Top Reasons Insurance Companies Deny Personal Injury Claims

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Know what to do if you have an insurance claim denied. There are steps that you can take to ensure you receive the compensation you deserve.

If you have been injured in a motor vehicle accident, you may be wondering what to do if insurance denies a claim relating to personal injury. If your insurance claim is denied, there are steps that you can take to ensure you receive the compensation you deserve. You must act quickly during the process and provide as much documentation as possible to avoid having your insurance claim denied.

Personal Injury Protection

Personal injury protection (PIP) is a clause in motor vehicle insurance policies meant to cover expenses related to medical bills resulting from an accident. It is not required in all states, and you do not need private health insurance to carry PIP coverage. The coverage is designed to protect you and sometimes the passengers in your vehicle at the time of an accident. It does not cover anyone in the other vehicle(s) involved.

The coverage is mandatory in the states of Florida, Hawaii, Kansas, New York, New Jersey, North Dakota, Massachusetts, Michigan, Minnesota, Pennsylvania, Utah, and Puerto Rico.

PIP coverage also can cover part of lost wages that result from an injury. These costs can add up quickly when combined with the bills of medical care. For this reason, you must respond immediately if you have an insurance claim denied.

PIP policies do have a limit to the dollar amount they will cover, both per person and per accident. If you have this coverage, typically your insurance claim won’t be denied, but it may happen. That is why it is critical to know what to do if insurance denies a claim.

Additionally, PIP must cover claims in no-fault states, regardless of which driver is deemed liable by the insurance companies. It is important to know this, as many individuals wonder how liability affects personal injury claims.

Why an Insurance Claim May Be Denied

Having the correct documentation relating to an accident and resulting injury is the most crucial part of ensuring there is no reason to have an insurance claim denied. First, you should have a police report that documents the accident, with the correct date, time, and location. If there was another party involved, you should have their information and the information about their vehicle.

Second, you must have documentation regarding all medical care you receive for your injuries. Documentation includes reports from the hospital, your primary care physician, an urgent care center, or any other medical provider. The reports must clearly outline your injuries, diagnosis, and recommended course of treatment. The records should also show that you followed your healthcare provider’s recommendations.

Keep all paperwork and receipts from any medical care, including receipts for office visits, medication, or medical equipment such as neck or knee braces that were deemed necessary. Without documentation of cost, you may have your insurance claim denied.

Failure to Seek Prompt Treatment

Most states have stipulations that dictate the amount of time you have to seek medical care following an accident if you wish to have your bills covered by insurance. You must see a doctor as soon as possible following an accident. If you do not do so, you may have a personal injury claim denied. The denial may be based on state law or the assumption that you were not injured as a result of the accident.

What to Do If Insurance Denies a Claim

If you are denied reimbursement, it’s essential to know what to do if insurance denies a claim. If you have a personal injury claim denied based on incomplete or improperly completed paperwork, this can usually be corrected by resubmitting the information following your insurance company’s protocol. However, time is of the essence, and you must do so as soon as possible. Your insurance company may give you an allotted time-frame to resubmit your claim. Make sure you adhere to their policies.

Second, you have a right to request an explanation of denial in writing. Ask the insurance company to include the specific section in your policy that explains why you had your insurance claim denied. Additionally, contact a personal injury lawyer immediately. They will help you throughout the process and handle most communication with your insurance company, fighting aggressively for your rights.

Commonly, insurance companies try to pressure individuals into dropping a claim. Or, they put up so much red tape that it seems impossible to receive compensation as they do not want to pay out. Do not accept this. When considering what to do if insurance denies a claim, it is strongly recommended that you seek legal representation to ensure that this does not happen.

The “Duty to Act in Good Faith”

Federal law states that all insurance companies have the “duty to act in good faith.” What this means is that the company must act in the policy holder’s best interest and must act fairly. When you purchase an insurance policy, you are entering into a contract with that company, and they must uphold their end of the contract.

If you have met the requirements when filing, and have an insurance claim denied despite providing all proper documentation, you have the right to sue the insurance company. To do so, hiring an experienced personal injury lawyer is essential.

For more information, read common liability & personal injury claims FAQs.

Hiring a Personal Injury Attorney

If you are struggling to receive compensation and have your personal injury claim denied, seek the help of an attorney right away. The sooner you contact a legal team, the better off you will fare, especially if you have to file a lawsuit either against the insurance company or the other driver.

An experienced personal injury attorney will advise you on what to do if insurance denies a claim. They will work tirelessly to ensure you receive proper reimbursement and know how to handle the more tedious steps in the process. Most importantly, when you hire an attorney to represent you, the insurance company knows you mean business.

If you are injured as the result of a car accident, seek medical treatment immediately, follow all doctor recommendations, and contact a lawyer for a case evaluation and information on personal injury verdicts and settlements as soon as possible.