What to do when an insurer denies benefits for a minor auto injury in Massachusetts

Quick summary: If your insurer denies payment for medical bills or other benefits after a minor crash, act quickly: get the written denial, gather evidence (medical records, police report, photos, witness statements), follow the insurer’s internal appeal procedures, and consider filing a complaint with the Massachusetts Division of Insurance or bringing a court claim before the statute of limitations runs. This is educational information and not legal advice.

Detailed answer — step-by-step guide under Massachusetts law

1. Understand common reasons insurers deny injury claims

An insurer may deny a claim for several routine reasons after a minor collision, including:

• Policy coverage exclusions or lack of liability (insurer says the other driver wasn’t at fault).
• Late notice of the accident or failure to follow procedural requirements in the policy.
• Lack of medical causation (insurer says your injury is not related to the accident).
• Insufficient documentation (no medical records, no bills, or no objective findings).

2. Immediate actions to protect your rights

Take these steps right away, while memories and records are fresh:

• Ask the insurer for the denial in writing and the specific reasons for the denial.
• Obtain a copy of the police crash report if one was filed.
• Get prompt medical care and keep all medical records, bills, imaging, and treatment notes showing diagnosis, treatment dates, and any link to the collision.
• Take and save photos of the scene, vehicle damage, visible injuries, and road conditions.
• Collect witness names and contact information. Ask witnesses for short written statements if possible.
• Preserve correspondence: save emails, text messages, and take notes of phone calls (date, time, who you spoke with, what was said).

3. Use the insurer’s internal appeal process

Most policies and insurers provide an internal appeals or reconsideration process. Follow these best practices:

• Review your policy for appeal deadlines and required forms.
• Send an appeal letter by certified mail with return receipt. Briefly restate the facts, explain why the denial is incorrect, and attach supporting documents (medical records, bills, photos, police report, statements).
• Ask for a clear explanation of any coverage or causation determination and request a timely written response.

4. Consider statutory remedies and regulatory complaints

If the insurer refuses to pay after a complete appeal, you have additional options under Massachusetts law:

• File a complaint with the Massachusetts Division of Insurance (DOI). The DOI reviews insurer conduct and may mediate or investigate unfair settlement practices. You can file online or by mail. See how to file at: Mass.gov — File a complaint against an insurance company, and general information at: Massachusetts Division of Insurance.
• Pursue a private lawsuit. You may bring a suit for breach of contract (policy benefits) or, in some cases, for unfair or deceptive practices under Mass. Gen. Laws ch. 176D (insurance-specific unfair practices) or Chapter 93A (consumer protection). See the Massachusetts statute on unfair insurance practices: M.G.L. c.176D, and the consumer protection statute: M.G.L. c.93A §11.

5. Watch the clock — statute of limitations

Time limits matter. For personal injury claims in Massachusetts the usual deadline to start a lawsuit is three years from the date the cause of action accrues. See: M.G.L. c.260 §2A. Filing deadlines for contract claims (policy disputes) can differ, so check your policy and get legal advice if you’re close to any deadline.

6. Alternative forums: small claims or arbitration

If the amounts at issue are small, consider small claims court for money-only disputes. Massachusetts courts publish filing guidance here: Mass.gov — District Court / Small Claims. Some policies also require or allow appraisal or arbitration procedures; review your policy for mandatory alternative dispute resolution clauses.

7. When to consult an attorney

Talk to an attorney if any of the following apply:

• Your injuries are more than minor, or you have lingering symptoms.
• The insurer denies liability and the facts about who caused the crash are disputed.
• You suspect bad faith or unfair settlement practices by the insurer.
• You’re near the statute of limitations or the case involves a coverage dispute, uninsured/underinsured motorist issues, or complicated medical causation.

Personal injury lawyers commonly work on contingency (they are paid a percentage of any recovery), which can make hiring counsel financially feasible for many claimants.

Hypothetical example

Imagine a low-speed rear-end crash. You saw your doctor twice; the insurer denied reimbursement saying the records do not show the injuries came from the crash. You should:

1. Obtain the written denial and the insurer’s explanation.
2. Request your full medical file and ask your provider to add a note linking treatment to the collision if supported by records.
3. Send a certified appeal packet with the police report, medical records, bills, photos of vehicle damage, and a short letter explaining the timeline.
4. If the insurer denies again, file a complaint with the Division of Insurance and consider a civil claim before the 3-year statute expires.

Helpful Hints

• Always get a written denial — the insurer’s reason is essential to craft an appeal.
• Document everything contemporaneously: call logs, medical visits, time off work, and out-of-pocket expenses.
• Send appeal documents by certified mail and keep the receipt and signed return copy.
• Don’t accept the first denial if you have supporting evidence — insurers sometimes reverse after new documentation.
• Use the DOI complaint process early if the insurer’s communications seem unfair or evasive.
• Keep an eye on deadlines: policy appeal windows, DOI timelines, and court statutes of limitations.
• If you hire a lawyer, ask how fees and expenses are handled and get the fee agreement in writing.

Resources

• Massachusetts Division of Insurance — file a complaint: https://www.mass.gov/how-to/file-a-complaint-against-an-insurance-company
• M.G.L. c.176D (unfair insurance practices): https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter176D
• M.G.L. c.93A §11 (consumer protection causes of action): https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXV/Chapter93A/Section11
• Statute of limitations for personal injury: M.G.L. c.260 §2A: https://malegislature.gov/Laws/GeneralLaws/PartIV/TitleI/Chapter260/Section2A
• Small claims filing guidance: https://www.mass.gov/info-details/file-a-case-in-district-court-small-claims-court

Disclaimer: This article explains general Massachusetts procedures and statutes and is for educational purposes only. It does not provide legal advice. For advice about your specific situation, consult a licensed Massachusetts attorney.