Every year, Californians spend thousands of dollars on car insurance, believing their provider will be there when they need it most. However, many policyholders find their claims denied, delayed, or undervalued after an accident, leaving them struggling with medical bills and repair costs. Insurance companies may promise protection, but prioritize paying out as little as possible.

This blog post is intended for general informational purposes only and does not constitute legal advice. If you need legal assistance, please contact a qualified attorney. Any references to laws or cases are for context only and do not serve as legal interpretation. Past results are not a guarantee or warranty of future outcomes. No attorney-client relationship is formed here.

Fassonaki Law Firm, P.C., can help if your claim was wrongly declined. Our experienced Los Angeles car accident lawyer strives to make insurers accountable and ensure you receive the compensation you deserve. Contact us today for a free consultation and take the first step toward getting the justice you need.

10 Common Reasons Insurance Companies Deny Car Accident Claims in California (And What You Can Do About It)

Identifying why insurance companies reject claims can help you challenge denial and get the compensation you deserve. Here are ten of the most common reasons for claim denials, and how to manage them is discussed.

1. Your Policy Doesn't Cover the Accident

One of the primary reasons for a denied claim is that your insurance policy doesn't cover the type of accident you were involved in. This can happen if:

• You were using your car for work (like Uber or Lyft), but you don't have commercial coverage.
• Your policy doesn't include uninsured/underinsured motorist coverage, and the other driver had no insurance.
• Your policy has failed due to missed payments.

What to Do

• Read through your insurance policy to see if your coverage should apply.
• Ask your insurance adjuster for a written explanation of why the claim was denied.
• If your policy was canceled without your knowledge, contact your state insurance department to file a complaint.

2. You Waited Too Long to Report the Accident

Most insurance companies require you to report an accident within a specific time frame. If you wait too long, they might argue that they can't properly investigate the claim, leading to a denial.

What to Do

Always report an accident to your insurer as soon as possible, even if you're not sure you'll file a claim. If your claim was denied for late reporting, explain any valid reasons for the delay (such as a hospital stay).

Request a reconsideration of your claim, especially if you have strong supporting evidence. Reporting delays can also affect how insurers calculate your settlement, so understanding the factors in their decision-making can help prevent future denials.

3. The Insurance Company Says You Were at Fault

If the insurance company believes you caused the accident, they may deny your claim or reduce the amount they're willing to pay. Some states follow comparative negligence laws, meaning your payout could be reduced if you're even partially at fault.

What to Do

• Please request a copy of the insurance company's liability assessment to see how they determined faults.
• Gather evidence that proves you were not at fault, such as Police reports, Dashcam or surveillance footage, and eyewitness statements.
• If the insurer refuses to change their decision, consider consulting a California auto accident attorney specializing in car accident claims.

A substantial settlement negotiation strategy can be crucial in these conditions. Determining how to assert against an unfair liability may influence your final settlement amount.

4. The Insurance Company Says You Had Pre-Existing Injuries

Insurance companies often try to argue that your injuries weren't caused by the accident but were from a pre-existing condition. This is their way of avoiding paying for your medical bills.

What to Do

• Get a medical report from your doctor stating that your injuries were caused by the accident.
• Provide X-rays, MRIs, or other medical records that prove your injuries were not present before the crash.
• If the insurance company insists on sending you to their doctor for an Independent Medical Exam (IME), be aware that this doctor works for the insurance company, not for you. You may need to get a second opinion from your doctor.

Document everything thoroughly and seek independent medical advice to protect your rights.

5. You Didn't Seek Medical Treatment Right Away

If you didn't go to the doctor immediately after the accident, the insurance company might claim that your injuries aren't serious or that the crash didn't cause them.

What to Do

• Always see a doctor as soon as possible after an accident, even if you initially feel fine.
• If there was a delay in seeking treatment, explain why (for example, you didn't notice symptoms immediately).
• Keep detailed records of all medical visits, treatments, and prescriptions related to your injuries.

Keeping a detailed timeline of your care can strengthen your case.

6. There's Not Enough Evidence to Support Your Claim

The insurance company may reject your claim if you don't provide enough proof of damage, injuries, or liability.

What to Do

• Take photos and videos of accident scenes, vehicle damage, and injuries. Get a copy of the police report and ensure it accurately describes what happened. Also, collect witness statements from people who had seen the crash.
• Keep medical bills, repair estimates, and other documents supporting your claim.

·         Keep detailed records of all communication with the insurance company.

7. The Insurance Company Made a Low Settlement Offer Instead

Sometimes, instead of denying a claim, the insurance company will offer a very low settlement, hoping you'll accept it because you need the money.

What to Do

Please don't accept the first offer without reviewing it carefully. Ask for a detailed explanation of how they calculated the settlement amount.

To negotiate, provide additional evidence, such as higher repair estimates or medical bills. If negotiations don't work, consider hiring a personal injury attorney to handle the talks.

8. Your Policy Lapsed or Was Canceled

Your claim will be denied if your insurance policy was inactive during the accident. This could happen if:

• You missed payment, and your policy was canceled.
• You forgot to renew your policy before it expired.

If your claim was denied, check if your policy includes a grace period that allows late payments. Some insurance companies offer a short window to catch up on missed payments before canceling the policy. If you believe your policy was canceled unfairly, you can file a complaint with your state's insurance commissioner.

If the other driver was at fault, you may still be able to file a claim under their insurance policy instead of your own.

