Having a car accident claim denied does not necessarily answer every question about the accident or eliminate every potentially available source of insurance.
An insurer may deny a claim for different reasons. The disagreement could involve liability, whether a particular policy applies, the cause of an injury or another issue affecting coverage or the claim.
Understanding why the insurer denied the claim is therefore more useful than treating every denial as the same.
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Why Was My Car Accident Claim Denied?
A denial can involve several different issues.
For example, an insurer may dispute:
- Who caused the accident
- Whether its insured was responsible
- Whether a particular policy or coverage applies
- Whether the claimed injuries resulted from the collision
- Whether requested losses are supported
- Whether a policy condition affects coverage
Those are materially different disputes.
A liability denial, for example, is not necessarily the same thing as an insurer determining that a particular coverage does not apply.
If the reason for the denial is unclear and significant injuries are involved, Hale Injury Law can review the denial, accident and available insurance and help explain what issues may still need to be resolved.
Does an Insurance Company Have to Explain Why It Denied a Claim?
Nevada law contains requirements governing insurer claim practices.
Under NRS 686A.310, certain insurer practices are considered unfair, including failing to affirm or deny coverage within a reasonable time after required proof-of-loss materials have been completed and submitted.
The statute also addresses an insurer’s failure to promptly provide its insured with a reasonable explanation of the policy basis, facts and applicable law for a denial or settlement offer.
That distinction matters: Nevada’s statute contains provisions that specifically refer to an insured, while other provisions refer more broadly to insureds or claimants.
Rather than assuming every statutory protection applies identically to every person making a claim, the relationship between the claimant, insurer and policy should be considered.
What If the Insurance Company Says You Caused the Accident?
A liability dispute is one possible reason for a car accident claim denied by another driver’s insurer.
The insurer may have received a different account of the collision from its insured or may interpret the available evidence differently.
An insurer’s liability position does not change the underlying evidence. Photographs, video, witness accounts, vehicle damage and other available information may still matter when the drivers disagree about what happened.
If you were injured and the other driver or insurer is blaming you for the collision, Hale’s upcoming disputed-fault article will address that issue in greater depth. Once that article is live, it should be linked here rather than creating a placeholder URL.
Is a Claim Denial the Same as a Low Settlement Offer?
No.
A denial and a settlement offer represent different positions.
A denial may involve an insurer refusing some or all of a claim or determining that coverage does not apply. A settlement offer generally means the insurer is proposing an amount to resolve some or all of a claim.
Hale’s guide to when to accept a settlement offer after a car accident explains why the terms of an offer and release deserve careful consideration before a claim is resolved.
If you’ve received a denial rather than an offer, identifying the stated reason for that denial is an important part of understanding the dispute.
What If the Denial Is Based on Insurance Coverage?
Coverage disputes can be particularly technical.
A policy may contain different types of coverage, limits, exclusions and conditions. The fact that a vehicle was “insured” does not establish that every loss arising from an accident is covered.
Likewise, shorthand such as “full coverage” does not identify which coverages were actually purchased.
When a serious injury claim is denied because of a coverage issue, reviewing the actual policy and denial can be important. Hale Injury Law can help evaluate potentially applicable policies and distinguish questions about coverage from questions about who caused the accident.
Can Other Insurance Matter After a Claim Is Denied?
Potentially.
A denial from one insurer does not establish that another policy or coverage necessarily applies, but some accidents involve more than one possible source of insurance.
Depending on the circumstances, questions may arise about:
- A driver’s liability coverage
- Uninsured or underinsured motorist coverage
- Medical Payments coverage
- Coverage associated with another vehicle
- Commercial or rideshare insurance
- Multiple potentially responsible parties
The applicable policies and facts determine whether any of those sources are relevant.
For example, Hale’s guide to being hit by an uninsured driver in Nevada explains why a driver’s own insurance can become important when no applicable liability insurance is available from the responsible driver.
Can You File an Insurance Complaint in Nevada?
The Nevada Division of Insurance accepts consumer complaints involving insurance companies and claims.
The Division specifically identifies alleged improper denial or delay in settlement of a claim as one type of complaint its Consumer Services Section addresses. After receiving a complaint, the Division sends the issues to the insurer or agent and generally requires a response to the Division within 20 business days.
The Division also makes an important limitation clear: it does not provide legal representation or legal advice. Filing an insurance complaint also does not extend time limits imposed by statutes, regulations or insurance policies.
A regulatory complaint and a personal injury claim therefore should not be treated as the same process.
Does Every Denied Claim Mean the Insurance Company Did Something Wrong?
No.
A claim can be denied for legitimate reasons, and the existence of a denial alone does not establish an unfair insurance practice.
At the same time, Nevada law regulates insurer claim practices. NRS 686A.310 identifies practices including misrepresenting pertinent facts or policy provisions, failing to act reasonably promptly on claim communications, and failing to provide prompt, fair and equitable settlements where the insurer’s liability has become reasonably clear.
Whether a particular denial implicates those rules depends on the specific facts, policy and insurer conduct.
When Is It Worth Having a Denied Claim Reviewed?
A professional review may be particularly useful when a car accident claim denied by an insurer involves significant injuries, disputed liability, conflicting evidence, multiple policies or a complicated coverage issue.
A denial letter is not something Hale needs to characterize as automatically right or wrong.
Instead, the reason for the denial can be compared with the accident evidence, applicable policies and Nevada law.
If you were injured in a Nevada car accident and an insurer has denied the claim, contact Hale Injury Law. Our team can review the circumstances and help you understand what options may be available.
Every accident, claim and insurance policy is different. This information is for general educational purposes and is not legal advice. Past results do not guarantee a similar outcome.
Frequently Asked Questions
Why would a car accident claim be denied?
A denial may involve disputed liability, a coverage issue, disagreement about causation or damages, policy terms or another claim-specific issue. The insurer’s stated reason helps identify what is actually being disputed.
Does a denied car accident claim mean the case is over?
Not necessarily. A denial represents an insurer’s position on a claim or coverage issue. Whether other options or insurance may be available depends on the facts, policies and applicable law.
Can the Nevada Division of Insurance investigate a denied claim?
The Division’s Consumer Services Section accepts complaints involving alleged improper claim denials or delays. The Division can investigate insurance-related concerns but does not provide legal representation.
Is a denied claim the same as a settlement offer?
No. A denial and an offer to settle represent different insurer positions and should not be treated as interchangeable.
