Denied Car Accident Insurance Claim Lawyer in Miami

When an insurance company denies your car accident claim, the denial letter is not always the final word. Denials happen with your own Personal Injury Protection (PIP) benefits, with claims against the at-fault driver’s insurance company, and with your own uninsured motorist coverage. Miami car accident lawyer Tomas Robirosa reviews denied and underpaid car accident claims for injured people in Miami-Dade, Broward and Palm Beach counties. Se habla español.

Why Car Accident Insurance Claims Get Denied

Insurance companies give many reasons for denying or cutting a car accident claim. Some are valid; many can be challenged with the right evidence.

• Late medical treatmentFlorida PIP medical benefits generally apply only if you receive initial medical care within 14 days after the crash. Every case is different, so speak with an attorney to confirm how this applies to you.
• No “emergency medical condition”If a treating provider does not find an emergency medical condition, PIP medical reimbursement is generally limited to $2,500 instead of up to $10,000.
• Disputed faultThe other driver’s insurer may say its driver was not at fault, or that you were mostly at fault. If you are found more than 50% at fault, Florida law generally bars recovery from the other driver.
• The injury thresholdTo recover pain and suffering from the at-fault driver, Florida law generally requires a significant and permanent injury, significant and permanent scarring or disfigurement, or death. Insurers often argue an injury doesn’t meet this threshold.
• Missed examinationsFlorida’s PIP law lets the insurer require a medical examination by a doctor it chooses, and policies generally require an examination under oath. Unreasonably refusing the medical examination can cut off later PIP benefits.
• Pre-existing conditionsThe insurer claims your pain comes from an old injury or wear and tear, not the crash.
• Coverage disputesThe insurer says the policy had lapsed, the driver was excluded, the vehicle was not listed, or the claim was reported too late.

Which Claim Was Denied?

After a crash in Florida, there can be several insurance claims, and each one is denied and challenged differently.

Your own PIP benefits

PIP is your own no-fault coverage and generally pays first for medical bills and lost wages, up to your policy limits. Florida law generally treats PIP benefits as overdue if they are not paid within 30 days after the insurer receives written notice of a covered loss, and overdue benefits carry interest. Before suing over overdue PIP benefits, Florida law requires a written demand letter, and the insurer then generally has 30 days to pay. Every case is different, so speak with an attorney to confirm the deadlines that apply to you.

A claim against the at-fault driver’s insurance

Florida does not require most drivers to carry bodily injury liability coverage, so some at-fault drivers have little or none. When they do, their insurer may deny or lowball the claim by disputing fault, arguing the injury threshold is not met, or saying your treatment is not related to the crash.

Your own uninsured or underinsured motorist coverage

If the at-fault driver has no insurance or not enough, your own uninsured/underinsured motorist (UM) coverage may apply, if you have it. A UM claim is made against your own insurance company, which may raise the same defenses the other driver’s insurer would.

Damage to your car

Vehicle damage is usually claimed under the at-fault driver’s property damage liability coverage or your own collision coverage. It is a separate claim from your injury claim, and a denial of one doesn’t decide the other.

What to Do After Your Claim Is Denied

• Get the denial in writing and keep every letter, email and explanation of benefits.
• Ask for a copy of your policy and its declarations page.
• Keep following your doctor’s treatment plan and keep all medical records and bills.
• Write down your claim number, the adjusters’ names and the date of every call.
• Don’t give a recorded statement to the other driver’s insurance company before speaking with a lawyer.
• Don’t sign a release or cash a check marked “final” until you understand what you are giving up.

Bring the denial letter and your policy to your free consultation. We read the insurer’s stated reasons line by line, compare them with the policy and the evidence, and explain your options.

When an Insurer Acts in Bad Faith

When an insurer fails to settle a claim it could and should have settled, Florida law may allow a bad faith claim. Before filing a statutory bad faith action, Florida’s bad faith statute (section 624.155, Florida Statutes) requires a civil remedy notice, and the insurer generally has 60 days to fix the problem. The statute also says that negligence alone is not bad faith, and on liability claims it generally protects an insurer that offers the policy limits, or the amount demanded if less, within 90 days after receiving notice of the claim with enough evidence to support it. These rules are complex and every case is different, so speak with an attorney about your situation.

Also see our car accidents, Uber, Lyft and delivery accidents and denied property insurance claims pages.

How We Handle Your Case

• Step 1Free consultationWe listen to what happened, answer your questions, and explain your options in plain language, in English or Spanish.
• Step 2InvestigationWe gather the police or incident report, photos, video, witness statements, and every insurance policy that may apply.
• Step 3Documenting your lossesWe organize your medical records and bills, lost income, and other losses so nothing is overlooked.
• Step 4Negotiation or lawsuitWe present your claim to the insurance company and negotiate. If a fair resolution is not offered, we are prepared to file suit.

Frequently Asked Questions