Question

While Stephanie is filling out the claims worksheet at her workplace, back at the T-Wrecks Insurance office, Jamal’s manager swings by his desk and says, “Here’s that next project I mentioned earlier! We have a few folks
whose cases we've reviewed and unfortunately, we have to deny their
claims. I just sent you their files. Please contact them back explaining why their claim was denied and provide them with some precautions that they can take in the future to make sure that their claim goes through next
time.”
Jamal double checks this list of reasons why car insurance claims can be
denied and then checks his email, seeing 2 different files from his
manager. The first customer called in two months after his car accident
and reported that he is suffering from whiplash. He would now like to add this information to his insurance claim.
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Last updated: 4/25/19
4. What reasoning should Jamal provide for why this car insurance claim was denied?
5. What advice can Jamal give this client to improve his chances of getting approved for a
similar claim in the future?
The second file is from a customer who was on a road trip and had a thief break into her car through her back window. She says that she thought she had comprehensive coverage, but in reality, her coverage did NOT include it.
Answer This:
6. What reasoning should Jamal provide for why this car insurance claim was denied?
7. What advice can Jamal give this client to improve his chances of getting approved for a
similar claim in the future?
8. What are 3 other common reasons that car insurance claims can be denied that you want
to make sure YOU are aware of for yourself?

Answer 1

4. Reason for denial (whiplash reported two months after the accident)
- The policy requires prompt notice of injuries and an opportunity for the insurer to investigate. Because the customer waited two months to report the whiplash and add it to the claim, there is insufficient timely medical documentation and the insurer cannot reasonably verify the injury was caused by the accident. Under the policy’s timely‑notice and cooperation provisions, the claim must be denied.

5. Advice to improve chances going forward
- Seek medical attention right away after any accident and keep all records (doctor notes, treatment plans, imaging, bills).
- Report any injuries to your insurer as soon as possible, even if symptoms are delayed or seem minor.
- Get and keep a copy of the police report, photos of the accident and any injuries, and contact information for witnesses.
- Follow the treating physician’s instructions and keep documentation of all follow‑up visits and costs.
- Read your policy so you know reporting deadlines and your responsibilities; if unsure, call your agent immediately after an accident.

6. Reason for denial (theft but no comprehensive coverage)
- The damage/theft described is a comprehensive loss. Comprehensive coverage (sometimes called “other than collision”) is the portion of an auto policy that covers theft, vandalism and glass breakage. Because the customer’s policy did not include comprehensive coverage, the loss is not covered and the claim must be denied.

7. Advice to improve chances going forward
- Add comprehensive coverage to the policy if you want protection against theft, vandalism, fire, animal strikes and glass breakage. Compare limits and deductibles to decide the right level.
- When traveling, reduce risk by locking the vehicle, keeping valuables out of sight (or in the trunk), parking in well‑lit or secured areas, and using anti‑theft devices if possible.
- If theft or break‑in occurs, call the police immediately and get a copy of the police report, take photos of the damage, and keep receipts for any stolen property—you’ll need these if you later have the right coverage.
- Review your policy coverages before trips so you know what’s and isn’t covered.

8. Three other common reasons claims are denied (and how to avoid them)
- Policy lapsed/non‑payment: If premiums aren’t paid and the policy lapses, there’s no coverage for accidents that happen during the lapse. How to avoid: keep payments current, set up autopay or calendar reminders, and confirm renewal notices.
- Excluded driver/use or wrong type of coverage: Claims can be denied if the driver was specifically excluded on the policy, the vehicle was being used for an activity not covered (e.g., commercial/rideshare work without proper endorsement), or a non‑permitted driver was operating the car. How to avoid: list all regular drivers, disclose business or rideshare use and buy the appropriate endorsements, and don’t let excluded drivers use the vehicle.
- Loss caused by illegal or intentional acts (DUI, racing, intentional damage) or fraud: Insurers typically deny coverage for losses that result from criminal activity, driving under the influence, racing, or staging/fraud. How to avoid: follow the law, don’t drive while impaired, avoid risky behaviors like racing, and always provide truthful, complete information to the insurer.

If you want, I can draft two short customer emails/messages Jamal can send to each client explaining the denial and the steps to take next.