Insurance can help you stay financially protected against unexpected accidents. However, when an actual accident occurs, and you file a claim for compensation, the insurance company could deny your claim.
If the insurance company denied coverage for your injury, you might feel helpless and confused. This can be especially frustrating if you have paid insurance premiums for years.
Insurance claims are denied for many reasons, but the denial of your claim is not necessarily the end of the story. If the insurance denied your coverage, you should work with an experienced personal injury attorney to appeal the claim denial and fight for the compensation you deserve.
Contact our personal injury lawyers at Howe.Law to discuss the denial of your claim and find out how you can appeal the insurance company’s decision. We offer a free initial consultation—Call 844-876-4357 for a case review.
Why insurance adjusters deny personal injury claims
After filing your personal injury claim, you will be dealing with the insurance company’s claims adjuster. It would help if you kept in mind that the adjuster represents the interests of their employer (the insurance company that hired them and pays them).
Every insurance company is focused on making profits. And the only way an insurer can make money is by paying claimants as little as possible and denying claims.
The insurance company pays the claims adjuster to handle claims and protect their interests. In other words, the adjuster’s job is to carefully review a policyholder’s claim and find a valid reason for denying coverage.
Your personal injury lawyer is the only one you can trust. Your attorney is your only advocate when pursuing compensation after sustaining an injury: our knowledgeable and results-driven lawyers at Howe.Law are committed to representing your interests and maximizing compensation for your injuries.
Top 10 reasons for personal injury claim denials
The reasons behind personal injury claim denials vary on a case-by-case basis. However, some of the most common reasons why an insurance company may deny your claim include:
1. Policy Exclusions
Insurance companies intentionally exclude certain accidents or injuries from their policies. These are known as “policy exclusions.” In addition, insurers often use ambiguous language to exclude a greater number of accidents and injuries.
2. Lack of Proof
When bringing an injury claim against the at-fault party’s insurance company, you are required to prove that the insured was responsible for causing the accident. If you fail to present a strong claim supported by conclusive evidence to prove liability, your claim could be denied.
3. Missing or Incorrect Information
When submitting your personal injury claim, you must make sure that the information you provide is correct, accurate, and complete. Also, you must follow the insurer’s strict submission requirements. Even a seemingly insignificant error could result in the denial of your claim.
4. Delay in Medical Treatment
Many personal injury claims are denied because the claimant did not seek medical attention immediately or otherwise delayed getting treatment for the injury.
5. Location Restrictions
Many auto insurance policies have strict location restrictions. Also, they may not cover accidents outside the United States or the state where the motorist purchased the policy.
6. No Connection Between the Accident and Your Injury
The insurance company could refuse to pay your injury claim if there is insufficient evidence to establish the link between the accident and your medical condition.
7. Pre-existing Injuries
A large percentage of personal injury claims are denied because of a prior injury or condition. The insurer may deny you coverage if it believes that your injury is attributable to a pre-existing condition. Also, your claim could be denied if you lie about or fail to disclose pre-existing injuries when submitting the claim.
8. Lack of Medical Records
Medical records are arguably the most important element of a personal injury claim. If you fail to present any medical records or submit incomplete records, the insurer may have grounds to deny coverage.
9. Expiration/Lapse of Coverage
Policyholders often forget to renew their insurance policy, while failure to pay premiums can result in a lapse of coverage. If your insurance policy has lapsed or expired, the insurer might deny your claim if the injury occurred when your insurance coverage wasn’t active.
10. Failure to Mitigate Injuries
If the insurance company believes that you failed to take all reasonable steps to mitigate the extent of your injuries, it could refuse to provide coverage.
No matter why your injury claim is denied, the denial is not the end of the world. You may still have the right to obtain compensation. Seek the help of our personal injury attorneys at Howe.Law to determine your best course of action.
What to do if my personal injury claim was denied?
The first thing you need to do when the insurance company denies your claim is staying calm and avoiding panicking. Remember: There may still be a way to get compensated even if your personal injury claim was denied.
Then, it would be best if you asked the insurance adjuster to explain in writing why your claim was denied. Asking for a written explanation of the denial kills three birds with one stone:
- Find out whether the insurance adjuster is bluffing;
- Have a chance to review and respond to the insurer’s reasons for denial; and
- Have a documented proof of the insurance company’s refusal to provide coverage in case you decide to take legal action later on.
If the adjuster refuses to provide a written explanation, you will need to prepare and send a letter to the adjuster confirming (a) the denial of your claim and (b) the refusal to explain the reasons for the denial in writing. When the insurance adjuster receives your letter, they will understand that you are building a solid foundation for a case.
The letter can accomplish one of the following:
- The insurance adjuster will reconsider the denial of coverage and may even make a settlement offer;
- be pressured to give a written explanation or
- confirm that they denied your claim and refused to explain the reasons behind the denial.
If you decide to file a complaint with the insurance commission or pursue a lawsuit against the insurance company, your correspondence and letters will serve as key evidence to prove a breach of contract or bad faith insurance practice.
It’s not uncommon for insurance adjusters to reconsider claim denials after facing resistance from the claimant. However, the insurance company could agree to negotiate a settlement if you put pressure on them and clarify that you won’t stop until your claim is approved.
However, since fighting a claim denial requires excellent negotiation skills and extensive legal knowledge, you should seek help from a skilled personal injury attorney at Howe.Law. We will protect your legal rights and exhaust all available options to put pressure on the insurance company.
Can I sue the insurance company for denying my claim?
Yes, you can. However, you will need to consult with a lawyer to determine whether the denial of your claim constitutes a breach of contract or bad faith conduct.
A knowledgeable and experienced lawyer will review the facts of your case to determine whether the insurance company had a valid reason to deny your personal injury claim.
In many cases, the claimant whose injury claim has been denied can sue the insurer for breaching a contract or engaging in bad faith insurance practices:
Breach of contract.
When a policyholder purchases an insurance policy, they enter into a contract with the insurance company. Therefore, the denial of a valid claim may constitute a breach of contract. By denying your claim without a valid reason, the insurer may have breached the contract by refusing to provide coverage. Typically, you will need to work with an attorney to examine the policy’s language and investigate the denial of your claim to determine whether the insurer breached the contract. If you win a breach of contract lawsuit against the insurance company that denied your personal injury claim, you will obtain compensation for your injury and may recover damages caused by the wrongful denial.
Bad faith conduct.
You can sue an insurance company when it engages in bad faith conduct. In other words, if the insurer fails to handle an injury claim fairly or violates the duty of good faith it owes to its policyholder, they can be sued for engaging in bad faith practices. If you win a bad-faith lawsuit against the insurer, the company will be ordered to pay the penalty in addition to providing coverage.
- Georgia: the bad faith penalty is no more than 50% of the amount of the claim or $5,000, whichever is greater (O.C.G.A. § 33-4-6).
- Tennessee: insurance companies that lose a bad-faith lawsuit must pay no more than 25% of the claim’s value, including any interest due (T.C.A. § 56-7-105).
- Mississippi: punitive damages and emotional distress damages may be awarded to the wronged party. However, their amount is determined on a case-by-case basis.
Do not hesitate to discuss your case with our personal injury lawyers at Howe.Law if your claim was denied. Our attorneys have decades of experience dealing with insurance claim denials in Georgia, Tennessee, and Mississippi. Schedule a free, no-obligation consultation with our lawyers to help you get full compensation for your claim. Call 844-876-4357 today.