What To Do When the At-Fault Driver’s Insurance Won’t Pay
Dealing with the aftermath of a car accident is challenging, especially when the at-fault driver’s insurance won’t pay. Understanding your rights and the best course of action in these situations is of the utmost importance.
If you’re encountering resistance from an insurance company in Orlando, the car accident lawyers at The Florida Firm Injury and Accident Lawyers are prepared to help you fight for the compensation you deserve. Don’t face this alone—let our experience guide you toward a fair resolution.
Call (407) 712-7300 today to schedule a FREE consultation. We are devoted to the folks we serve in Orlando and throughout Florida. We will do everything we can to secure the just compensation you deserve for your losses.
What Is It Called When an Insurance Company Refuses To Pay a Claim?
When an insurance company unjustly refuses to pay or process a claim, it is termed bad faith. Insurance carriers have a legal and contractual obligation to act in good faith and fair dealing with those they insure, which includes paying out valid claims promptly under Florida Statutes § 624.155.
In Florida, if an insurer unjustly denies a claim, the policyholder or claimant may have the right to pursue a bad faith insurance claim against them, potentially opening the door for compensation beyond the original policy limits. However, our state has a strict statutory process that our team at The Florida Firm Injury and Accident Lawyers wants you to understand for these types of lawsuits, including:
Resolution: If the insurer pays or settles your claim satisfactorily within those 60 days, you no longer have grounds for a bad faith lawsuit.
Notice Requirement: The policyholder must provide a 60-day written notice to both the insurer and the Florida Department of Financial Services detailing the insurer’s “bad faith” actions.
The “Cure” Window: The insurance company has up to 60 days to pay the damages or correct the circumstances that led to the violation.
Why Would the At-Fault Driver’s Insurance Company Refuse to Pay After a Crash?
There are several reasons why an at-fault driver’s insurance won’t pay after a crash, including:
Disputing Liability
Insurers often conduct their own investigations and may conclude that their policyholder was not responsible for the accident. They might argue that the fault lies entirely or partially with another party—including you—to reduce or deny your claim.
Policy Exclusions
Insurance policies come with specific exclusions detailing scenarios where coverage does not apply. For instance, if the accident occurred while the policyholder was committing a crime or using the vehicle for commercial purposes without appropriate coverage, the insurer might refuse the claim based on these exclusions.
Lapsed Policies
At times, an at-fault driver’s insurance might have lapsed due to unpaid premiums, or the policy might have been canceled before the accident occurred. In such cases, the insurer is not obligated to cover damages, leaving claimants to seek compensation through other means.
Insufficient Evidence
Insurers require substantial evidence to process claims. If they deem the provided evidence—such as photographs of the accident scene, medical records, or police reports—inadequate to establish their policyholder’s fault, they may deny the claim.
Underestimation of Injuries
Insurance companies frequently challenge the severity of the claimant’s injuries to minimize payout amounts. They might claim the injuries are not as severe as stated or that the treatment received was excessive and not medically necessary.
Pre-existing Conditions
Another common ground for refusal is attributing injuries to pre-existing conditions rather than the accident. Insurers may sift through medical records to find previous injuries or health issues similar to the claimant’s current injuries and argue these were not caused by the crash.
Addressing each of these points requires a tailored approach, often involving gathering additional evidence, negotiating with insurers, or even taking legal action to ensure fair compensation. An experienced attorney can help address these challenges effectively.
What Do You Do If an Insurance Company Refuses to Pay?
If you find yourself up against an insurance company that refuses to pay, you may ask yourself, “What can I do if my insurance company won’t pay?” We suggest you take these steps to protect your rights:
Review the Denial Letter
Carefully read the insurer’s denial letter to understand their reasons for refusal. This document often provides crucial information on the appeal process and deadlines. Understanding the specifics is essential, as this will guide your next steps.
Gather More Evidence
Strengthen your claim by collecting additional evidence. This could include more detailed medical records, expert opinions on your injuries, further documentation of the accident scene, or witness statements that corroborate your account of the events.
File an Appeal
Most insurance companies have an internal appeals process. Submit a formal appeal against the denial, including all additional evidence you’ve gathered. Be thorough and precise in your appeal, directly addressing the reasons for the initial denial.
