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Fighting Against A Denied Claim

Personal Injury Lawyer

A denied personal injury claim from an insurance company can be a frustrating and disheartening experience for an individual who has suffered injuries due to someone else’s negligence. When a claim is denied, it means that the insurance company has chosen not to provide compensation for the injuries and losses the claimant has incurred. There are several reasons why an insurance company may deny a personal injury claim, and understanding these reasons can help the claimant navigate the situation more effectively.

  1. Insufficient Evidence: One of the most common reasons for a denied personal injury claim is a lack of compelling evidence to support the claimant’s case. Insurance companies require solid evidence to establish liability and the extent of damages. If the evidence presented is weak, inconclusive, or contradicts the claimant’s account, the insurance company may deny the claim.
  2. Late Reporting: Insurance policies have strict timelines for reporting incidents and filing claims. If the claimant fails to report the incident promptly or misses the deadline for filing the claim, the insurance company may deny it.
  3. Disputed Liability: In some cases, there may be a dispute over liability, where the insurance company believes that their insured party was not at fault for the accident. If liability is unclear or contested, the insurance company may deny the claim until fault can be determined.
  4. Pre-existing Conditions: If the claimant had a pre-existing medical condition that the insurance company believes is responsible for the injuries rather than the accident, they may deny the claim on the basis of the pre-existing condition.
  5. Uninsured/Underinsured Motorist Coverage: In auto accidents, if the at-fault party is uninsured or underinsured, the claimant may need to rely on their own uninsured/underinsured motorist coverage. However, if the claimant’s policy does not have this coverage, the insurance company may deny the claim.
  6. Failure to Seek Timely Medical Treatment: If the claimant fails to seek medical attention immediately after the accident or delays treatment, the insurance company may use this as grounds to deny the claim, arguing that the injuries may not be as severe as claimed.
  7. Fraud or Misrepresentation: If the insurance company suspects that the claimant has misrepresented facts, inflated the extent of their injuries, or committed insurance fraud, they will likely deny the claim.

When faced with a denied personal injury claim, the claimant has several options to pursue:

  1. Appealing the Decision: The claimant can file an appeal with the insurance company, providing additional evidence and clarifying any misunderstandings that led to the denial.
  2. Seeking Legal Counsel: Consulting with a lawyer, like a personal injury lawyer from a law office such as Ted A. Greve & Associates is extremely beneficial, as they can assess the claim, negotiate with the insurance company, and represent the claimant’s interests in court if necessary.
  3. Mediation or Arbitration: In some cases, mediation or arbitration may be an option to resolve the dispute without going to court.

It’s essential for claimants to be aware of their rights and the terms of their insurance policies. Being proactive, gathering strong evidence, and seeking legal advice can increase the likelihood of a successful resolution to their personal injury claim. Reach out to a local lawyer for help with your claim now.