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You reported the accident. You provided information to the insurance company. You sought medical treatment and expected the claims process to move forward.
Then the insurance company denied the claim.
A denied car accident claim in Arizona can be frustrating, particularly when you are dealing with medical expenses, vehicle damage, missed work, and injuries caused by a collision. However, receiving a denial does not necessarily answer every legal or factual question surrounding the accident.
The first step is understanding why the claim was denied.
At Skousen, Gulbrandsen & Patience, PLC, we help injured people evaluate disputed motor vehicle accident claims throughout Arizona. A denial should be examined alongside the insurance policy, available evidence, Arizona law, and the specific reason the insurer gives for its decision.
There is no single reason an automobile insurance claim may be denied.
A denial may involve liability, insurance coverage, medical evidence, documentation, or disagreements about whether particular damages resulted from the accident.
Some common issues include:
Understanding the insurer's stated reason is important because different problems require different responses.
A claim denied because the insurer believes its driver was not responsible presents a different issue from a claim denied because the insurer contends no applicable policy existed.
Do not rely solely on a brief telephone conversation with an insurance adjuster.
Determine the specific reason for the denial and preserve communications related to the claim.
Arizona regulates certain insurance claim-handling practices through Arizona Revised Statutes § 20-461. Among other provisions, the statute identifies as an unfair claim settlement practice, when committed with sufficient frequency to constitute a general business practice, failing to promptly provide a reasonable explanation based on the policy, facts, or applicable law for denying a claim or offering a compromise settlement.
The statute also addresses practices such as refusing to pay claims without conducting a reasonable investigation based on available information and failing to affirm or deny coverage within a reasonable time after completed proof-of-loss statements. Arizona's statute expressly states that § 20-461 itself provides an administrative remedy to the insurance director rather than creating a private cause of action.
For an accident victim, the practical starting point is simpler: understand what the insurance company says is wrong with the claim.
Once you know why the insurer denied the claim, examine the evidence related to that issue.
Potential car accident evidence may include:
Different evidence serves different purposes.
Photographs and video may help establish liability. Medical records may help document injuries and treatment. Employment records can help establish lost income.
The goal is to identify evidence relevant to the insurer's specific reason for denying the claim.
Liability disputes are one reason a car accident claim may become difficult.
Imagine two vehicles collide at an intersection. Each driver claims to have entered on a green light. Without independent evidence, the insurer may dispute its driver's responsibility.
This is where additional evidence can become important.
A nearby surveillance camera may show the traffic signal. An independent witness may have seen the collision. Vehicle damage may provide information about the direction and sequence of impact.
An insurer's position about fault should be evaluated against the available evidence.
Even if you contributed to an accident, that does not automatically mean an injury claim is barred.
Arizona follows a comparative negligence system.
Under Arizona Revised Statutes § 12-2505, when comparative negligence applies, a claimant's damages are reduced according to the claimant's relative degree of fault rather than the claim automatically being eliminated solely because the claimant shared responsibility.
Suppose an injured person establishes $100,000 in damages but is determined to have been 25 percent responsible for the collision.
The recoverable damages could be reduced by 25 percent.
Arizona also generally allocates each defendant's liability according to that defendant's percentage of fault, subject to statutory exceptions.
That makes a complete liability investigation important when an insurer attempts to place some or all responsibility on the injured person.
Another dispute may involve causation rather than responsibility for the collision itself.
An insurance company might accept that its insured caused the accident while disputing whether the crash caused all of the injuries or medical treatment being claimed.
Medical documentation can become particularly important in these situations.
Relevant records may show:
Accident victims should provide accurate information about their medical history. A prior injury does not automatically mean a later collision caused no new injury or aggravation, but determining causation may require careful review of the medical evidence.
A delay in seeking medical treatment can create additional questions.
The insurer may argue that a significant gap between the accident and treatment makes it harder to connect the claimed injuries to the collision.
That does not necessarily establish that an injury is unrelated to the accident.
People delay medical treatment for many reasons. Some symptoms become apparent gradually. Others initially believe pain will resolve without treatment. Financial concerns or access to care can also influence when someone sees a medical professional.
