Reasons an insurance company may refuse to cover your motor vehicle accident claim

Date: May 27, 2016

If you are injured by a car crash, you can sometimes sue the other party for damages to you and your property.

However, when it is the defendant's insurance company expected to pay the damages when you sue, it is important to understand some of the reasons the insurer may attempt to minimise or deny payment.

Has the insurer been made aware of the accident?

The policy holder you are suing must notify the police and their insurance company of the accident. The policy holder's failure to do so will allow the insurance provider to claim they are unaware of the accident.

If you are not badly injured, your claim may fail

There are limits on who can claim compensation for non-economic loss and how much compensation they get. With compulsory third party insurance, the State Insurance Regulatory Authority of NSW (formerly the Motor Accidents Authority) says "These limits keep the cost of compulsory third party insurance down by ensuring that non-economic loss damages are paid only to those with severe injuries resulting in permanent impairment."

Non-economic loss damages are only paid out by insurers to insured people if a person has whole-person permanent impairment of more than 10 per cent.

What kind of expenses can you ask someone to pay?

Insurers can pay out hospital, medical, past loss of earnings, rehabilitation and travel expenses to their insured clients or to people injured by those clients. This is only possible if the medical treatment claimed for is proven to be related to the motor vehicle accident and the treatment is likely to regain the injured person's ability to function. There needs to be medical research supporting these claims and an injured person's treating doctor(s) must recommend the treatment

If you are not keeping careful accounts of the above expenses you may find it difficult to be compensated.

A 'without prejudice' payment does not mean an insurer will pay all claims

The insurer may pay for your medical, therapy and rehabilitation expenses without accepting liability. Such payments are known as 'without prejudice' payments. Before costly medical services are provided the insurer should be informed of these costs, and your legal representatives should be notified that such a payment is being made.

Limits to damages claims

If you are claiming non-economic loss under insurance coverage as the result of a motor vehicle accident, the maximum payable in NSW is $492,000.

Another cost to factor is 'Lost income,' which is a claim to cover the cost of time you are unable to work in the way you did before the accident. Lost income payments were capped at just over $4512 per week in 2014 but have been adjusted upward slightly since then.

If you are injured by a car crash, you can sometimes sue for damages to you and your property, but don't forget to work out whether and insurance company is likely to be asked to pay out. You will need a lawyer like the friendly folks at Gerard Malouf and Partners to help you see things from their perspective.

Call us now on 1800 004 878 to book a free appointment with one of my compensation experts or email your enquiry.