January 2021

Florida law requires personal injury protection (PIP) insurance for all vehicle owners to help ensure that people who are injured in car accidents have access to medical coverage regardless of fault. The law also requires liability insurance, to cover damages to another party who is injured or suffers property damage in an accident that was your fault. 

You also have the option of purchasing other insurance coverage, such as uninsured motorist coverage to protect you if you’re injured by a driver who isn’t carrying the required liability insurance. While uninsured motorist coverage isn’t required, it provides important protection–especially in Florida, which is home to the highest percentage of uninsured drivers in the country. 

The Florida system of combining no-fault coverage with the possibility of pursuing claims against the responsible party is intended to maximize access to benefits and compensation for those injured on Florida roads. But what happens when you’ve protected yourself with insurance coverage or been injured by an insured driver and then the insurance company won’t pay? 

The answer depends in part on the specifics of your situation, such as the reason for the denial, the insurance coverage in question, and the circumstances surrounding the accident. Your best source of information about your rights and guidance on how to proceed will be a Miami car accident attorney. This general information will help you understand your options and the possible obstacles.

Thinking Strategically after an Insurance Denial

Clear, methodical action helps protect your claims after a car accident, and that’s just as true if an insurance claim has been denied. Lashing out at the insurance company representative won’t help you secure compensation, and it may backfire. Remain calm, gather the information you need, plan your next steps, and get help if you need it. 

Insurance fraud is a very real problem, in Florida and around the country. One study found that fraudulent claims resulted in at least $5.6 billion per year in excess automobile insurance injury payouts. This included both bodily injury liability claims and PIP claims. Florida led the nation in fraud-related and inflated PIP payments. 

However, it’s important to be aware that not all insurance company delays and denials involve actual problems with the claim, or even legitimate suspicions. Insurance companies turn a profit by taking in more in premiums than they spend. That means the larger the claim, the greater the motivation to deny the claim or minimize its value. 

Never assume that an insurance company denial is appropriate or the end of the road.

Review Your Denial Notice

When your claim was denied, you should have received a letter or written notice explaining the reason for the denial. The first step is to understand what justification the insurance company is offering for the denial. If you didn’t receive a notice, contact the insurance company and request one. The reason for the denial will inform your next steps. 

Occasionally, the claim will have been denied due to a missed step or missing information that can be remedied. For instance, the insurance company may deny a claim because some piece of necessary documentation hasn’t been received. In that situation, you may be able to remedy the situation and have the claim reconsidered by submitting the missing information. 

Often, though, more will be required. 

Some common reasons offered for insurance company denials include: 

The insurance company questions the extent of your injuries

Either your own insurance carrier or the responsible party’s liability insurance carrier may question or dispute the seriousness of your injuries, or whether the injuries were sustained in the car accident. Sometimes, the insurance company will have legitimate doubts or questions. For instance, the injuries may seem too serious given the nature of the accident. Or, medical records may suggest that the injury pre-dated the accident. In other cases, claims may be denied in bad faith.

In high-value cases, insurance companies may even hire investigators to search for evidence that your injuries aren’t as serious as you claim, or that your injuries didn’t result from the accident. This may include background research, review of social media posts, talking to people who come in contact with you, and even surveilling your activities to see whether you’re doing anything inconsistent with your injury claims. 

Misrepresenting your condition to the insurance carrier or trying to hide past injuries is a mistake that can ultimately hurt your claim. However, if your claim is complicated by injuries that are more severe than might have been expected or the accident aggravated a prior injury or condition, medical experts may be required to establish your claim. An experienced Miami car accident lawyer can help determine when outside assessment is required and hire a qualified expert.

Liability is in dispute

If you’re making a claim under the other driver’s liability policy, the insurer may claim their driver was not responsible, or dispute the amount of responsibility attributable to each driver. Sometimes, these questions arise because the two drivers, or other witnesses, tell conflicting stories about how the accident happened. 

The best way to proceed in this situation will depend on the specifics of the case, including how the accident happened, the potential value of the claim, and the injured person’s priorities. It may be worthwhile to investigate, engage experts to prove liability, and argue liability in the courtroom. Or, it may make more sense to negotiate with the insurance company, factoring in the time and expense required to establish liability. 

Most people who have been injured in car accidents don’t have the knowledge and experience required to make these judgments. An experienced Miami car accident lawyer can assess the strength of the case, the potential value of the claim, the likelihood of a favorable settlement and other factors to help you determine how best to proceed.

In other cases, the dispute may be limited to the percentage of responsibility attributable to each driver. Under Florida’s comparative fault law, an injured person can recover damages even if his or her own negligence contributed to the accident. But, compensation is reduced proportionately. So, an injured person who has $100,000 in damages but was 50% responsible for the accident could recover 50%, or $50,000. 

A dispute over the percentage of responsibility can often be resolved through negotiation. However, if the insurance company won’t offer fair compensation, your attorney may advise arguing the issue to a jury.

There are problems with insurance coverage

Automobile insurance is contractual. The terms of that contract include both specifications about what is and is not covered under the policy and the obligations of the policyholder. The simplest example is that if the policyholder fails to make payments within the time allowed, the policy will lapse. If the policy had lapsed and there was no insurance in effect at the time of the accident, the insurer won’t provide coverage. Similarly, if the policy specifies that it covers only personal use of the vehicle, the insurance company will generally deny coverage if the driver was using the vehicle for commercial purposes at the time of the accident. 

If the responsible driver didn’t have coverage when the accident happened or coverage contains provisions that clearly exclude incidents like the one that caused the injuries, that’s generally a hard stop. But, that doesn’t necessarily mean that the injured party can’t recover compensation. Rather, it means it’s time to explore other options.

One possibility is the injured person’s own uninsured motorist coverage. Another is to explore additional parties who may bear some responsibility for the accident. The possibilities will depend on the specifics of the accident. Some examples include: 

  • The driver’s employer may be liable, if the driver was working when the accident occurred
  • A bar or restaurant that illegally served alcohol to a minor may be responsible if the underage driver causes an accident while under the influence
  • The manufacturer of a vehicle or a part may be liable if a malfunction contributed to the accident

Call Elstein Legal Today

Dealing with insurance companies can be complicated and they don’t always play fair. The examples above illustrate the many ways an insurance company may resist paying claims. Of course, this overview isn’t exhaustive. The key point is that while insurance companies often try to avoid making payment, a denial isn’t necessarily the end. 

Fighting back can be complicated. Fortunately, you don’t have to do it alone. Attorney Brian L. Elstein dedicates his legal practice to fighting for the rights of people who have been injured through someone else’s negligence. 

Whether you’ve received a denial from an insurance company or have recently been injured in a car accident and are just beginning the quest to secure fair compensation, a consultation with an experienced Miami car accident lawyer is a strong next step. To learn more about your rights and how Elstein Legal can help build the strongest possible case on your behalf, schedule yours right now. It’s absolutely free, and there’s no obligation.

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