If symptoms develop or worsen after an accident, seek appropriate medical care based on your health needs.
From a legal perspective, medical records and an accurate treatment history can help explain when symptoms appeared and how the condition progressed.
A coverage denial raises a different set of questions.
The insurer may contend that:
These disputes can require careful review of the actual insurance policy and circumstances surrounding the accident.
Do not assume that "no coverage" and "no compensation" necessarily mean the same thing.
Depending on the facts, other potential sources of coverage may need to be investigated. For example, an injured person may have uninsured motorist coverage available through an applicable automobile policy if the responsible driver ultimately qualifies as uninsured under Arizona law and the policy.
The key is identifying what coverage exists rather than stopping the investigation after the first insurer denies the claim.
Depending on the circumstances and claims process, additional information may help address the reason for a denial.
Suppose an insurer denies a claim because it believes there is insufficient evidence that its insured caused the accident.
Later, surveillance footage is located showing how the collision occurred.
That evidence could materially change the information available for evaluating liability.
Other potentially useful documentation may include:
Whether additional evidence changes the insurer's position depends on the facts of the individual case.
Arizona law regulates insurance claim settlement practices.
A.R.S. § 20-461 addresses conduct including misrepresenting relevant facts or policy provisions, failing to act reasonably and promptly on claim communications, refusing payment without a reasonable investigation based on available information, and failing to provide a reasonable explanation for a denial or compromise offer when those practices occur with the frequency described by the statute.
The Arizona Department of Insurance and Financial Institutions, or DIFI, accepts consumer complaints involving issues such as claim-handling delays, denials, and unsatisfactory settlements. DIFI explains that it can review matters within its regulatory jurisdiction and determine whether an apparent violation of applicable insurance statutes or rules occurred.
DIFI also makes an important limitation clear: the department does not act as a consumer's attorney, determine liability or fault, or award damages. Filing a complaint also does not extend deadlines imposed by statutes, regulations, or insurance policies.
Consumers who want information about that process can review the Arizona DIFI insurance complaint information.
Not necessarily.
Some disputes may be addressed by providing additional information or continuing negotiations. Others involve fundamental disagreements over liability, damages, or insurance coverage that cannot be resolved informally.
If a resolution cannot be reached, litigation may be one available legal option depending on the circumstances.
Filing a lawsuit changes the process considerably. Evidence can be obtained through formal procedures, witnesses may provide sworn testimony, experts may become involved, and ultimately disputed issues can be presented to a court or jury.
A lawsuit should not be viewed simply as an automatic response to every denied claim.
The appropriate next step depends on why the claim was denied, the available evidence, the damages involved, applicable coverage, and relevant legal deadlines.
One of the most important mistakes to avoid is allowing negotiations or a disputed insurance claim to distract from applicable legal deadlines.
Communicating with an insurer does not necessarily stop a statute of limitations from running.
Likewise, filing a regulatory complaint with DIFI does not extend applicable policy, statutory, or regulatory deadlines. DIFI specifically warns consumers about this limitation.
This becomes especially important when a claim has been disputed for months.
Knowing the applicable deadline early can prevent an insurance disagreement from becoming a missed opportunity to pursue a legal claim.
Not every insurance disagreement requires legal representation.
It may be appropriate to speak with an attorney when:
An attorney can review the denial, evaluate available evidence, examine applicable insurance coverage, communicate with insurers, and determine what legal options may remain available.
An insurance company's denial is important, but it should be understood in context.
Why was the claim denied?
What evidence did the insurer consider?
Is additional evidence available?
Is liability disputed?
Does another insurance policy potentially provide coverage?
Are important deadlines approaching?
Those questions can help determine what should happen next.
At Skousen, Gulbrandsen & Patience, PLC, we represent people injured in motor vehicle accidents throughout Phoenix, Mesa, and communities across Arizona. Our attorneys can review a denied car accident claim, investigate the circumstances of the collision, evaluate available evidence and insurance coverage, and help clients understand their legal options.
If your Arizona car accident claim has been denied and you are unsure what to do next, contact our legal team to discuss your situation.
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