9. The Insurance Company Suspects Fraud

If the insurance company believes your claim is fraudulent, they will deny it. This could happen if:

• There are inconsistencies in your statements.
• The accident wasn't reported to the Police.
• The damage doesn't match the reported incident.

To avoid this, always make sure your statements remain consistent and match the facts of the accident. Gather police reports, medical records, and other supporting evidence to prove your legitimate claim. You can dispute the decision and request a formal review if your claim was denied unfairly.

10. You Filed the Claim Under the Wrong Insurance Coverage

Sometimes, claims are denied because they were filed under the wrong type of coverage. For example, if you file a claim under collision coverage when the damage falls under comprehensive coverage, your insurer may reject it. Similarly, your claim may not be covered if you drove for work when the accident happened, but your policy only covers personal use.

If your claim was denied, review your insurance policy carefully to ensure you're filing under the correct coverage. If your insurer refuses to reconsider the denial, ask whether another type of coverage applies. In cases where the insurance company does not provide a clear explanation, seeking legal assistance can help you understand your options.

Can You Still Get Compensation If Your Insurance Denies Your Injury Claim?

You can still get compensation if your insurance rejects your injury claim. A denied injury claim is not the end of the road. Insurance companies habitually try to minimize payouts, but you can challenge their decision with substantial evidence.

Many people sometimes face these circumstances because the insurer questions the injury's seriousness, claiming it was a pre-existing condition or arguing that the accident caused it. Understanding why the denial happened and what steps you can take can help you fight for the compensation you deserve.

How to Deal with an Independent Medical Exam (IME) in California

Be prepared if the insurance company asks you to attend an Independent Medical Exam (IME). The insurer often hires the doctor they assign; their report may not always be in your favor. Here are some tips to handle the situation:

• Be honest but concise – Answer questions truthfully, but do not give unnecessary details that might be used against you.
• Stick to the facts – Focus on what happened, how you feel, and what your doctor has already diagnosed.
• Bring a witness – Some states allow you to have a friend or family member present to take notes.
• Request a copy of the IME report – If the report downplays your injury, you can challenge it with another medical opinion.
• Keep all records and notes regarding the IME, including who was present and what was discussed.

What to Do If Your Injury Claim Is Denied

If your injury claim is denied, do not give up. You can take the following steps to fight back:

• Review the denial letter – Understand the exact reason your claim was rejected.
• Gather additional medical evidence – Get updated records, a second medical opinion, or a letter from your doctor explaining your injuries.
• Write a formal appeal – Many insurance companies allow appeals. A well-documented appeal with supporting evidence can sometimes reverse a denial.
• Consult an auto accident attorney – If the insurer is unwilling to negotiate or acting in bad faith, a personal injury attorney can help you file a legal claim.

How Long Do You Have to Dispute a Denied Car Insurance Claim in California?

If your appeal with the insurance company doesn't work, you may need to take legal action. California's statute of limitations sets the general time limits, but exceptions may apply depending on the circumstances. Here's what you need to know:

• Property damage claims: You have three years from the accident date to file a lawsuit against the at-fault driver or your insurance company if they fail to pay.
• Personal injury claims: You have two years from the accident date to sue for injuries caused by the crash.

How to Escalate a Complaint in California

If your insurance company isn't cooperating, you can file a complaint with the California Department of Insurance (CDI). This state agency regulates insurance companies and investigates biased claim denials.

To file a complaint, you'll need to:

• Bunch up all documents related to your claim (denial letter, medical records, repair estimates, emails with the adjuster).
• Submit a complaint online over the CDI website or call their consumer hotline.
• Wait for CDI to review your case and act if they find that your insurer breached California insurance laws.

While this won't always force the insurance company to pay, it can pressure them and help you build a stronger case if you decide to take legal action.

When to Hire a Lawyer for a Denied Car Insurance Claim in California

Not every denied claim involves legal action, but there are conditions where getting a car accident lawyer is the most brilliant move. Here's when you should seriously consider hiring an attorney:

• Bad Faith Insurance Tactics: If your insurer unfairly delays, ignores, or denies your claim without excuse, they may be acting in bad faith. This may include failing to investigate your claim, misrepresenting your coverage, or offering an unreasonable settlement. A lawyer can help you hold them responsible.
• Serious Injuries & High Medical Bills: If you need ongoing medical treatment, an attorney can ensure that all payments are covered and dispute insurers who downplay injuries or claim they were pre-existing.
• Disputed Liability: If the insurer blames you for the accident or assigns you a partial fault, a lawyer can help collect proof, like eyewitness statements and accident reports, to prove your case.
• Low Settlement Offers: If you receive an unfairly low payout, an attorney can negotiate a settlement that reflects the true cost of medical bills, lost wages, and pain and suffering.
• Unclear Legal Rights: If you're unsure whether to appeal, negotiate, or file a lawsuit, a lawyer can explain your options and help you make the right decision.

How Fassonaki Law Firm, P.C. Can Help You with a Denied Car Accident Claim

Insurance companies are financially interested in paying as little as possible on claims. If your claim was denied, delayed, or undervalued, you don't have to accept their decision.

If your insurance company refuses to act fairly, legal representation can be a powerful tool in fighting back. Fassonaki Law Firm, P.C. is here to help accident victims across California hold insurers accountable and recover the compensation they are owed. Contact us today for a free consultation.