Consult with an Attorney
Seek legal advice immediately, especially if the insurance company resists resolving your claim or you believe they are not treating you fairly. An experienced Orlando car accident lawyer can review your case, advise you on the best course of action, and represent you in negotiations or further legal actions.
Consider Mediation or Arbitration
Before resorting to a lawsuit, consider alternative dispute resolution methods like mediation or arbitration. These can be quicker and less costly ways to reach a settlement. Your lawyer can advise on whether this is a suitable option for your case.
File a Complaint
If you believe the insurance company is acting in bad faith—refusing to pay a claim without a reasonable basis or failing to investigate promptly—you can file a complaint with the Florida Department of Financial Services. They can investigate the insurer’s practices and may provide assistance.
Prepare for Litigation
If other avenues don’t lead to a satisfactory resolution, your lawyer may recommend filing a lawsuit against the insurance company. Litigation can be a longer process, but it might be necessary to receive fair compensation for your damages.
Each step is crucial in contesting an insurance company’s refusal to pay. If you’ve been in a motor vehicle accident and the at-fault driver’s insurance won’t pay, having legal representation can significantly increase your chances of a favorable outcome. An attorney can ensure that your rights are protected and help you understand the process.
Recent Legislation Addresses Bad Faith Claims in Florida
Unfortunately, bad faith insurance tactics are relatively common in Florida car accident claims. This is largely due to the state’s massive volume of daily traffic accidents and a historically highly litigious insurance environment.
While the majority of cases settle routinely, car accidents represent the single most frequent source of third-party bad faith litigation in Florida. Reforms enacted under HB 837 introduced significant modifications to how bad faith claims are handled, potentially making it harder for you to successfully sue an insurance company for bad faith, such as:
- Safe Harbor for Liability Insurers: Liability insurers are now shielded from bad faith claims if they tender the lesser of the policy limits or the amount demanded by the claimant within 90 days of receiving notice and sufficient evidence.
- Mutual Good Faith: Insureds and claimants also have a legal duty to act in good faith when providing information or making demands. Failing to do so can reduce any bad faith damages awarded by the trier of fact.
- No Mere Negligence: The law clarifies that simple negligence alone is insufficient to prove insurance bad faith.
Could Florida’s 51 Percent Rule Prevent an Insurance Payment?
Yes. Another common factor that could affect an insurance company’s willingness to pay your claim is Florida’s 51 percent rule. Under our modified comparative negligence law (Florida Statutes § 768.81), if you are found to be more than half responsible for an accident, you are completely barred from recovering any damages. Rest assured, insurance companies know about this loophole.
If you are 50 percent (or less) at fault for the crash, you can still receive some compensation. However, your final payment is reduced directly by your portion of blame. This rule is why you need the assistance of a Colling Gilbert Wright attorney to formally dispute an unfair fault allocation simply to get out of paying your claim.
Can the At-Fault Driver’s Insurer Deny My Claim Due to PIP?
No. The at-fault driver’s insurer generally cannot deny a bodily injury claim simply because you have Personal Injury Protection (PIP). Because Florida is a no-fault state, you must first file a PIP claim with your own insurance company for initial medical bills and lost wages, regardless of who caused the crash.
However, you can step outside this system and pursue a bodily injury claim against the at-fault driver, assuming your injuries meet state thresholds. Your own PIP covers $10,000 in medical expenses and lost wages when you seek treatment within 14 days of the accident. The at-fault driver’s insurer may deny the claim if the driver does not carry bodily injury liability coverage, as it is not mandatory for all drivers in Florida.
Contact the Experienced Orlando Car Accident Attorneys at Colling Gilbert Wright
Facing an uncooperative insurance company can feel overwhelming, but you don’t have to brave this challenging time alone. The distinguished and understanding car accident attorneys at The Florida Firm Injury and Accident Lawyers are committed to advocating for your rights and securing the compensation you deserve.
If the at-fault driver’s insurance won’t pay, let us put our knowledge and resources to work for you. Many of our clients come to us as referrals from other law firms, because our award-winning team is just that good. Contact us today for a FREE consultation, and let’s take the first step towards justice together!
