- 1. 1. Your Actions Contributed to the Crash
- 2. 2. You Have Pre-Existing Medical Conditions
- 3. 3. You Delayed Getting Medical Treatment or Your Medical Records Are Inaccurate
- 4. 4. The Other Driver’s Insurance Policy Had Lapsed or Has Insufficient Coverage
- 5. 5. You Don’t Have a Personal Injury Lawyer
- 6. What to Do If Your Insurance Claim Is Denied
- 7. Do You Need Help with a Car Accident Claim? Contact Crosley Law
When an insurance adjuster denies your car insurance claim, it can be tempting to give up and walk away. However, you should remember that having your claim denied doesn’t necessarily mean the claim is weak. The main reason many claims get denied is simply because that’s what insurance companies do—their profit margins depend on it. They do not have your best interests at heart, and may be acting in bad faith.
Before you accept a low settlement offer or miss a filing deadline because you’re discouraged after an insurance claim denial, make sure you understand why insurers deny claims and how you can fight back.
Below, we’ll list five common reasons the insurance company may have used to deny your claim and explain why those justifications often do not hold up when victims contact a lawyer for help and pursue legal action to get compensation.
“The main reason many claims get denied is simply because that’s what insurance companies do—their profit margins depend on it. They do not have your best interests at heart, and may be acting in bad faith.”
1. Your Actions Contributed to the Crash
Under Texas’ comparative fault rules, the auto insurance company does not have to cover your damages if you were more than 50% at fault for the collision. If you contributed to the accident, but your conduct wasn’t its primary cause, the insurance company can reduce your damages proportionally.
For example, suppose the primarily at-fault driver crashed into your vehicle and you suffered injuries that created $200,000 in medical bills and lost income. However, let’s say your actions partially caused the crash and a court decides you were 10% at fault for the wreck. The insurance company can reduce your payout by this amount and only pay you $180,000 ($200,0000 x 0.1 = $20,000).
Unfortunately, insurance companies often try to take advantage of this law and exaggerate a victim’s level of fault, hoping they can undervalue their auto insurance claims.
If the insurance company offers you an unreasonable, low-ball offer, it’s always in your best interest to consult an experienced personal injury lawyer. A lawyer can help you understand your claim’s actual value and use their training and experience to estimate your percentage of fault.
2. You Have Pre-Existing Medical Conditions
If you have a pre-existing condition, such as an old back injury or degenerative joint disease, it can be difficult to pinpoint exactly how the collision worsened the condition. Insurance companies take advantage of this uncertainty and dispute many legitimate claims.
However, Texas (and all other states) apply a rule called the “eggshell skull doctrine” for personal injury claims. This rule states that even if you had a pre-existing condition that made you more vulnerable to injuries, it doesn’t make a negligent person any less responsible if they injure you. Your injuries must be considered as they are, without regard to how a similar incident might have affected a “typical” individual.
Still, documenting your health before and after the crash and explaining how the collision made any pre-existing conditions worse won’t be simple. Usually, it will require testimony from doctors and car accident reconstruction experts. An experienced personal injury attorney can help you secure these experts and put all the pieces together to clearly show how the wreck affected your health.
“Insurance claims adjusters aren’t your friends or advocates. They are agents of the insurance company, and they have a vested interest in denying your claim or getting you to accept a low settlement offer.”
3. You Delayed Getting Medical Treatment or Your Medical Records Are Inaccurate
Accident victims don’t always immediately realize the extent of their injuries. Some serious conditions, like herniated discs and traumatic brain injuries, don’t present their full range of symptoms until days or weeks after the initial trauma. This can lead to delays in medical treatment.
Unfortunately, insurance companies might view delayed medical treatment as evidence of a fraudulent claim. They may try to argue that your injuries occurred after the time of the accident and are unrelated to the incident.
RELATED ARTICLE: Do You Have Any of These Delayed Symptoms After a Car Wreck?
For this reason, we encourage all our clients to seek immediate medical attention and treatment after a crash, even if they believe they only experienced bumps and bruises. When you see your doctors, they should document the extent of your injuries, how those injures are connected to the crash, and how they progress over time. This can establish a timeline and show exactly how the crash affected your health.
However, even if you seek care right away, medical records can sometimes be vague or inaccurate. This can be a problem if your doctors simply checked boxes on an electronic medical chart rather than writing detailed notes about your visit. In these circumstances, the insurance company might argue that your symptoms had improved when they really didn’t or even accuse you of lying about the extent of your injuries or disabilities.
RELATED ARTICLE: Even with Normal Brain Scans, You Can Sue Someone for your TBI
If your medical records aren’t accurate, you need help from an experienced lawyer. Sometimes, a careful examination of your full medical records, including diagnostic tests, can help clear up any errors or omissions and firmly establish the connection between your injuries and a collision.
