After an accident in California, you may expect the claims process to move steadily toward payment, especially when your injuries and medical bills seem well documented. But when an insurer disputes your claim, you may be unsure how to pursue compensation.
Understanding the insurer’s concerns
When an adjuster reviews your claim, the insurer looks at whether the policy applies, who caused the accident and how the injury has affected you. Even if the company does not dispute fault, it may question the connection between the accident and all of your symptoms or whether your medical and financial records support the amount requested.
A previous injury or medical condition does not necessarily end your claim. However, the carrier may look closely at whether the accident made it worse, especially if you waited to seek care or your records do not clearly show when your symptoms began.
Responding to the carrier’s decision
After the insurer receives your proof of claim, California generally provides it with 40 calendar days to accept or deny the case. If the company needs more time, it generally must explain the delay in writing and provide updates every 30 days.
When the carrier offers a settlement, you can review whether the amount reflects your medical expenses, lost income and other documented losses. Signing a release usually ends your right to seek further payment from the parties it names, even when your condition later worsens.
Considering further options
When direct discussions do not resolve the disagreement, you may submit a complaint to the California Department of Insurance. The department can contact the carrier and review whether it followed state claims-handling rules, but it cannot decide fault, award damages or order payment.
An unreasonable denial or delay by your own insurer may support a breach of contract claim or an insurance bad faith claim. In a bad faith case, the court considers whether the company withheld covered benefits without a reasonable basis.