Detailed Answer
Disclaimer: This is general information only and not legal advice. For advice about your specific situation, consult a licensed Wisconsin attorney.
If an insurer refused to pay for injury-related losses after a minor accident, you have several practical and legal routes to challenge that denial under Wisconsin law. The right path depends on whether you are making a first‑party claim under your own policy (for example, uninsured/underinsured motorist or medical-payment benefits) or a third‑party claim against the at‑fault driver’s insurer. Below are clear, step‑by‑step actions to take and what to expect at each stage.
1. Read the denial and the policy closely
Insurers must send a written denial or explanation. Read that letter and your insurance policy. Look for:
- Reasons for the denial (coverage exclusion, late notice, insufficient evidence, preexisting condition, etc.).
- Any internal appeal procedures and deadlines in the policy.
- Arbitration clauses or requirements to use appraisal or alternative dispute resolution.
2. Preserve and collect evidence
Gather everything that supports your injury claim:
- Accident report and photos of the scene and vehicles.
- All medical records, diagnostic images, and bills tied to the accident.
- Paystubs or proof of lost earnings, rental car receipts, and other out‑of‑pocket costs.
- Contact information and statements from witnesses.
3. Respond in writing and submit a demand
Send a clear written response to the insurer’s denial. Explain any facts the insurer missed and attach supporting documents. Often you’ll also send a formal demand letter outlining your injury, damages, and the amount you seek. Keep copies of all correspondence and proof of delivery.
4. Use the insurer’s internal appeal process (if any)
If the policy describes an internal appeal, follow it exactly and on time. Even if the insurer has no formal appeal, give the company one more chance in writing to reconsider before escalating the matter.
5. File a complaint with the Wisconsin Office of the Commissioner of Insurance (OCI)
If the insurer will not reverse the denial, you can file a consumer complaint with OCI. OCI cannot give you legal advice or guarantee a payout, but it will investigate unfair practices and may help secure a resolution or explain your options. OCI also provides consumer guides that explain insurers’ duties.
OCI consumer assistance: https://oci.wi.gov
6. Consider mediation or arbitration
Some policies require arbitration. Others allow mediation as a faster, cheaper alternative to court. Arbitration limits judicial review, so review your policy carefully before agreeing. Mediation leaves the final choice to you and the insurer and can often produce faster settlements.
7. Evaluate small claims or civil litigation
If the dispute remains unresolved, you can sue in court. For relatively small losses, small‑claims or simplified civil procedures may be appropriate. For larger claims, you would file a personal injury lawsuit in Wisconsin circuit court. Be aware of timing: the statute of limitations for most personal injury claims in Wisconsin is three years from the date of the injury. See Wis. Stat. § 893.54 for the governing time limit.
Wisconsin statute of limitations for personal injury: https://docs.legis.wisconsin.gov/statutes/statutes/893/54
8. When to hire an attorney
Consider hiring a Wisconsin injury attorney if:
- The insurer refuses to pay clearly covered losses.
- You claim substantial medical expenses or lost wages.
- Liability is disputed or complex factual issues exist.
- There are policy limits, multiple insurers, or the insurer pressures you to accept a low offer.
Many personal injury lawyers work on contingency (they advance costs and are paid from any recovery). An attorney can handle evidence, negotiate, file suit, and manage discovery and depositions.
9. Realistic expectations after a minor accident
Minor accidents often produce modest medical bills and shorter recovery. Insurers may deny payment if injuries are subjective (pain only) or preexisting. If damages are small, weigh the time and expense of litigation against potential recovery. Mediation or a targeted demand letter often resolves smaller disputes.
10. Practical timeline and next steps checklist
- Immediately preserve evidence and medical records.
- Request denial reason and copy of your policy in writing.
- Within weeks, submit a written response and demand with documentation.
- If denied again, file a complaint with OCI and consider mediation.
- Decide whether to sue before the three‑year statute of limitations expires (see Wis. Stat. § 893.54).