4. The Other Driver’s Insurance Policy Had Lapsed or Has Insufficient Coverage
Texas is a fault-based liability state. This means that state law holds negligent drivers and their insurance companies financially responsible for the damages that those drivers cause. However, if the driver who hit you did not pay their insurance premiums on time, the insurance company might argue that the driver’s policy had lapsed and deny your claim.
Even if the other driver is insured, the policy coverage limits may not be enough to cover your expenses. In Texas, a driver is only obligated to carry liability coverage of $30,000 per injured individual (up to $60,000 per accident). If you suffer catastrophic injuries, or multiple passengers are hurt, you may quickly exceed these limits.
Because a surprisingly large percentage (an estimated 8.3% as of 2019) of Texas drivers are uninsured, and even more lack sufficient insurance coverage, it’s always in your best interest to buy uninsured and underinsured motorist (UM/UIM) coverage as part of your auto insurance policy. UM/UIM coverage steps in when a negligent driver lacks insurance or has insufficient liability policy limits to cover your injuries. Unfortunately, if the other driver was uninsured or underinsured and you opted against UM/UIM coverage, you may have few options for compensation, even if your case is strong.
Remember, though, that adjusters at your own insurance company may deny your claim or try to minimize your settlement for many of the same reasons as the at-fault driver’s insurance company. This is exactly what happened to Wes, a Crosley Law client who still needed help with medical bills after the other driver’s coverage limit was reached. When a fair settlement couldn’t be achieved, we took his insurance carrier to court and secured a generous jury verdict in his favor.
5. You Don’t Have a Personal Injury Lawyer
Insurance claims adjusters aren’t your friends or advocates. They are agents of the insurance company, and they have a vested interest in denying your claim or getting you to accept a low settlement offer.
When adjusters know an accident victim has no legal representation, they often try to take advantage of their inexperience and lack of knowledge. Statistically, a sizable percentage of unrepresented accident victims will simply accept a claim denial, give up, and save the insurance company a lot of money. Insurance companies know this, and that’s why they often deny claims as a first resort—because it frequently works.
Other times, unrepresented crash victims make serious mistakes when trying to handle their claims, such as:
- Failing to file a lawsuit before the statute of limitations expires. Under Texas state law, you have two years from the date of the accident to file a lawsuit. However, the insurance company may also set an earlier deadline to file a claim.
- Accidentally making statements that are harmful to their claims. Again, insurance adjusters are not your friends. They may try to get you to admit fault or make statements on the record which would allow them to justify denying your claim.
- Not requesting compensation for the full extent of their damage. In the first few days after a crash, it can be especially tough to estimate your long-term financial needs, including ongoing medical expenses, lost ability to earn wages, payments for attendant care, diminished property value, etc.
- Accepting an unreasonably low settlement offer. Once you accept a settlement, you permanently lose your right to sue for further compensation. If the settlement can’t cover your needs, you will be out of luck. Compounding the problem, it can often be extremely difficult to project what your long-term care needs will be, so underestimating your future loses can have devastating consequences. Initial settlement offers, especially those offered soon after the time of the accident, should almost never be accepted.
These last two points were critical for Andrew, another client. After suffering a significant back injury as the result of an accident, Andrew learned he would likely need revision surgeries down the road due to his young age. The team at Crosley Law consulted with the experts to calculate his future needs, and were able to negotiate a settlement more than four times higher than the initial offer.
CLIENT STORY: Crosley Law More than Quadruples a Settlement Offer
What to Do If Your Insurance Claim Is Denied
Receiving a car insurance claim denial can be extremely frustrating, and even demoralizing. But don’t quit! If you believe that your claim was wrongly denied, you should absolutely fight it.
When in doubt, it’s always best to consult an experienced personal injury lawyer. A lawyer can educate you about your legal rights and assess the value of your claims, and they should be able to do it during a free initial consultation that won’t cost you anything.
And, unlike an insurance adjuster, your injury lawyer is on your side. If you hire the right attorney, you can expect him or her to give you honest and practical legal advice and to fight for fair compensation for you and your family.
Your attorney can help you gather and organize the essential evidence you’ll need to make your case. They can subpoena records, negotiate on your behalf, and (if necessary) fight for your interests at trial. This can not only greatly increase your chances at obtaining a fair settlement or result at trial, but also gives you peace of mind and allows you to focus on your healing and recovery.
Do You Need Help with a Car Accident Claim? Contact Crosley Law
If you or a loved one suffered injuries during a car wreck, truck crash, or other serious accident, contact Crosley Law for a no-risk free consultation. Our experienced injury lawyers help victims navigate the complicated insurance claim process. We fight tirelessly for our clients, and we won’t back down when the facts and the law are on our side.
Facts + statistics: Uninsured drivers. (n.d.). Insurance Information Institute. Retrieved from https://www.iii.org/fact-statistic/facts-statistics-uninsured-motorists
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.
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