Insurance Company Won't Settle?
Wondering why your insurance company won’t settle your car insurance claim? Here is a list of common reasons for insurance claim denials—and what you can do to overcome them.
If you have been injured in a car accident, recovering your losses will most likely involve filing a claim with your insurance company. While your insurance company must handle your claim in good faith, it is also well within its rights to deny coverage if you do not do everything that is required of you. If your insurance company won’t settle, you need to be smart about your next steps, and you will want to discuss your options with an experienced accident attorney.
Insurance Company Won’t Settle? Here’s What You Need to Know
So, you filed a car insurance claim, and your insurance company is refusing to pay what you are owed. Why is this the case? What options do you have available?
Here are 25 common reasons why your insurance company won't settle plus tips on what you can do to keep fighting for the compensation you deserve:
- Reason #1: You Didn’t File Your Insurance Claim on Time
- Reason #2: You Waited Too Long to File Your Insurance Claim
- Reason #3: You Didn’t Provide Enough Information When You Filed Your Claim
- Reason #4: You Admitted to Being at Fault in the Accident
- Reason #5: The Insurance Company Determined You Were at Fault
- Reason #6: You Didn’t Provide Evidence of Your Medical Treatment and Expenses
- Reason #7: You Ignored Communications from Your Insurance Adjuster
- Reason #8: You Made False Statements to Your Insurance Adjuster
- Reason #9: You Had a Pre-Existing Medical Condition
- Reason #10: You Ignored Your Doctor’s Advice
- Reason #11: You Posted Information about the Accident on Social Media
- Reason #12: You Were Driving Under the Influence of Alcohol or Drugs
- Reason #13: You Were Driving Without Your Glasses or Contacts
- Reason #14: You Were Under a Doctor’s Orders Not to Drive
- Reason #15: You Failed to Submit Adequate Evidence of Liability
- Reason #16: You Hadn’t Adequately Maintained Your Vehicle
- Reason #17: You Did Not See a Doctor Immediately After Your Accident
- Reason #18: Your Doctor Said Your Injuries Were Minor
- Reason #19: Your Doctor Did Not Indicate that Your Injuries Were Accident-Related
- Reason #20: You Didn’t Pay Your Insurance Premiums
- Reason #21: You Don’t Have the Right Type of Insurance Coverage
- Reason #22: There are No Witnesses to Corroborate Your Version of the Accident
- Reason #23: Witnesses Reported that You Seemed Fine at the Accident Scene
- Reason #24: You Accepted Payment and Waived Your Rights
- Reason #25: You Made Other Mistakes that Justified a Denial of Coverage
When you are injured in a car accident, you only have a limited amount of time to file an insurance claim. In fact, there are two deadlines that you potentially need to meet. All 50 states have legal deadlines for filing car insurance claims (called “statutes of limitations”), and auto insurance policies typically specify deadlines as well.
While car accident statutes of limitations are usually at least a year (and several years in some states), the deadline specified by your insurance policy could be much shorter. Some policies also include general language (such as “a reasonable amount of time”) that gives the insurance companies flexibility to deny claims.
What you can do: If your insurance company won’t settle because you didn’t file your claim on time, you should consult with an attorney promptly. Even if you missed your policy’s deadline, an attorney may be able to argue that you still filed within a “reasonable” amount of time. Additionally, there are certain circumstances in which the statute of limitations can be “tolled,” resulting in more time to file your claim.
Even if you didn’t miss your deadline, your insurance company could still try to claim that you waited too long to file your claim. This is particularly common in circumstances in which a delay in filing prevents the insurance company from conducting an on-scene investigation.
What you can do: This is a common insurance defense tactic, and it is also unfortunately a tactic that is commonly used in bad faith. If your insurance company won't settle but you can demonstrate that you met the deadline for filing a claim and your insurance company had access to the information it needed in order to evaluate your claim, then you may still be able to secure a settlement.
When you file a car insurance claim, your insurance company should notify you if there are any issues with the information you provide. However, if your claim was missing information and your insurance company didn’t follow up (or if it did and you didn’t respond), then this could be the reason for your claim denial.
