Insurance Claim Denials: Automobile Uninsured Motorist

In the State of Florida, automobile owners are required to carry no-fault insurance, known as “Personal Injury Protection” or “PIP.” These types of policies are required because Florida law requires automobile insurance companies to pay claimants regardless of who was at fault for an accident. As we noted in our post about Commercial General Liability Policies, insurance companies are in the business of making money. So, it’s not unusual initially to see your PIP claim denied.

There are five main categories of claim denials:

Medical Treatment and the 14-Day Rule: Florida’s PIP statute states that a motorist has 14 days after an automobile accident to seek medical treatment from a hospital facility, emergency transport, medical doctor, doctor of osteopathy, chiropractor, or a dentist. If a PIP claimant does not seek medical treatment within 14 days, they have forfeited their PIP coverage. This means that if certain symptoms do not surface within the two-week period, they will not be covered by the PIP provisions of their automobile insurance policy.

Proper Notice: Insurance policies specify how long after a collision you have to notify them of the collision. The carrier could claim that you reported after the notice period.

Non-Payment of Premiums: The insurer might claim that that you failed to make your premium payments or there was coverage lapse because you supposedly made a late payment. Retaining detailed payment records helps prevent this type of claim denial.

Lack of Coverage: Claims agents often analyze claims seeking to find a reason for denial. The denial letter may claim that the circumstances of the accident fell into one of the insurer’s exclusionary provisions.

Proof: The insurer might claim you lack evidence of your medical expenses, lost wages, and other damages.

Keeping detailed records about the accident, when you received medical treatment, reported the claim and participated in any conversations with insurance company representatives are vital to making a successful claim.

Hiring an attorney to negotiate the claims process on your behalf could save you headaches and prevent you from working through mountains of paperwork. If your claim has been denied, please reach out to us today. In many cases, we can help a client resolve the claim denial without going to court.