Why & When an Accident Insurance Claim can be Denied

What are your legal options when facing some of the common reasons an insurance claim may be denied?

Sometimes, even if you are counting on the money coming in in order to pay your medical bills and other costs, this doesn’t always happen because sometimes your insurance claim can be denied. If this occurs, it is important to understand why it was denied.

Even if the situations are different, here are some common reasons used by the insurers.


The accident was avoidable

You may have your insurance claim denied if you could have avoided the accident or you were the one that led to or caused it. If the insurer thinks that you did something that would render the policy coverage ineffective, like driving under influence at the time of the accident or letting an unlicensed driver use your car, be sure the adjuster will use this against you. That’s why, if you find yourself in a situation like this, it is best to talk to a lawyer in order to protect your interests, that usually are directly opposite with those of the insurance company’s attorney.

The lack of treatment or no complaint at the time of the injury

Claiming that you got injured as a direct result of the car accident, has to be backed up by evidence. The adjuster may argue that the injuries didn’t really happen as a result of the accident or that the injuries are not related to the accident. Any kind of proof that you went to a hospital and got your injuries diagnosed will help you with your case.

Delaying seeking professional medical care will also allow the adjuster to either say that you weren’t hurt (because a person that got hurt normally seeks medical help), or that the injuries got aggravated as a direct result of delaying seeking medical help, or that the injuries happen after the accident.

Medical records and indication of injury/pain

To avoid having your claim denied, your medical records should indicate that you actually suffered an injury. Don’t forget that a claim adjuster has the right to ask for your medical records.

Pre-existing conditions

Having a pre-existing condition, will allow the claim adjuster to argue that it was this condition that is causing your injury and pain, and not the accident. If your condition was worsened by the accident, it will be hard to prove what was caused by the accident and what extent of the injury was pre-existing.

These are just a few of the most common reasons why insurance claims are denied. You need to talk as soon as possible with your insurance company in case you received a notice of denial and find out what went wrong with your claim and what do you need to do to fix it.

Keep in mind that insurance companies might deny claims in bad faith.  If the insurer doesn’t want to respect its obligation to resolve your case as per agreement with the insured (you or the other driver), please seek legal help.

When to get professional help?

Best advice is to speak with a car accident lawyer as soon as possible. Don’t wait for your claim to be denied. Having the help of a professional means you might avoid having your claim denied or adjusted too much. Beside, a lawyer increases the chances of getting a better settlement.

Most of the car accident lawyers work on a contingency fee, meaning you don’t have to pay anything upfront but you agree to pay the lawyer a percentage of the settlement if he/she successfully handles your case.

If your insurance claim got denied, the cost of legal representation is absolutely worth it.

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