What you can do: Review the insurance company’s denial notice, and review the information you submitted with your claim to determine what (if anything) you may have omitted. If your insurance company won't settle, an attorney for car accidents can help you determine what information you need to submit and can seek to overturn your insurance company’s denial on your behalf.
When you filed your insurance claim, did you give a recorded statement? The insurance companies record call with their policyholders, and anything you say beyond reporting where and when the accident occurred is considered a “recorded statement” that your insurance company can use to deny your claim.
If you admitted to being at fault (or even possibly being at fault), then there is a very good chance that this is why your insurance company won’t settle. While this includes coming out and saying you were at fault, it also includes saying that you were speeding, that you weren’t paying attention, or that you did anything else that could have possibly contributed to causing the collision.
What you can do: Unless and until you hire an attorney to conduct an investigation, you have no way of truly knowing what caused your accident. The insurance companies know this, but this will not stop them from relying on your recorded statements in the immediate aftermath of your accident. If your insurance company won't settle, an attorney can use the available evidence to show that your “admission” was misguided, and that you are entitled to compensation under the terms of the relevant policy(ies).
Even if you did not admit to being at fault, the insurance company may have still determined that you were at fault based on the outcome of its investigation (or lack thereof). While fault is only a barrier to recovering full compensation in some states, it can justify a complete denial of coverage in others.
What you can do: Make sure you know what type(s) of claim(s) you have. If you are filing a personal injury protection (PIP) or medical payments (MedPay) claim, then you are entitled to coverage regardless of fault. If you have a bodily injury liability (BIL) and/or uninsured/underinsured motorist (UIM) claim and your insurance company won't settle, an attorney can help you argue that either (i) you were not at fault in the accident, or (ii) your percentage of fault does not justify a full insurance claim denial.
In order to recover financial compensation for your injuries, you need to provide evidence of your medical treatment and expenses. If you don’t, your insurance company won’t have a way to verify that your injuries resulted from your accident, and it won’t have a way to confirm how much it needs to pay.
Your medical records are essential not only for calculating coverage for your medical bills, but for calculating your lost wages and non-financial losses as well. As a result, failing to provide medical records is a common reason for complete insurance claim denials.
What you can do: If your insurance company won't settle, it may not be too late to submit your medical records in order to prove your claim for coverage. In order to do this, you should not provide your insurance company with a medical records authorization (unless otherwise advised by an attorney), but instead provide your records directly. If you aren’t sure what records to submit or how to obtain them, an accident lawyer will be able to help.
An insurance claim is a two-way street. You need to hear from your insurance adjuster, and your adjuster needs to hear from you. If you ignore your adjuster’s calls, texts, and emails, he or she may will not be able to determine how much to offer in settlement of your claim.
What you can do: Review the voicemails, texts, and emails you have received from your adjuster, and determine what information you need to submit in support of your insurance claim. Submit this information, and be sure to respond promptly to all future communications. If your insurance company won't settle, or if your claim has formally been denied, you should consult with an attorney promptly.
Making false statements to your insurance adjuster is a form of “insurance fraud,” and it can result in the denial of your insurance claim. This is true even if you would have otherwise been entitled to coverage. Insurance companies will look for even the smallest misstatements in order to find ways to deny coverage; and, even if you unintentionally misspoke or made an assumption, this could still lead to a refusal to settle.
What you can do: If you are being accused of insurance fraud, you will need to hire a lawyer to help with your claim. If you made an honest mistake, your lawyer can show this, and he or she can work to get your claim back on track for settlement.
Pre-existing medical conditions are among the most-common reasons for car insurance claim denials. However, having a pre-existing condition is not a bar securing coverage. If you were injured in an accident, you are entitled to coverage regardless of your medical history. Unfortunately, this will not stop your insurance company from trying to use your pre-existing condition to deny a settlement.
What you can do: You will want to hire a lawyer to review your medical records and determine if they sufficiently demonstrate that your treatment relates to the effects of your accident. If they do not, your lawyer can work with your doctor to update your medical records so that they clearly reflect your right to coverage. If they do, then your lawyer can challenge your denial and potentially seek additional compensation for insurance bad faith.
One of the most-common mistakes car accident victims make is ignoring their doctors’ advice. When you have a car insurance claim, you need to follow your doctor’s advice in order to retain your right to coverage.
