Negotiating Injury Insurance Personal Settlement Claim

During your injury insurance personal settlement negotiation with the auto claims adjuster, the issue of whether a car insurance policy actually covers your accident comes up often.

There can be several valid reasons for denying your auto accident coverage:

For example:

  • Your auto insurance policy has lapsed.
  • The person who caused your car accident is not covered.
  • You live in a no fault state and cannot file a third party claim.

However, it’s in your best interest to verify if any of these reasons apply to your specific injury insurance personal settlement claim. You should never accept being denied coverage simply because the auto claims adjuster said so. The claims adjuster is there to save his or her insurance company money, not to advise on how who will pay for your personal injury settlement.

Here is how you should argue denied coverage in your injury insurance personal settlement…

Ask for a written statement

Your first response should be to ask the auto claims adjuster for a written statement saying that you are being denied coverage. Getting a written document from the adjuster accomplishes two things:

  1. It lets you know if the auto claims adjuster is simply bluffing.
  2. Gives you the specific reasons why your auto accident coverage was denied. This will give you the opportunity to research each reason and see if it’s valid.

For example, you may find out that your injury insurance personal settlement was denied because of insufficient information, such as lack of medical reports. Knowing this you could now address this issue and send your medical records to the insurance company to reopen your accident claim.

(Note: If your injury insurance personal settlement is denied, you should try to find if the insurance company has an appeals process and how much time you have to file one.)

If the auto claims adjuster refuses to give you a written statement, then let them know you will send a letter to the insurance company confirming the adjuster’s refusal to provide coverage and explain it in writing. This puts the pressure on the adjuster because he or she knows that if your injury insurance personal injury settlement claim ever ended up in a court, the letter will not look good because it shows a lack of cooperation from the insurance company.

Ask for a copy of the insurance policy

Your next step is to ask the auto claims adjuster for a copy of the insurance policy in question and the specific sections which show why your auto accident settlement coverage is denied. This way you can read the policy yourself and see if the adjuster’s reasons are valid. If the adjuster denies this, write a letter stating the adjuster’s denial in providing you the policy so that it becomes part of your personal injury settlement file.

Beware of the Insurance Lawyer’s Letter

The auto claims adjuster may try to discourage you from questioning the accident coverage by saying their lawyers have already researched this issue.

The adjuster may something like “our lawyers have reviewed the policy and confirm that you are not covered under it”.They may even send you a letter from the lawyer restating this point.

However, this should not sway you. A letter from the insurance lawyer is not an insurance policy.Whether or not you are covered depends on the terms of the policy and the policy can be read in several different ways.

There is something known as the preponderance of evidence.This basically states that the policy has to clearly state why you are being denied coverage

Any vagueness in the policy language can be interpreted multiple ways. One lawyer’s interpretation is not concrete evidence that you are not covered. In fact, this interpretation will just become another issue of negotiation in your injury insurance personal settlement claim.

So insist on getting a copy of the actual policy or the specific sections that deny your auto accident coverage. If after reviewing the policy, you conclude that the adjuster was in fact correct about you not being covered, you may want to contact a personal injury lawyer. Ask the lawyer to take a look at the policy and see if there is any technical way around lack of coverage.

Bottom Line

Don’t be discouraged if your injury insurance personal settlement claim is being disputed because of a lack of apparent coverage. A lot of times, the claims adjuster will initially deny that you are covered, but as soon as you indicate that this isn’t the end of the story, that you still plan on pursuing your personal injury settlement, the adjuster will begin to negotiate.

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