Suffering an injury after a car accident can be traumatic enough without having to deal with issues surrounding insurance claims and coverage. Unfortunately, insurance companies often deny claims for a variety of reasons. You may find your personal injury claim denied even though you promptly notified your insurance company after the accident.
Being aware of the most common reasons why insurance companies deny claims, like pre-existing injuries, disputed liability and questionable severity, is key. Work closely with your personal injury attorney or car accident lawyer to file your insurance claim and personal injury claim promptly, provide documentation, and appeal if your claim is denied.
Knowing the 5 reasons insurance companies frequently deny claims is vital to avoid pitfalls and have a better chance of getting your injury claim approved. With persistence, many initially denied claims eventually get settled. Don’t let an insurance denial deter you from getting fair compensation for your injuries.
1. Delayed Reporting of Your Car Accident Claim to the Insurance Company
One of the most frequent reasons insurance companies give for denying a personal injury claim is that the policyholder waited too long to file the claim. Most insurance policies have strict time limits on when you must notify them of an accident or injury, often within 24 hours or as soon as reasonably possible.
If you fail to report your injury promptly, the insurance company may argue that too much time has passed for them to investigate properly or verify details surrounding the accident. They may suspect you are making a fraudulent claim or inflating your injuries.
Tips to avoid a late reporting denial:
- Report your injury to the insurance company as soon as possible after the accident occurs, even if you do not yet have all the details or medical records.
- Note the exact time and date you reported the claim and who you spoke with. Follow up any phone calls with a written incident report.
- If there is a delay in reporting, explain why in writing. Reasons like being hospitalized or unconscious may be acceptable.
2. Lack of Medical Records to Support Your Personal Injury Claim
Insurance companies want to see medical documentation that proves you suffered an injury and require treatment. A lack of this documentation is a common reason for denying claims.
The insurance company expects you to seek prompt medical attention after an accident and to follow prescribed treatment plans. Gaps in treatment or failure to get recommended medical care may cast doubt on the validity of your injury.
Tips to avoid a lack of documentation denial:
- Seek medical attention immediately after an accident and follow up with the recommended treatment plan.
- Provide the insurance company with documentation like emergency room and doctor’s visit records, therapy notes, and receipts for medications, equipment, etc.
- Explain any gaps in treatment, like needing to wait for an appointment with a specialist. Get notes from doctors if you must postpone treatment for any reason.
3. Pre-Existing Injury or Condition
Insurers will scour your medical history to determine if you had any pre-existing injuries or conditions that may be related to your current claim. If they find evidence of a pre-existing problem, they may allege it caused or contributed to your claimed injury.
For example, suppose you have previous chronic back pain and make a claim for a back injury. In that case, the insurance company may argue your current back problems stem from a pre-existing condition rather than the accident.
Tips to avoid a pre-existing injury denial:
- Be upfront about any past injuries or conditions when reporting your claim. Explain how the current injury differs or is more severe.
- Provide records clearly showing treatment and recovery from your pre-existing condition before the accident occurred.
- Get a doctor’s statement explaining how the new injury is unrelated to past conditions and resulted directly from the accident.
4. Establishing Liability for Your Car Accident Claim When Questions Arise
Insurance companies will investigate who is at fault or liable for an accident when evaluating a claim. If they determine you bear some or all responsibility, they may deny your injury claim entirely or reduce payouts proportionate to your share of fault.
For example, if their investigation shows you were texting while driving when the accident occurred, they may allege you were primarily liable due to distracted driving.
Tips to avoid a disputed liability denial:
- Provide evidence like police reports, eyewitness statements, video footage, etc., to back up your version of events.
- Act quickly to gather evidence and witness statements while the accident is still fresh. Memories fade, and evidence can disappear over time.
- If you were partially at fault, be honest about what happened. In some states, you may still recover damages in proportion to the other party’s fault.
5. Severity of Your Personal Injury Claim
Insurance companies will often dispute the true severity of an injury to avoid paying out large settlements. An insurer may claim you are exaggerating your pain and suffering or that treatment is unnecessary.
For example, they may argue that continuing physical therapy for a sprained knee is excessive. Or they may claim pain levels are too high for what medical tests indicate is a minor soft tissue injury.
Tips to avoid disputed injury severity denials:
- Get second and even third opinions from doctors to substantiate your injuries objectively.
- Follow all recommended treatments and document how they are helping improve your condition.
- Be honest about pain levels and how the injury is impacting your life without exaggerating.
- Provide detailed medical reports on diagnostic tests, treatment plans, and prognosis from your doctors.
What to Do if the Insurance Company Denies Your Accident Claim
If an insurance company denies your injury claim, don’t panic or give up. There are still steps you can take to appeal the decision and get the settlement you deserve.
- Request a formal reason for the claim denial in writing. Review the specific reasons given and whether you have evidence to dispute them.
- Appeal the decision and provide additional documentation to address the insurance company’s concerns directly.
- Consult with a personal injury attorney to evaluate whether you have grounds to dispute the denial in court. An experienced personal injury lawyer can negotiate with insurers on your behalf.
- File a complaint with your state insurance commissioner if you believe the insurer is handling your claim in bad faith.
With persistence and the right legal help, many initially denied injury claims eventually get settled through negotiations or lawsuits. Don’t let an insurance company’s denial deter you from getting fair compensation for your accident injuries. Know your rights and explore all options for overturning the decision.
Frequently Asked Questions
Q: What should I do if the insurance company denies my personal injury claim after a car accident?
A: If your claim has been denied, notify your insurance company in writing and consult a personal injury attorney. The lawyer can review your case, determine the potential reasons for denial, and advise if it’s worth appealing or negotiating the claim settlement. Don’t delay seeking legal help.
Q: How can I prove my injuries to the insurance company if they think I’m exaggerating?
A: Keep detailed records of doctor visits, tests, treatments, medications and costs. Get all diagnoses, prognoses and limitations documented in your medical records. Your personal injury lawyer can work with doctors to validate your injuries and losses. Thorough documentation is key.
Q: Will the insurance company investigate my claim? How does this affect my personal injury case?
A: Yes, the insurance company will do a thorough investigation of your claim, including your medical history, accident details and more. That’s why it’s critical to consult an accident injury lawyer early. An attorney can help manage the claims process and the insurance company’s investigation.
Q: If my claim was denied, does that mean the insurance company won’t pay anything?
A: Not necessarily. Insurance companies often initially deny a claim to see if you will accept a lower settlement. With an attorney’s help negotiating, you may still recover damages, even if the original personal injury claim was denied. Don’t give up if your claim is denied.
Q: How long does the insurance company have to respond to my injury claim?
A: There are different claim response time limits depending on your state. However, it’s wise to submit your claim to the insurance company as soon as possible while the evidence is fresh. If you’ve suffered an accident or injury, consult a personal injury lawyer immediately.
