediate steps to take, how to strengthen your case, and how working with an experienced Cumming car accident lawyer can help you challenge the denial and recover the compensation you deserve.
Why Insurance Denials Happen in Georgia
Insurance denials after a car accident can feel unfair and confusing. Understanding the most common reasons helps you take the right next steps to protect your rights and strengthen your claim.
Missing or Delayed Documentation
Insurance companies often deny claims when key information is missing. This includes the police report, medical records, or proof of vehicle damage. If you do not report the accident promptly or fail to provide required documents, the insurer may claim the delay affected their ability to assess the claim accurately.
Disputes Over Fault
If the insurance company believes you caused the accident or shares responsibility with the other driver, they may deny your insurance claim. Georgia follows a modified comparative fault system under O.C.G.A. § 51-12-33, which means if you are found to be 50% or more at fault, you cannot recover damages. This makes accurate documentation from the accident scene critical, including photos, license plate numbers, and statements.
Lapses or Exclusions in the Insurance Policy
A denial may happen if the insurance policy was inactive or if the claim falls under an exclusion. Common exclusions include unlisted drivers, commercial use of a personal vehicle, or failure to pay premiums. Always check your policy to confirm the limits and the type of coverage in place at the time of the collision.
Medical Necessity and Treatment Disputes
Insurers may challenge the medical necessity of your treatment. If they believe the treatment was not related to the accident or was excessive, they may refuse to pay. Supporting your claim with medical records, doctor’s notes, and timelines of care helps prevent this type of denial.
Bad Faith Insurance Practices
Some insurance companies act in bad faith by delaying the claims process or misrepresenting facts. This is illegal under O.C.G.A. § 33-6-34, which prohibits insurers from knowingly offering false information or refusing to pay claims without a valid reason. If you suspect the denial was made in bad faith, it may be time to contact a car accident attorney.
Immediate Steps After a Denial
If your insurance claim is denied, take quick and clear action. These first steps can protect your right to appeal and help you recover what you are owed.
Request a Written Explanation
Ask the insurance company for a written explanation of the denial. This letter should explain why the claim was denied and which part of the insurance policy they used to justify the decision. Georgia law requires that insurers provide accurate information to policyholders.
Review Your Insurance Policy
Read your insurance policy carefully. Look for the sections that apply to your situation, including coverage for property damage, medical bills, or a rental car. Compare the denial letter with the policy to find any conflicts. Understanding your coverage is key to building a response.
Collect and Review All Accident Documents
Check your accident report, medical records, and any communication with the insurance company. Make sure your file includes license plate numbers, insurance information from the other driver, and photos of the accident scene. Missing or incorrect information can cause a denied claim.
Contact the Claims Adjuster
Call the claims adjuster and ask for details about the denial. Keep a record of the date, time, and name of the person you spoke with. Write down the explanation they gave. Stay calm and professional, and do not accept blame.
Track Everything in Writing
Create a file with all emails, letters, and notes about your car accident claim. Keep receipts for repairs, medical bills, and roadside assistance. Use this documentation to support your appeal or legal case if the insurance company refuses to pay.
How to Strengthen a Denied Claim
If your insurance company denied your car accident claim, you can still take steps to build a stronger case and push for a review.
Organize Key Information and Documents
Gather all documents related to the accident. This includes the police report, photos of vehicle damage, proof of medical treatment, and contact details for any witnesses. Make sure your file includes the other driver’s insurance information and license plate number. Having complete documentation shows the facts clearly.
Get a Second Opinion on Property Damage
If your vehicle was declared a total loss or the insurance company undervalued the repairs, seek an independent inspection. A repair shop or third-party adjuster can give you a new estimate. Submit this report to the insurer as part of your appeal.
Prove Medical Necessity
Insurance companies may question the need for certain treatments. Ask your doctor to provide a written statement explaining the medical necessity of your care. Include timelines, test results, and treatment plans. This can help counter a denial based on insufficient proof.
Keep Track of All Communication
Write down every conversation you have with the insurance company. Save all emails, letters, and claim forms. Keeping a clear record of the claims process shows you followed the rules and helps identify delays or errors by the insurer.
Ask for an Internal Review
Most insurance policies allow you to request a review of a denied claim. Contact the claims department and ask how to begin this process. Include any new information or missing documents. This step often leads to a different decision without needing legal action.
The Appeals Process in Georgia
If your car accident claim has been denied, Georgia law gives you the right to appeal. Following the correct steps can improve your chances of getting the claim reviewed and approved.
Understand Your Rights Under Georgia Law
Under O.C.G.A. § 33-24-44, insurance companies must explain the reason for a denial and give you a chance to respond. The appeals process is part of your legal right to challenge a decision you believe is wrong or unfair. Insurers must act in good faith and process appeals within a reasonable time.
Submit a Formal Appeal
To start the appeals process, submit a written request to the insurance company. Include your claim number, the denial letter, and a clear explanation of why you believe the denial is incorrect. Attach all supporting documents, such as medical records, photos of the accident scene, estimates for vehicle damage, and the police report.
Meet All Deadlines
Most insurance policies set deadlines for filing an appeal. Read your policy to find the exact time limit. Missing a deadline can result in a lost opportunity to reverse the denial. Act quickly and keep a copy of everything you send.
Request an Internal Review
Ask the insurance company for an internal review of your denied claim. This review is done by a different claims adjuster or supervisor who was not involved in the original decision. Provide any new documents or updates that support your case.
Consider Mediation or Legal Help
If the appeal is denied again, you may be eligible for mediation or legal action. A car accident attorney can help you evaluate the situation and decide if further action is needed. In some cases, insurers that deny valid claims in bad faith may owe extra damages under Georgia law.
Contact an Experienced Cumming Car Accident Attorney Today!
If your insurance claim has been denied after a serious car accident, you don’t have to face the process alone. Denials can feel final, but there are steps you can take to challenge the decision and protect your rights. Our team at the Law Offices of Humberto Izquierdo, Jr., PC is here to help.
Contact us at (770) 888-8901 for a free claim review today!
