What to Do If Insurance Denies Your Personal Injury Claim

As personal injury lawyers, we spend a lot of our time fighting insurance companies. Insurers devote huge resources to denying and devaluing claims in order to keep their profit margins high.

If you end up falling victim to this strategy while seeking injury-related compensation, we can help you.

Auto Accident Claims

When you get into a car accident, you’ll almost always have to deal with an insurance company to get compensation for your injuries.

Pennsylvania’s choice no-fault system means your own insurer may cover your medical expenses regardless of who was at fault for your collision. However, if your losses exceed the limits of your Personal Injury Protection (PIP) coverage (which commonly happens), you may need to file a claim against the at-fault driver in order to recover the full amount of the compensation you need.

Common Reasons for Claim Denial

• Disputed liability: An insurer may argue that you were responsible for the crash, rather than their policyholder. It might also suggest that some third party (such as a local road authority) should be liable.
• Lack of damages: An insurer might argue that you’re not truly injured, or that injuries you do have are related to pre-existing conditions. This might be the case if you present with back pain after your car accident, but engage in lifestyle activities (such as weightlifting) that could also have contributed to your back pain.
• Lack of documentation: If there’s no photographic evidence or eyewitness testimony from the scene of your accident, your insurance company might dispute your version of events.

Medical Malpractice Claims

In medical malpractice cases, the insurance companies of hospitals and healthcare providers accused of negligence often fight cases on their behalf. These cases can get very technical, as they depend on highly specific arguments around care methods and medical practice.

If you suspect you’ve fallen victim to medical malpractice, you should contact a lawyer for a free initial consultation before you make a complaint to the facility that treated you. This way, your attorney can ensure you don’t make any statements to the hospital that might affect your right to compensation later on.

Common Reasons for Denial

• No proof of negligence: The insurer may argue that the healthcare provider acted within the standard of care. It can be difficult to pin down exactly what the standard of care should be in a given situation, so this argument can arise in many different contexts.
• Pre-existing conditions: The company might claim your injury or condition existed before the alleged malpractice. This is very common in medical negligence cases, as the plaintiffs in these cases are typically sick or injured by the time they come into contact with the healthcare facility. It is often difficult to separate the effects of pre-existing conditions and those of substandard care.
• Lack of input from independent experts: Because medical malpractice claims are so technical, your hospital’s insurer may insist that you undergo independent examination before you receive compensation.

Slip and Fall Claims

Slip and fall cases often involve providers of premises liability insurance. If you’re facing a case like this, the insurance company involved may try to argue that its policyholder’s negligence was not responsible for your accident.

Common Reasons for Denial

• No hazardous condition: In order for a business to owe you compensation after you fall on its property, you must be able to show that there was some hazardous condition on the property that the business did not address or provide adequate warnings about. This might be a puddle without a “wet floor” sign near it, for example. An insurer might try to argue that no such dangerous condition existed at the time of your accident.  
• Comparative negligence: Pennsylvania follows a modified comparative negligence rule, meaning that the value of your claim may be reduced if your own carelessness contributed to your accident. Insurers may claim you were partly at fault for your fall in order to reduce your payout.
• Insufficient evidence: Without photos of the hazard or witness statements, the insurance company might deny your claim because of a lack of evidence.

What to Do If Insurance Denies Your Personal Injury Claim

It’s difficult to find reliable statistics on claim denials, as insurance companies are reluctant to share them. However, investigations by journalists have found that some insurance companies appear to have a policy of rejecting a large percentage of claims at first instance.

There’s a clear lesson here; you shouldn’t be too surprised when an insurance company denies your claim. In fact, you should be preparing for your denial letter before you even submit your claim.

There are a number of proactive steps you can take in this regard.

Review Policy Documents

Before you submit an insurance claim, you should carefully examine your policy to understand its coverage limits, exclusions, and conditions. Pay particular attention to deadlines and any requirements for providing notice or documentation; insurers often use these provisions to deny claims.

Consult With a Lawyer

We generally recommend contacting a personal injury lawyer as soon as you receive a claim denial letter. In fact, it can be a good idea to start working with an attorney before you even submit your claim.

Your lawyer will be able to highlight the precise reasons for your claim denial and indicate whether or not it has a solid basis. If it does not, they’ll suggest a strategy for filing an appeal and pursuing the compensation you need.

At The Cochran Firm in Philadelphia, we offer free consultations. So, it’s worth discussing your case even if you’re unsure about pursuing legal action.

Gather and Submit Additional Evidence

If you receive a denial letter citing insufficient evidence, your lawyer will suggest ways in which you can strengthen your claim with additional documentation. This might include:

• Medical records, including those related to pre-existing injuries; these may make it easier to link your accident and your new symptoms.
• Witness statements from anyone who saw your accident or is familiar with your situation.
• Photographs and video footage from the scene of your accident.

File an Appeal

Most insurers have internal appeal processes. Your attorney will be able to help you complete this promptly and effectively, ensuring you don’t miss anything that could result in payment delays or further denials.

Consider Filing a Lawsuit

If the insurance company’s internal appeal process doesn’t resolve the issue, you may need to file a lawsuit. While it can take time to see a lawsuit like this through to the end, it’s sometimes the only way to secure fair compensation.

In Pennsylvania, the statute of limitations for personal injury claims is two years. So, you need to officially file a lawsuit in advance of this deadline, or you could lose your right to file one at all. If you’ve already been caught up in disputes with your insurer for a number of months, this is worth keeping in mind.

Contact The Cochran Firm in Philadelphia Today

Whether your case involves an auto accident, medical malpractice, a slip and fall, or a workplace injury, don’t give up after an initial denial. By reviewing your policy, gathering evidence, consulting a lawyer, and pursuing appeals or lawsuits if necessary, you can fight for the compensation you deserve.

Contact us today to schedule a free initial consultation about your case. You can reach us via our online contact form or by calling 800-969-4400. Don’t delay; the sooner we start working together, the better your chances of successfully appealing your denial will be.