If your car accident claim is denied in Florida, it does not mean the process is over. You still have the right to appeal, file a complaint, or pursue legal action with the help of an attorney.
Why Car Accident Claims Get Denied
Insurance companies deny car accident claims for several reasons. Recognizing the specific reason for the denial allows you to craft the correct response to challenge the decision. Claims in Florida are often denied due to:
- Coverage & Policy Issues
Claims can be denied when the policy is expired, canceled, inactive, or premiums were not paid. Denials also occur when the at-fault driver was not listed on the policy.
- Fault & Liability Disputes
If the insurer believes you were partially or fully at fault for the accident, or liability is unclear, they may deny your claim.
- Insufficient Evidence or Documentation
Missing police reports, incomplete medical records, or lack of accident scene evidence can trigger denials. Insurers may also argue your injuries were not caused by the accident or did not meet Florida’s serious injury threshold.
- Pre-Existing Injuries or Conditions
If the insurer suspects your injuries existed before the crash, they may reject coverage.
- Fraud or Misrepresentation
Even unintentional mistakes in accident details, injury descriptions, or repair costs can be grounds for denial.
- Exclusions & Limitations
Policies often exclude coverage for racing, DUI, reckless driving, or using the vehicle for unauthorized commercial purposes.
What to Do If Your Car Accident Claim Is Denied
- Consult an Attorney
The most important step is to consult an injury attorney before continuing to deal with the insurer. A lawyer will evaluate your case, negotiate on your behalf, and determine whether the denial was made in bad faith. If necessary, they can file a personal injury lawsuit or a bad faith insurance claim.
- Understand the Reason for the Denial
Your attorney will review the denial letter carefully, looking for references to policy terms, exclusions, or factual findings that explain why your claim was denied.
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Request a Detailed Written Explanation
He or she will then ask the insurer for a clear breakdown of its decision. Florida law (Statute 627.4137) requires insurers to disclose certain policy details upon request, such as coverage limits. In addition, your attorney can request supporting documents, like accident reports, medical evaluations, or adjuster notes, to better understand the denial.
- Gather More Evidence
Your lawyer will then collect additional medical records, police reports, witness statements, accident photos, or proof of lost wages and expenses. The stronger your documentation, the harder it is for the insurer to justify denial.
- File an Appeal with the Insurance Company
Most insurance companies allow policyholders to appeal denials, often within 30-60 days (the exact deadline depends on the policy). Your appeal should include your claim number, a timeline of events, supporting evidence, and references to policy language that supports your position. Your attorney will always keep copies of what is submitted.
- File a Complaint with the Florida Office of Insurance Regulation (OIR)
If your appeal is rejected or ignored, your attorney can submit a complaint online with the Florida Office of Insurance Regulation. Florida law requires insurers to acknowledge claim-related communications within 14 days.
FInal Thoughts
A denial of your car accident claim in Florida is not the end of the road. You still have legal options to fight back and recover compensation. The key is to act quickly, preserve evidence, and, most importantly, speak with a skilled personal injury attorney before continuing to deal with the insurance company. With proper legal guidance, you can protect your rights and pursue the fair settlement you deserve.
Call Wilkes & Mee today. Our Jacksonville car accident injury lawyers will meet with you, review your claim, and begin confronting the insurance company.