Dealing With Insurance Claim Denials in Illinois Car Accident Claims

It’s difficult enough to suffer the shock and pain of an injury car accident. The situation can get tragic if you lose a loved one that way. Then there is the outrage that follows when you learn that the accident didn’t have to happen except for the careless behavior of the at-fault party. Just when you thought the situation couldn’t get any worse, the insurance claim adjuster or lawyer denies your claim for a frivolous or even arbitrary reason. At some point, it becomes time to fight back.

Profit is an insurance company’s bottom line

Insurance companies are not charities. They are businesses, and they exist to turn a profit. They make money by accepting monthly premiums, and they spend money by paying claims. The moment you submit a claim, your interests become directly adverse to theirs. Don’t be surprised if the insurance company ignores your claim or tries to minimize its value.

How to fight an insurance claim denial in Illinois

An insurance company denial isn’t necessarily the end of the road for your claim. Take the following steps if the facts of your case justify it.

Review your denial letter

Why did the insurance company say that they rejected your claim? If they gave no reason, or if their “reason” was too vague, you may have the right to demand a specific reason for the rejection. If you are unsure why your claim was denied, you should immediately contact a lawyer specializing in car accidents or insurance claims. You should also stop all communication with the insurance company once you hire a lawyer.

Gather additional evidence

Collect the following items:

• The police report
• Medical records
• Photographs of the accident scene
• Eyewitness statements
• Repair estimates
• Expert opinions
• Surveillance footage
• Cell phone records
• Your own written narrative of your pain and suffering
• Evidence of lost wages

Talk to your lawyer about other possible evidence.

Examine the insurance coverage

If you are filing a third-party claim (a claim against the at-fault driver’s liability insurance policy) you might not have possession of the relevant insurance coverage at this point. If not, submit a formal written request under Section 143.24b of the Illinois Insurance Code. The insurance company will be legally obligated to provide you with the dollar amount of the at-fault driver’s liability coverage  you are claiming against. Your lawyer can examine the wording to see if your claim is valid- alternatively. If you have a lawyer, your lawyer will submit this request on your behalf.

Send a demand letter

Your demand letter should include the following:

• Your identifying information
• Information about the accident
• A summary of your damages
• An explanation of why the insurance company is liable
• A settlement demand that includes a breakdown and a specific dollar amount
• A deadline for a response (typically 14 days or 30 days)
• A threat of legal action if the insurance company ignores your settlement demand
• Supporting documents, such as photos, wage loss, medical bills and records.

The insurance company is more likely to heed your claim letter if your lawyer writes it and signs it. If you hire the correct lawyer, you are more likely to get a proper and fair resolution of your claim. Lawyers have the knowledge and experience to present and resolve your claim for just compensation under Illinois law.

Negotiate your claim

Typically, a demand letter is a starting point for negotiations. For best results, have your lawyer handle negotiations on your behalf.

Mediate your claim

With the consent of the opposing party, you can recruit a professional third-party mediator to help you resolve your claim. Mediators often break deadlocks that the parties alone cannot resolve.

File a lawsuit

Just because you file a lawsuit doesn’t mean you have to go to trial. Indeed, you can use a lawsuit to strengthen your bargaining position, and then offer to drop the lawsuit in exchange for an acceptable settlement offer by the other side. Going all the way to trial should be an absolute last resort.

Gather evidence using pretrial discovery

Pretrial discovery is a powerful, court-supervised process where each party demands evidence that is in the other side’s possession. You can even cross-examine their witnesses at a deposition (and they can do the same to you). Pretrial discovery often yields mountains of important evidence.

Draft and sign a settlement agreement

Once you have reached an agreement in principle, your lawyer will need to hammer out the exact wording of the settlement agreement with the opposing party’s lawyer. Once both parties sign, the settlement agreement becomes a binding legal contract that you can enforce in court.

Common reasons insurance companies deny car accident claims in Illinois

There are a number of reasons – or excuses – that an insurer might give to deny a claim. Some of them include:

• Disputed fault: Insurers might try to shift blame to you. If you are 50% or more at fault, the law prevents you from recovering damages.
• Insufficient medical documentation: If you don’t have enough evidence to show that you suffered injuries, they may deny your claim or argue that you are asking too much.
• Policy exclusions or lapses: Sometimes, the at fault driver’s policy may have lapsed, leaving them without coverage. In such cases, you might need to review your uninsured motorist policy.
• Pre-existing conditions: Insurers may claim your injuries pre-date the accident, and that you are trying to recover for them despite the fact that they aren’t related.
• Failure to cooperate: If they have grounds to claim you gave inconsistent information or were not responding to requests for information, they might deny the claim.

Additionally, insurers only cover up to the limits of a policy. The policy might not compensate you for your full damages. Insurance companies only have to pay for the coverage its customers purchase. There may be options to seek additional compensation from the at-fault driver. Your attorney should inquire into the financial condition of the at-fault driver if the policy limits are insufficient to cover your damages and injuries.

Talk to an experienced Illinois car accident lawyer

Attorney Neal Gainsberg has spent the last 25+ years fighting to protect the rights of the injured in Chicago and throughout Illinois. For dedicated legal help with a personal injury, car accident, or wrongful death matter, contact Gainsberg Injury and Accident Lawyers in Chicago for a free consultation.