Is it legal for an insurance company to deny a claim even though a police report assigns fault to their client?

Answer 1

Quite possibly. There are many factors that impact insurance claims, and there are some situations where a claim could be denied.

It's possible that the other driver's actions are not covered by their policy. For example, if someone intentionally rammed you with their car, they would certainly be at-fault, but insurance generally does not cover intentional acts. Some jurisdictions allow insurance companies to exclude coverage for acts that, while not intentional per se, the insured should have expected to result in a claim (such as running a red light on a city street at high speed in wet weather).


Keep in mind, in most states, the police are not actually allowed to assign fault. They simply show up and take a statement. The case itself is a civil matter, not criminal. In some jurisdictions, liability can be assigned on a contributory basis. If this is the case, any claim beyond the other driver's share of liability will be denied.


Also, any insurance policy has a limit of liability. No insurance company will pay claims in excess of the policies limit. If the at-fault driver hit multiple cars in a single occurrence and you were the last one to turn in your claim, their policy's limit has probably already been exhausted.


These are just a few examples. If you think you claim has been handled unfairly, consult an attorney. You have the right to seek arbitration or bring the matter to court. If you have an auto insurance policy that included collision coverage and medical payments, you can file a claim with your insurance company instead, and let them handle the other insurer, a process called subrogation.


Policy conditions and local laws vary.