Was Your Claim Denied After A Georgia Car Accident Because of the Policy’s Language?
If your accident claim was denied due to confusing policy language, you’re not alone — and Georgia law may be on your side.
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When recovering from a car accident and dealing with injuries and medical bills, understanding a confusing insurance policy should be the least of your concerns. And if your claim is denied, this can result in unexpected costs. Fortunately, Georgia law has special rules for insurance contracts that often favor you — the policyholder.
What Are The Special Rules For Insurance Contracts?
In Georgia, insurance policies are treated differently than ordinary contracts for several important reasons, including:
- You didn't write it — The insurance company drafted your policy.
- You had no opportunity to negotiate — It was offered as a "take it or leave it" deal.
- There's an imbalance of power — Insurance companies have teams of lawyers and experts.
Because of these factors, Georgia courts apply special rules when interpreting your insurance policy, especially when there's a dispute about what it means.
How These Rules Can Protect You After an Accident
If you were injured in a car accident, you’re likely counting on your insurance to cover the costs of your medical bills and other damages. But if your insurance company denies your claim due to unclear or ambiguous policy language, Georgia’s special rules are applied.
Rule #1: Ambiguous Language Is Interpreted in YOUR Favor
If your policy contains language that could reasonably be understood in more than one way, Georgia law requires courts to interpret that ambiguity in your favor — not the insurance company's.
Real-world example: Sarah was injured in a car accident at the intersection of Scott Boulevard and Clairemont Avenue in Decatur when her car was hit by an uninsured driver. Her insurance policy included uninsured motorist coverage, but her claim was denied because the insurance company said she was "commuting to work," which they claimed fell under a policy exclusion for "business use." However, the policy didn't clearly define "business use," creating ambiguity. Under Georgia's special rules, this ambiguity was interpreted in Sarah's favor and her claim was covered.
Rule #2: Exclusions Are Strictly Interpreted
Insurance policies often have exclusions, which are situations where coverage doesn't apply. Georgia law states insurance companies must follow the policies exactly as written, and can’t use unclear or confusing language to avoid paying.
Rule #3: Your Reasonable Expectations Matter
Courts in Georgia may consider what a reasonable person in your position would expect the policy to cover. This may involve evaluating industry standards and policy language.
Why Should This Matter to You?
If you or a loved one is injured in a car accident, you’re likely counting on your insurance policy to cover costly medical bills and other damages. And if your claim is denied, it’s important to understand how these special rules could help you. Here are some benefits of knowing these rules:
- Understand your rights — Insurance adjusters might not tell you about these rules when denying your claim.
- Challenge denials — If your claim is denied based on confusing policy language, you have grounds to challenge that decision.
- Negotiate from strength — Knowledge of these rules gives you leverage in negotiations.
A Story That Shows How This Works
Michael was driving his daughter near David T. Howard Middle School in Atlanta on their way to soccer practice when another driver ran a red light and crashed into them. Both were injured and required hospitalization. When Michael filed a claim, his insurance company denied coverage, citing a policy exclusion for "activities related to organized sports."
The insurance company argued that driving to soccer practice was related to organized sports. Michael found this unreasonable — he thought he was simply driving his car, not participating in sports.
After consulting with an attorney who explained Georgia’s special rules for insurance contracts, they filed a challenge against the insurance company’s decision, arguing:
- The exclusion was ambiguous (i.e. what exactly constitutes "activities related to" sports?) and therefore should be interpreted in Michael's favor.
- A reasonable person would not expect their insurance policy to exclude driving to sporting events.
The court agreed, finding that the exclusion was ambiguous and should be interpreted in Michael's favor. Michael's claim was ultimately covered, paying for both his and his daughter's medical expenses.
What You Should Do If Your Claim Is Denied
If you've been in an accident and your insurance company is denying coverage based on policy language that seems unclear, you should:
- Request the specific policy language they're using to deny your claim.
- Look for any ambiguity in how the language could be interpreted.
- Document your reasonable understanding of what the policy covered.
- Consult with an attorney familiar with Georgia insurance law who can explain how these special rules might apply to your situation.
Georgia's Laws on Complex Policies Can Help You - Hire a Lawyer if You're Still Having Issues
Because insurance policies are often complex and difficult for the average person to understand, Georgia’s special rules can help level the playing field between you and your insurance company.
If you were in an accident and your claim was denied based on confusing policy language, remember special rules apply and any unclear language in your policy must be interpreted in your favor. This protection is designed to help people like you get the coverage you deserve after an accident.
In Georgia, if your insurance policy contains ambiguous language or wording that could reasonably be understood in more than one way, courts are required to interpret that ambiguity in the policyholder’s favor. This allows your claim to proceed even when the insurer cites the ambiguous language as grounds for denial.
Insurance policy exclusions — instances when coverage doesn't apply — are strictly interpreted against the insurance company under Georgia law, meaning that if an insurer tries to deny your claim based on an exclusion, the exclusion language must be clear and unmistakable. Any ambiguity in how an exclusion is worded will typically be resolved in favor of the policyholder.
If your claim is denied, you should:
Request the specific policy language the insurer is using to deny your claim.
Look for any ambiguity in how the language could be interpreted.
Document your reasonable understanding of what you believed the policy covered.
Consult with an attorney familiar with Georgia insurance law who can explain how the special rules might apply to your situation.
The term "reasonable expectations" means that Georgia courts may consider what a reasonable person in your position would expect the policy to cover when interpreting insurance contracts. This acknowledges that policyholders purchase insurance with certain coverage expectations, and those expectations should be honored if reasonable — even if the policy language might be interpreted differently by insurance experts. It helps protect policyholders who don't have the legal expertise to fully understand complex policy language.
