NJ insurance claim denied cases in New Jersey require experienced legal representation. At Maxwell, Tassini & Gardner, LLC in Spring Lake, we help injured clients throughout Monmouth and Ocean counties pursue their NJ insurance claim denied claims. If you need a NJ insurance claim denied attorney who understands New Jersey law, call (732) 230-5003 for a free consultation.
What If the Insurance Company Denies My Claim in NJ?
Having your insurance claim denied after a car accident in New Jersey can feel devastating. You are injured, facing mounting medical bills, and the insurance company that is supposed to help you is refusing to pay. But a claim denial is not the end of the road. Many initial denials can be overturned through proper appeal, negotiation, or litigation.
Common Reasons for Claim Denials
Insurance companies deny claims for a variety of reasons, including:
- Disputed liability: The insurer argues that their policyholder was not at fault, or that you were primarily responsible for the accident.
- Disputed causation: The insurer claims your injuries were not caused by the accident but by a pre-existing condition or subsequent event.
- Lapsed policy: The at-fault driver’s insurance policy was not in effect at the time of the accident.
- Late reporting: You did not report the accident or file your claim within the required timeframe.
- Failure to cooperate: The insurer alleges you did not provide requested documentation, attend an IME, or otherwise cooperate with the investigation.
- Treatment not “reasonable and necessary”: The insurer (often through utilization review) determines that the medical treatment you received was not medically justified.
- Verbal threshold not met: For bodily injury claims, the insurer argues your injuries do not constitute a “permanent injury” under N.J.S.A. 39:6A-8.
Steps to Take After a Denial
If your claim has been denied:
- Request the denial in writing. The insurance company must provide a written explanation of why the claim was denied, including the specific policy provisions or legal basis for the denial.
- Review the denial letter carefully. Identify the specific reason for denial and assess whether it is accurate or based on incomplete information.
- Gather supporting evidence. Collect medical records, police reports, witness statements, and any other documentation that contradicts the basis for the denial.
- Consult a personal injury attorney. An attorney can evaluate whether the denial is legitimate or constitutes bad faith, and advise you on the strongest course of action.
Appealing a PIP Denial
If your PIP claim is denied, you can challenge the denial through several mechanisms:
- Internal appeal: Submit additional medical documentation and request that the insurer reconsider.
- Alternative dispute resolution: Under NJ’s PIP arbitration system, disputes over PIP benefits can be resolved through arbitration rather than a full lawsuit.
- Lawsuit: You can file a lawsuit against your own insurance company to recover PIP benefits that were wrongfully denied.
Bad Faith Insurance Practices
New Jersey law prohibits insurance companies from acting in bad faith. If an insurer denies a legitimate claim without a reasonable basis, unreasonably delays payment, or fails to conduct a thorough investigation, the insurer may be liable for additional damages beyond the original claim amount. The New Jersey Unfair Claims Settlement Practices Act (N.J.S.A. 17B:30-13.1) outlines prohibited insurance company conduct.
Filing a Bodily Injury Lawsuit
If the at-fault driver’s insurer denies your bodily injury claim, your attorney can file a personal injury lawsuit in New Jersey Superior Court. The lawsuit initiates formal discovery, depositions, and ultimately trial if the case does not settle. Many cases that are denied at the claims stage settle during litigation once the insurer sees the full strength of the evidence. The statute of limitations is two years, so do not delay.
Contact MTG Lawyers Today
Maxwell, Tassini & Gardner, LLC
302 Washington Avenue, Suite 101
Spring Lake, NJ 07762
Phone: (732) 230-5003
Serving Monmouth and Ocean counties
If you were injured in an accident in New Jersey, you may have a compensable claim. Call MTG Lawyers at (732) 230-5003 for a free, no-obligation consultation. We speak English and Spanish. Hablamos español.
Understanding your NJ insurance claim denied case is essential. Our attorneys handle NJ insurance claim denied matters daily and know how to maximize your recovery. A NJ insurance claim denied attorney at Maxwell, Tassini & Gardner, LLC can evaluate your claim during a free consultation.
Learn More About NJ insurance claim denied
For more information about nj insurance claim denied, explore these related resources:
- recorded statement insurance NJ — related guide from MTG Lawyers
- why hire NJ personal injury lawyer — related guide from MTG Lawyers
- NJ car accident insurance claim — related guide from MTG Lawyers
- NJ DOBI consumer complaint process — official NJ resource
For personalized guidance on nj insurance claim denied, contact MTG Lawyers for a free consultation. Call (732) 230-5003 or reach out online today. Our NJ personal injury attorneys have helped thousands of accident victims recover the compensation they deserve.