If you ignore your doctor’s advice, your insurance company will blame you for your own medical expenses, and it will deny coverage as a result. This may be true even if your actions do not actually have any impact on your physical recovery.
What you can do: If you have ignored your doctor’s advice (i.e. by engaging in physical activity or returning to work) and your insurance company won't settle, you will need to be able to show that your medical expenses are still a direct result of your accident. You will need your doctor to provide an expert medical opinion, and you will need to hire a lawyer to fight your insurance claim denial.
When you have an insurance claim, your insurance company will look for any excuse to deny coverage, and it will seek to gather information from all possible sources. This includes your social media profiles. If you posted photos of yourself being active when you were supposed to be resting, or if you admitted to causing your accident online, your insurance company could use your own posts as justification for refusing to settle.
What you can do: While the insurance companies will often utilize accident victims’ social media posts, they will often selectively pick-and-choose information as well. If your insurance company won't settle and it has taken your comments out of context or painted a misleading picture of your post-accident activity, you will want to submit additional evidence to present the whole truth and overcome your insurance company’s denial.
If you were legally impaired at the time of your accident, this is almost certainly the reason why your insurance company won’t settle. Driving under the influence of alcohol or drugs is dangerous, and the insurance companies do not provide coverage to individuals who make poor decisions that lead to their own injuries.
What you can do: Even if you were drunk or high behind the wheel, this does not automatically mean that you should be denied coverage. For example, if your impaired state was not a factor in your accident, then you may still be entitled to a settlement. However, this is a challenging situation, and you will want to consult with an attorney in order to ensure that you receive the compensation you deserve.
If your license indicate that you need to where glasses or contacts while driving, then failing to wear your glasses or contacts could lead to an insurance claim denial. This can be considered a form of “negligence” that can lead to vehicle collisions.
What you can do: If your insurance company won’t settle because you weren’t wearing your glasses or contacts, you should consult with an attorney. Depending on the circumstances involved, your attorney may be able to argue that your failure to wear your glasses or contacts was not a factor in your accident. This could be the case, for example, if you got rear-ended at a stoplight or in stop-and-go traffic.
Certain medical conditions can make it dangerous to drive. If you were under doctor’s orders not to drive when your accident occurred, the insurance companies will likely accuse you of being negligent and seek to deny coverage as a result.
What you can do: Was your medical condition a factor in your accident? If not, then you are still entitled to coverage. You will need to submit proof of the true factors involved, and in order to do this you will need to work with an experienced attorney.
When seeking fault-based insurance coverage under a bodily injury liability (BIL) or uninsured/underinsured motorist (UIM) policy, it is up to you to prove that you are entitled to coverage. If you have not submitted adequate evidence of liability, then your insurance company may not currently have an obligation to cover your claim.
What you can do: In order to keep your claim moving toward settlement, you will need to submit evidence of liability. This will require an investigation, and you will need to hire a lawyer promptly.
Another common reason why insurance companies won’t settle car insurance claims is because the policyholder’s car supposedly had not been adequately maintained. From work brakes and balding tires to past-due oil changes, the insurance companies will truly look for any excuse to deny compensation to accident victims and their families.
What you can do: If your insurance company is claiming that an issue with your car played a role in your accident, you will most likely need to hire a lawyer to get an expert report prepared. If an expert can demonstrate that your accident would have happened regardless of your car’s condition, then you may still be able to obtain a settlement.
One of the most-important steps to take after a car accident is to see a doctor as soon as possible. If you don’t, you might not have the evidence you need to prove that your injuries resulted from the collision.
Auto insurance only covers accident-related injuries. So, if you do not seek medical attention in time for your doctor to link your injuries to your accident, then this could result in a denial of coverage for your medical expenses, lost wages, and other injury-related losses.
What you can do: Hopefully you have seen a doctor by now; but, if not, you should do so promptly. If your insurance company won't settle, you will also need to talk to an accident lawyer to determine what you can do to still secure coverage.
