Car Insurance Claim Denied: What to Do When a Pennsylvania Insurer Says No

Can you fight a denied car insurance claim?

Yes. A denied or lowballed car insurance claim can be challenged, and when your own insurer treats you in bad faith, Pennsylvania law lets a court award interest, punitive damages, court costs and attorney fees against it (42 Pa.C.S. § 8371). Against the other driver's insurer, the pressure comes from filing a lawsuit against its driver before the deadline.

Start by getting the denial in writing, with the specific policy language the insurer relies on. Then look at which kind of claim was denied, because the rules differ.

Claims against your own insurer

Your own policy owes you first-party benefits, such as medical benefits and any income loss coverage you bought, and uninsured or underinsured motorist (UM/UIM) benefits if you carry them. These are contract claims, and your insurer owes you good faith in handling them.

First-party benefits are overdue if not paid within 30 days after the insurer receives reasonable proof of the amount, and overdue benefits carry 12% interest per year. If the insurer acted unreasonably in refusing to pay, it must also pay a reasonable attorney fee (75 Pa.C.S. § 1716). A four-year limitation period applies to suits for first-party benefits (75 Pa.C.S. § 1721).

A common reason for cutting off medical benefits is a peer review, where a reviewing organization decides treatment is not necessary. Your treating doctor's records and opinions are the answer to that, and the decision can be challenged.

• Medical benefits stopped after a peer review
• Income loss benefits denied or paid late
• UIM claim valued far below your losses
• A claim that you rejected UM or UIM coverage, when the rejection form may not meet the statute
• A denial based on a late notice or a policy exclusion

Claims against the other driver's insurer

The at-fault driver's insurer works for its policyholder, not for you. Pennsylvania's bad faith statute covers an insurer's conduct toward its own insured, so it is generally not a tool against the other driver's company. What works instead is evidence and a real deadline: a documented claim, and a lawsuit filed against the driver if the offer does not reflect your losses.

Lowball offers often arrive early, before you know whether you will need surgery or more time off work. Once you accept and sign a release, the claim is usually over. Do not sign anything until you know the full extent of your injuries.

What adjusters look for, and how to protect your claim

Adjusters look for gaps in treatment, statements that minimize your injuries, social media posts, and any hint that you were partly at fault. Under Pennsylvania's comparative negligence rule (42 Pa.C.S. § 7102), a share of fault reduces what you recover, so adjusters push hard on that point.

What moves adjusters is a well-documented claim with a filed lawsuit behind it. Consistent medical care, wage records, photos and the crash report give them less room to argue.

• Do not give a recorded statement to the other driver's insurer
• Keep every letter, email and claim number
• Follow your doctors' treatment plan and keep appointments
• Ask for the denial reason and the policy language in writing
• Stay off social media about the crash and your injuries

Filing a complaint with the Pennsylvania Insurance Department

You can file a complaint against an insurer with the Pennsylvania Insurance Department through its online consumer portal, by mail, fax or email. A complaint can prompt a review of how the claim was handled, but it does not replace a lawsuit and does not stop the two-year deadline for an injury claim (42 Pa.C.S. § 5524).

How we help with denied and lowball claims

Warren I. Siegel has practiced in Pennsylvania since 1992 and has served the Philadelphia courts as a court-appointed arbitrator and as a Settlement Master. He reviews your full policy, the denial, and your records, and tells you plainly whether the insurer's position holds up.

Our fee is 100% contingency. No attorney fee unless we recover, the firm advances all case costs, and those costs are repaid only from a recovery. Call (267) 412-4601 or send the free case review form.