It can be upsetting and distressing to have a denied road accident compensation claim. Thus, this article will be a comprehensive guide on the steps you should take if your claim is denied. Here, we will cover important measures such as gathering additional evidence, understanding the reasons for denial, and navigating the appeals process.
Understanding Insurance Rejections
The first step in addressing a denied claim is to understand the reasons behind the decision. Insurance providers or the Insurance Commission of Western Australia (ICWA) may deny a claim for a variety of reasons, including:
- Insufficient Evidence: The insurer or ICWA may determine that there is insufficient evidence to support your claim. This could be due to a lack of documentation, witness statements, or medical records to substantiate the extent of your injuries and losses.
- Contributory Negligence: If the insurer or ICWA believes that you were partially at fault for the accident, they may deny your claim or reduce the amount of compensation you are entitled to receive. This is known as contributory negligence.
- Exclusions in the Policy: Your insurance policy may have specific exclusions that prevent certain types of claims from being covered. For example, if the accident occurred while you were under the influence of alcohol or drugs, your claim may be denied.
- Failure to Report the Accident: In Western Australia, you are required to report a road accident to the police and the ICWA within a reasonable timeframe. If you fail to do so, your claim may be denied.
Statute of Limitations
There are strict time limits for filing a road accident compensation claim in Western Australia. In general, if you were in a motor vehicle crash and sustained catastrophic injuries, such as spinal cord injuries and brain injuries, you must lodge the claim within three years of the accident. Otherwise, your claim may be denied. Nonetheless, a different time limit will apply if you are below 18 when you have sustained the injury.
Understanding the specific reasons for the denial of your claim is crucial in determining the next steps you should take.
Evidence Strategy Framework
If your claim has been denied, the next step is to gather additional evidence to support your case. This may include:
- Medical Records: Ensure that you have comprehensive medical documentation, including reports from healthcare providers, diagnostic tests, and records of any treatment or rehabilitation you have received.
- Witness Statements: Obtain written statements from any witnesses who were present at the scene of the accident or who can attest to the extent of your injuries and losses.
- Photographic Evidence: Take photographs of any damage to your vehicle, the accident scene, and any visible injuries you sustained.
- Financial Documentation: Gather records of any lost wages, out-of-pocket expenses, and other financial losses you have incurred as a result of the accident.
The more detailed and well-documented your evidence, the stronger your case will be when appealing the denial of your claim.
ICWA Resolution Process
If your claim has been denied, you have the right to appeal the decision. The appeals process in Western Australia can vary depending on the type of claim you have made.
Personal Injury Claims
If your claim is for personal injuries sustained in a road accident, you can appeal the decision through ICWA’s internal dispute resolution process. This involves submitting a written request for a review of the decision, along with any additional evidence you have gathered.
If you are still unsatisfied with the outcome of the internal review, you can escalate your appeal to the Australian Financial Complaints Authority (AFCA), an independent external dispute resolution service.
Property Damage Claims
If your claim is for property damage, such as damage to your vehicle, the appeals process may differ. In this case, you would need to pursue your claim through the civil court system, as there are no internal or external dispute resolution mechanisms available through ICWA or other government agencies.
It is important to note that the appeals process can be complex and time-consuming, and it is recommended that you seek the assistance of an experienced compensation lawyer to guide you through the process.
WA Legislative Requirements
If your claim has been denied and you decide to pursue legal action, it is crucial to understand the legal landscape in Western Australia. The key pieces of legislation that govern road accident compensation claims are:
The Motor Vehicle (Third Party Insurance) Act 1943: This Act establishes the compulsory third-party (CTP) insurance scheme in Western Australia, which provides coverage for personal injury claims arising from road accidents.
The Civil Liability Act 2002: This Act sets out the principles and rules for determining liability in personal injury claims, including the concept of contributory negligence.
The Motor Vehicle (Catastrophic Injuries) Act 2016: This Act provides for the treatment, care, and support of individuals who have sustained catastrophic injuries in road accidents, regardless of fault.
Understanding the relevant legislation and how it applies to your specific case is crucial in navigating the legal system and increasing your chances of a successful appeal or legal action.
Specialist Legal Representation
Navigating the road accident compensation claims process can be complex and overwhelming, especially when your claim has been denied. Seeking the assistance of an experienced compensation lawyer such as ours can be invaluable in ensuring that your rights and entitlements are protected.
Our expert compensation lawyers can help you:
- Understand the Reasons for Denial: Our experienced Compensation Lawyers Perth can review the insurer’s or ICWA’s decision and provide an expert analysis of the reasons for the denial, helping you to identify the best course of action.
- Gather and Present Evidence: We can assist you in gathering the necessary evidence to support your claim and present it in a compelling and persuasive manner.
- Navigate the Appeals Process: We can guide you through the complex appeals process, ensuring that all deadlines are met and that your case is presented in the best possible light.
- Represent You in Legal Proceedings: If your claim requires legal action, we can represent you in court and negotiate on your behalf to secure the maximum possible compensation.
Your Action Plan
Facing a denied road accident compensation claim can be an upsetting and stressful experience. However, remember that you have rights and options available to you. Gajic Lawyers are here to help you understand the reasons for the denial and aid you in every step of the appeals process. Get in touch with one of our experienced Car Accident Lawyers Perth today for free!
