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Personal Injury Claim Denied? Tips for Insurance Denial

If you are injured in a motor vehicle accident, by slipping on a wet floor at your local supermarket, or by being bitten by your neighbor’s pet, you should be covered by insurance. If your injury is the result of a traffic accident, both you and the other driver are required to have car insurance. If your injury is the result of a slip and fall accident at a store, that store is required to have business insurance, and if your injury occurred because of negligent neighbors, their homeowner’s insurance is responsible for compensating you. 

Unfortunately, many claims are denied by insurance companies. Sometimes they have good reasons, but sometimes they are motivated simply by the hope that you will drop the case and give up. In other words, personal injury claims are often denied unfairly.

The best course of action is to contact a personal injury attorney experienced with some of the tactics used by reluctant and profit-seeking insurance companies. Although an average of 67% of all personal injury cases are indeed settled and 4% go to trial, that still leaves 29% of all cases that result in neither a settlement nor a trial.

However, people received payouts 91% of the time when they had lawyers (as opposed to only 51% of the time when they didn’t).

Possible Reasons for Denial:

In many cases, your insurance claim is denied simply because the insurance company doesn’t want to lose money by compensating you. However, there are many reasons your claim could be denied including:

  • The insurance policy has lapsed. If you (or the responsible party) forgot to renew your insurance, you will find that you are not covered. If the problem lies with the other driver, you will be able to claim against your own Uninsured/Underinsured Motorist Coverage (unless you formally rejected this in writing).
  • The policy doesn’t cover the terms of the accident. It was an excluded or “not covered” event. Since the language in insurance contracts is sometimes ambiguous, you may be able to argue your case.
  • There is incorrect or missing information on your claim. The solution to this is to double and triple-check everything. An experienced personal injury attorney will be able to fill out your forms correctly for you. 
  • Your claim may be denied because you failed to inform the insurance company about what happened quickly enough.
  • You may have missing or insufficient medical records. This is something that can be rectified.
  • Your claim exceeds the limits of the policy.
  • The insurance adjusters say that the accident was your fault. An experienced car accident attorney or personal injury lawyer may be able to prove otherwise. A strong claim with supporting evidence will be needed to prove that the other person (or company) was liable.
    • Even if you do hold some of the blame, you may still have recourse, because Indiana has modified comparative negligence laws. As long as you are less than 51% at fault for whatever happened, you can file an injury claim. If you go to trial, the court will reduce recovery in proportion to each party’s contribution to the negligence. 
  • If the other party insurance company denied your claim, they may say that the accident was not responsible for your injuries or that you had preexisting injuries. It is possible to have a preexisting injury that was exacerbated by your accident and yet still receive compensation. You can read our article about pre-existing conditions and car accident claims here. Keep in mind the fact that you can be denied for lying about (or denying) pre-existing conditions. Always stick to the truth.
  • You may be denied for not seeking medical attention and treatment soon enough and also for making your condition worse by not following medical advice. This is called failure to mitigate damages.

What to Do if the Insurance Company Denies Your Claim

  1. First of all, do not panic – and don’t give up. There may still be a way for you to be compensated. You need information about the reason for the denial before deciding on your next steps.
  1. Either you or your attorney should ask the insurance claims adjuster for a written explanation for your denial. The letter you receive will give the reasons for the denial. It is best to review this explanation with your attorney. 
  1. If you are not provided with a written explanation, you or your attorney will send a letter to the insurance adjuster confirming the fact that your claim has been denied and also the fact that your request for an explanation has been denied. 
    • This letter lets the insurance adjuster see that you are not going to forget about the whole thing, and he or she may decide to offer a settlement after all.
    • The letter may motivate the adjuster to explain so that you can solve any solvable problems (like missing medical records or incorrectly filled out forms).
    • If nothing else, the letter will be part of the evidence you need if you decide to make a bad faith insurance claim.
    • You can also file a complaint with the Indiana Department of Insurance
  1. Once you have received your explanation of denial, if you disagree with anything, you and your lawyer can go through the insurance company’s appeals process. This needs to happen as soon as possible.
  1. Gather all of the evidence you need to include with your appeal.
  • In the case of a car accident, you will want photographs, police records, witness statements, possible statements from accident reconstructionists, medical records, etc.
  • In a slip-and-fall accident, you will want medical records, witness statements, photos, video footage, a copy of store procedures, and evidence of poor lighting, slippery steps, or lack of signage. 
  1. In the ideal situation, the insurance company will examine your additional or newly in-depth evidence and reverse their decision to deny compensation. The less ideal outcome would be that the insurance company denied you again. 
  1. At this point, if you have right on your side, you may wish to file a lawsuit against the insurance company. If you have been working with a skilled personal injury lawyer all along, you will be ready to proceed. If you have not, this is the time to consult with an experienced personal injury law firm

Having your claim denied by an insurance company is not the end of everything. Stay positive, gather evidence, and consult a personal injury lawyer who can help you fight for the compensation you deserve. 

At Crossen Law Firm, we have decades of experience handling all kinds of personal injury claims, including if your slip and fall claim was denied. 

To schedule a free consultation with one of our reputable Indianapolis personal injury lawyers, dial (317) 401-8626 now or contact us online.