Vermont operates under a traditional fault-based insurance system, meaning the driver found at fault in a car accident is responsible for covering damages. Despite this, insurers may find various reasons to deny claims.

Here's a breakdown of the common reasons for claim denials in Vermont and how you can avoid them.

Policy Coverage Issues

One of the most frequent reasons for denial is that the policy does not cover the type of damage or incident involved. Some examples include:

• Expired Policy: If your car insurance policy lapsed due to missed payments, the insurer has no obligation to cover the claim.
• Excluded Drivers: If the driver at the time of the accident was not listed on your policy or was specifically excluded, your claim may be denied.
• Policy Limits: Damages exceeding your policy's coverage limit may result in partial denial or no payout for the excess amount.

How to Prevent This:

• Regularly review your policy for expiration dates and coverage details.
• Ensure all frequent drivers of your vehicle are included in the policy.
• Consider increasing your policy limits if your coverage seems insufficient for Vermont's average accident costs, which were reported as $10,590 per property damage claim in 2023.

Late Claim Filing

Car insurance companies require claims to be filed promptly after an accident. Vermont laws do not set a strict deadline, but most insurers outline filing requirements in their policies. Failure to report the incident within the specified time frame can lead to denial.

Common Scenarios:

• The claimant delays reporting while gathering information.
• Minor accidents are not reported, but later injuries or damage arise.

How to Prevent This:

• Report the accident to your insurer immediately, even if damages seem minor.
• Familiarize yourself with your policy's specific deadlines.

Lack of Documentation

Insufficient or incorrect documentation is a frequent reason claims are denied. Insurers require clear evidence to validate your claim, including:

• Police reports
• Medical records (for injury claims)
• Repair estimates
• Photos of the accident scene and damage

If any of these are missing or inconsistent, the insurer may argue they cannot properly assess your claim.

How to Prevent This:

• After an accident, document as much as possible. Take photos of:
  • Vehicle damage
  • Road conditions
  • License plates of involved vehicles
• Obtain a copy of the police report and keep all repair invoices.
• Maintain detailed records of any medical treatment related to the accident.

Disputes Over Fault

Vermont's fault-based system places significant importance on determining liability. Insurers often deny claims if there is a disagreement over who caused the accident. For example:

• The insurer argues their policyholder was not at fault.
• Comparative negligence reduces or eliminates your ability to recover compensation. Vermont follows a modified comparative negligence rule, which means you cannot recover damages if you are found 51% or more at fault for the accident.

How to Prevent This:

• Collect statements from witnesses to support your version of events.
• Hire an accident reconstruction expert if fault is disputed.
• Avoid making statements at the scene or to the insurer that could be interpreted as admitting fault.

Alleged Fraud or Misrepresentation

Insurance companies are vigilant about fraud and may deny claims if they suspect dishonesty. Common red flags include:

• Exaggerating damages or injuries.
• Submitting inconsistent statements about the accident.
• Filing a claim for a pre-existing condition or damage.

Even unintentional misrepresentations can lead to denial.

How to Prevent This:

• Be honest and consistent when reporting the accident to both law enforcement and your insurer.
• Avoid exaggerating the severity of your injuries or damages.

Driving Under the Influence or Violating Laws

If you were driving under the influence of alcohol or drugs at the time of the accident, your claim is likely to be denied. Additionally, engaging in illegal activities, such as speeding or reckless driving, can void your claim.

Vermont DUI Statistics:

• In 2022, 33% of fatal accidents in Vermont involved alcohol impairment, according to the National Highway Traffic Safety Administration (NHTSA).

How to Prevent This:

• Always follow Vermont's traffic laws and never drive under the influence.
• Consult an attorney if legal violations are cited in the denial.

Pre-Existing Damage

If the damage being claimed existed prior to the accident or cannot be directly linked to the incident, insurers are likely to deny coverage.

Example:

• A dent or scratch on your car that was present before the accident may be excluded from your claim.

How to Prevent This:

• Keep up-to-date photos of your vehicle to show its condition before the accident.
• Obtain a professional inspection after the accident to confirm the extent of damage.

What to Do If Your Claim Is Denied

If your claim is denied, you don't have to accept the insurer's decision without question. Take the following steps:

1. Review the Denial Letter:
   • Understand the specific reasons for the denial. Vermont law requires insurers to provide detailed explanations.
2. Contact the Insurer:
   • Clarify any misunderstandings or provide additional documentation.
3. File an Appeal:
   • Submit a written appeal with supporting evidence, such as new photos, witness statements, or repair estimates.
4. Consult an Attorney:
   • If the denial seems unjust, contact a Vermont personal injury lawyer to help you negotiate or litigate the claim.

Conclusion

Insurance companies often deny claims for reasons such as late filing, insufficient coverage, or disputes over fault. Understanding the common reasons for denial can help you avoid mistakes and strengthen your claim. Should your claim be denied, persistence and proper legal guidance can improve your chances of receiving compensation. For Vermont drivers, being proactive and informed is key to navigating the insurance claims process successfully.

Need Legal Help? Brandon J. Broderick, Attorney at Law is One Phone Call Away

Navigating Vermont car accident claims can be challenging. Fortunately, you don't need to do it alone. The experienced personal injury lawyers at Brandon J. Broderick, Attorney at Law, are available 24/7 to help you understand your legal options, gather necessary evidence, and build a strong case to secure the settlement you deserve.

Contact us now for a free legal review.