If you saw a doctor and your doctor said your injuries were minor, your insurance company may refuse to provide compensation for your lost wages, pain and suffering, and long-term treatment needs. This is true even if your doctor’s diagnosis was incorrect—and even if you subsequently received a more-comprehensive diagnosis that accurately depicts the traumatic effects of your collision.
What you can do: Here, too, the best thing you can do if your insurance company won't settle is to consult with a lawyer promptly. An experienced accident lawyer will be able to determine what you can (and need) to do in order to secure coverage, and your lawyer should be able to refer you to a local doctor who can help prove your claim if your insurance company won't settle.
Even if you saw a doctor promptly and received an accurate diagnosis, your insurance claim could still be denied if your medical records do not reference your accident. Your insurance company may claim that the timing is purely coincidental, and that without additional evidence it cannot make a determination as to liability.
What you can do: If your medical records are insufficient for purposes of your insurance claim, you should ask your doctor to update them. While this is something you can do on your own, you will be better off hiring an attorney to make sure your records are adequate and to calculate the full compensation you deserve.
Did you miss a payment on your auto insurance policy? If you are behind on your premiums, this is yet another reason why your insurance company may deny coverage for your accident-related losses.
What you can do: While failing to pay your premiums can justify a denial of coverage in some cases, it is not an automatic bar to filing a claim. For example, if your insurance company failed to provide timely notice that it was cancelling your coverage, then your denial may have been wrongful. If your insurance company won't settle, you will want to consult with an attorney to determine if your failure to pay your premiums is an issue—and, if it is, to determine if you have any alternate options for seeking financial compensation.
There are four primary types of auto insurance for accident-related injuries: (i) personal injury protection (PIP), (ii) medical payments (MedPay), (iii) bodily injury liability (BIL), and uninsured/underinsured motorist (UIM) coverage. The amount that you can recover—and what you need to prove in order to secure coverage—depends on the type(s) of claim(s) you have.
What you can do: First, you will need to determine what coverage is available to you. If you are seeking coverage above your PIP limit and no other insurance is available, then you may be out of options (although you could also potentially have a “third party” claim). On the other hand, if you are seeking liability-based coverage (i.e. under BIL or UIM) and have not submitted proof of fault, then you will want to hire a lawyer to investigate and present proof of liability on your behalf.
If your word is the only “evidence” your insurance company has to go on, you can expect to have your claim denied. Lack of witnesses is a common excuse for why insurance companies will refuse to settle accident victims’ claims for just compensation.
What you can do: While witness testimony is one form of evidence, it is not the only form of evidence that is available. Even if there were no witnesses to your accident, an attorney may still be able to present various other forms of evidence (i.e. traffic camera footage or cell phone records) in order to keep your claim open and work toward negotiating a favorable settlement.
In some cases, the insurance companies will rely on witness statements to deny coverage on the basis that the claimant did not appear to be significantly injured at the scene of the accident. Essentially, this is a way of accusing you of falsifying your insurance claim. But, the reality – which the insurance companies know – is that it is extremely common for accident victims to seem fine initially despite having suffered serious injuries.
What you can do: This “ground” for denial is often a sign of insurance bad faith. The insurance companies know better (or should know better) than to deny coverage on the basis of lay witnesses’ interpretations of an accident victims’ symptoms in the immediate aftermath of an accident. Consult with an attorney, and determine how best to approach this dubious denial.
Did you accept a check from your insurance company, believing that it was a “partial” payment for your injury-related losses. If so, you may have unknowingly waived your right to seek additional coverage. Once you waive your rights, you are no longer able to pursue your claim, and your insurance company won’t settle because it will have already legally paid what it owes.
What you can do: If you accepted a check from your insurance company, you should not assume that this means your denial is legitimate. Your waiver may have been invalid, and it may still be possible to fight for the full compensation you deserve. Contact a lawyer promptly to determine your next steps.
In addition to the issues we have discussed above, there are numerous other mistakes that can lead to auto insurance claim denials. If your insurance company won’t settle and is telling you that you only have yourself to blame, you will want to discuss your claim with an attorney promptly.
What you can do: Again, the best thing you can do when dealing with an insurance claim denial is to consult with an attorney. In order to make sure that unnecessary delays do not further impede your ability to secure coverage, you should schedule a free initial consultation right away.