Denial of a personal injury claim can be disheartening, but it doesn’t mean the end of the road. In this blog, we’ll discuss why claims are denied and what your next steps should be. There are several reasons why an insurance provider might deny a personal injury claim, but it’s essential to know that a denial does not close a case.
Why Personal Injury Claims are Denied
There are several reasons why an insurance provider might deny a personal injury claim, such as:
Administrative Errors
Insurance companies are extremely strict about submission rules, and a claim can be denied due to a simple error. There may be a minor discrepancy between the police report and your medical records that can trigger a denial, so when you file a claim, you must be attentive to every step.
Missed Deadlines
If the statute of limitations has expired, your claim will be immediately rejected. If this deadline has passed, you may be unable to follow up in court, so do not delay submitting your claim for any reason.
Insufficient Evidence
If the insurance adjuster believes there is insufficient evidence that the incident caused your injury, they will deny the claim. If they have their own evidence proving the injury and accident are unrelated, they will not hesitate to deny your claim.
Disputed Liability
Your claim will likely be denied if there is the slightest doubt about the liable party. If the insurance adjusters think you are wholly or partly at fault for the incident, your claim will be denied, and you may have to resubmit with different information.
Pre-Existing Conditions
If you have a pre-existing condition and the insurance adjuster believes that your injury is linked to your condition, they will deny the claim. If you do not share that you have a condition, and the insurance company finds out, they will assume you are lying and deny the claim.
Policy Limitations
If your claim falls within specific policy exclusions, it will be denied. Insurance providers have carefully worded contracts that exclude specific injuries and circumstances from the policy. These exclusions can take effect for something as simple as if they believe you were injured while performing a work-related task.
Steps to Take After a Claim Denial
If you have not received an explanation, you must demand a written denial letter explaining why your claim was denied. This demand is vital. If the adjuster refuses to send a letter, you won’t have documented proof that can be used as evidence later on.
They may also hope you will move on, but your continued demand for an explanation will make them take your claim more seriously. If they send a denial letter, you can carefully review why your claim was rejected.
Review Denial Letter
You must thoroughly review the letter and compare each reason to your policy. There may be ambiguous wording that could lead to misunderstandings. If any information is intentionally misleading, you can use it as evidence when you dispute the denial.
Consult with an Attorney
It is crucial to consult with an attorney to determine whether you have a case. You may be entitled to compensation for numerous damages, such as medical expenses, psychological suffering, lowered quality of life, and lost wages.
If the lawyer determines that the claim was denied unfairly, you may be able to sue the insurer for bad faith or breach of contract. If you were dismissed, in the hope that you wouldn’t involve a personal injury lawyer, hiring an attorney shows the insurer that you are taking the claim seriously and do not intend to drop it. This stance may make them reconsider their position and offer a settlement.
Send a Dispute Letter
Your attorney will help you compile and submit a dispute letter to the insurer stating that you disagree with their decision and intend to proceed with the claim. It is vital that this letter is detailed and carefully explains any potential mistakes or misconceptions.
It is best to refer directly to your policy to explain why you should be covered. You must make counterarguments against each point in the denial to convince the insurer to start settlement negotiations.
Arbitration
Once the insurer has reviewed your dispute, they may require arbitration, a settlement process overseen by an independent third party. Having a lawyer with you is vital when you attend arbitration hearings, as they can be confrontational and often go in the insurer’s favor.
Your attorney will prepare you for the arbitration, which can include advice about what you should say, how you should behave, and what’s appropriate to wear. They will be by your side and guide you through the arbitration, ensuring that your needs are prioritized. They will speak on your behalf unless you are asked a direct question.
Attending an arbitration hearing without an attorney is extremely risky. You could be exploited and end up with a low settlement or none.
Fighting Back Against Unfair Claim Denials
A denied personal injury claim isn’t the end of your journey. Contact HHJ Trial Attorneys for guidance on why your claim was denied and what your next steps should be. When we work together, we will have the best possible chance of securing the compensation you deserve.
