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Common reasons for insurance claim denial

If you or a loved one suffers a serious injury in a California auto accident, you can file an insurance claim to recover the costs of your medical bills, lost wages and certain other losses associated with the accident. Depending on who caused the accident, the claim will either go through your own auto policy or another driver’s policy.

Unfortunately, insurance companies may deny your claim or offer a settlement for much less than your actual costs. Explore the common reasons for personal injury claim denial and the legal recourse you can take.

Lack of liability

An insurer may argue that the policyholder did not cause the accident or that his or her policy does not cover the specific injuries and damages. You will need evidence of fault, such as a police report or eyewitness accounts, to prove your case. California has a comparative negligence law, which means that if you share fault in this type of accident, you will receive a settlement reduced by your fault percentage. The insurer cannot deny your claim if you are less than 50% at fault for the accident.

Lack of coverage

If the policyholder did not pay his or her auto insurance premium, the policy will lapse. If this has occurred, the insurer may argue that the person did not have auto insurance coverage at the time of the accident. In this case, you can seek coverage through your own policy’s underinsured or uninsured motorist provisions. If you do not have this type of coverage, you can sue the other driver for your monetary damages.

When an insurance company acts in bad faith, you can sue for legal damages. Bad faith actions may include giving a low settlement amount without providing a reason, failing to respond to your communication attempts, lying about your claim or withholding evidence that could affect your settlement.

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