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Insurance carriers like to avoid their obligations by arguing that the policy simply doesn’t cover the incident in question. Here’s how this scam works:

A secret weapon in the insurance industry’s arsenal is a defense that we refer to as “insurance policy inapplicability.” Now, you should know that other defenses exist but we’re talking about the inapplicable policy defense in this article.

In a nutshell, if the insurance carrier can allege that the actions of their driver were outside the scope of what the policy covers, then they are able to avoid paying you even though their driver caused the accident. This article will explain how insurance companies can manipulate the policies, and what we can do to help.


Questions Answered on This Page:

  • How does the “insurance policy inapplicability” defense work?
  • What are examples of when a car insurance company won’t pay for an accident?
  • How do I know if I should file a car accident claim or not?

An Overview of Car Insurance:

We all understand that not all insurance policies cover the same issues. For instance, if you cause a car accident, you wouldn’t expect to file a claim to your home or life insurance because those two policies only cover certain situations. As such, when an insurance carrier can argue that the scope of a policy does not include the type of situation on which your grievance is based, then you are completely barred from receiving compensation for that policy. So when a car insurance carrier can explain that the situation surrounding your accident is not covered, they are often essentially saying “sorry, but the person who hurt you has coverage, it just doesn’t cover this.”

An Example

Our firm was contacted by a woman who suffered moderate injuries in an accident when her car was sideswiped. Her claim had been denied, and she contacted us hoping we could remedy the situation. She explained that the person that hit her was probably in a rush and not paying attention, but in order to make her story sound more compelling she told the insurance adjuster that the other driver hit her in a fit of road rage.

She thought this would frighten the insurance adjuster into making a quick settlement because, she figured who would want to defend a driver like that? Her plan backfired, and the insurance carrier denied the claim on the basis that they do not cover intentional torts (deliberate acts). The policy only covered negligence, and if he hit her on purpose, that’s not negligence, and the insurance policy does not apply. She admitted she exaggerated, thinking it would help, and since we cannot in good conscience help someone who was being dishonest, we could not represent her in her case.

Myth - Insurance Carriers Must Pay Accident Victims This is not how insurance works at all. In this article, we address the myth and explain how insurance policies actually do work...Read More >

How Insurance Policies are Supposed to Work

As you have probably gathered, insurance policies cover negligent acts. Negligent acts are really mistakes or general recklessness. An insurance policy may not apply, however, in obviously dangerous and illegal acts, i.e. when an insured driver is racing, either on track or street, or when the driver is driving drunk, or if they ram their car into someone on purpose. The technical explanation is that racing is not an act of negligence, it’s a willful and wanton act; and drunken driving or deliberately hitting people with one’s car are intentional criminal acts. But is that the whole story?

The Problem

Insurance carriers love nothing more than to argue that your accident claim isn’t something the policy covers. This is convenient for them because they basically shut the claim down before they ever even need to entertain the idea that their driver is liable. If this happens, you have no recourse against the other driver and their insurance carrier. The problem is that insurance carriers will unfairly claim that the circumstances of your accident fall outside the scope of what their policy was designed to cover, even when it most likely does.

And although this position (where the insurance carrier will claim that they’re not responsible) is not technically a legal defense, nonetheless it definitely acts as one. It serves to keep the case from moving forward. It acts as a sort-of pre-trial tactic to keep your claim from ever getting off the ground.

How We Can Help

Our attorneys at Grossman Law Offices have over 25 years of experience and have dealt with literally thousands of car accident cases. We know how to deal with the insurance companies to make sure that they accept responsibility for their driver’s actions. The “silver bullet” we use to defeat this insurance company tactic is to simply provide them with samples cases where courts have ruled that the act the insurance carrier tells you isn’t covered is in fact an act of negligence. In other words, sure, drunk driving is a criminal act, and most insurance policies don’t cover criminal acts. But it’s also an act of negligence, so we argue that the policy does cover the part of drunk driving that is negligent, notwithstanding the part that is also criminal misconduct.

We will help you through the entire process and deal directly with the insurance company on your behalf, getting you the fair settlement that you deserve. Call today for a free consultation at (855) 326-0000.


Commonly, we’ve also seen the defendant party use one of the following defenses to combat your car accident case. Click on any of the articles below to read more:

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Call us anytime toll Free 1-855-326-0000