Insurance companies are within their rights to deny a claim, provided they have legitimate reason for doing so. While each situation is different, these are some valid reasons for an insurance company to deny a crash victim’s claim:
You were more than 50 percent at fault: Wisconsin allows you to seek compensation if you were partially at fault for an accident. However, you cannot recover any compensation if you are more than 50 percent at fault. In other words, you cannot bear more fault than the other party involved in the collision. An example of when you may be more than 50% at fault is if you violated a rule of the road, like speeding.
Failure to report the claim in a timely manner: The insurance company may say you did not file a claim in a timely manner, in violation of their regulations. They might also say they denied your claim because you failed to call the police, which also violates their policies. In Wisconsin, drivers are required to report crashes to the police when they result in injuries, death or more than $1,000 worth of property damage.
Lack of medical documentation: Injury victims can recover compensation if they prove they got hurt in the crash. Victims must also provide proof about the extent of their injuries and the cost of treatment. If your medical records do not support the injuries claimed, the insurance company may deny your claim. For example, if you claim you need surgery and rehabilitative therapy for a spinal cord injury, you need medical records and test results to support your argument. Even though there may be some causation dispute, you may still be entitled to compensation.
Uncovered drivers or vehicles: If the driver or vehicle involved in the accident is not covered under the policy, the claim will likely be denied. ​​Insurance companies are not responsible if they don’t insure the vehicle or driver.
Fraud: Like other businesses, insurance companies have a right to protect themselves from fraud. For example, they might claim someone staged an accident or exaggerated the value of their damages.
The policy lapsed: This would only apply if you were filing a claim against your own policy, such as a claim for uninsured motorist coverage. The insurance company may say the policy lapsed because you missed a payment. They may also claim you misrepresented facts when you purchased the policy.
If the insurance company denied your claim for one of the reasons listed above, our lawyers may be able to help you appeal. We have obtained millions on behalf of our clients.