When an insurance adjuster denies your car accident claim, it can be tempting to give up and walk away. However, you should remember that having your claim denied doesn’t mean the claim was weak. The main reason why many claims get denied is simply because that’s what insurance companies do—their profit margins depend on it.
Before you accept a low settlement offer or miss a filing deadline because you’re discouraged after a claim denial, make sure you understand why insurance companies deny claims and how you can fight back. Below, we’ll list five common justifications the insurance company may have used to deny your claim and explain why those justifications often fail to hold up when victims contact a lawyer for help and pursue legal action to get compensation.
1. Your Actions Contributed to the Crash
Under Texas law, the 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 proportionately reduce your damages.
For example, suppose another 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 determines you bore 10% of the responsibility for your own injuries. The insurance company can reduce your damages by this amount and pay you $180,000 ($200,0000 x 0.1 = $20,000).
Unfortunately, insurance companies frequently try to take advantage of this law and exaggerate a victim’s level of fault in an attempt to underpay 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
When you have a pre-existing condition, such as a previous back injury or a degenerative joint disease, it can be difficult to pinpoint exactly how the collision worsened the condition. Insurance companies use this uncertainty to 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.
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 accident reconstruction experts. An experienced personal injury attorney can help you secure these experts and put all the pieces together to clearly demonstrate how the wreck impacted 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, which is why they sometimes fail to seek medical treatment right away. In fact, 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. However, insurance companies frequently view delayed medical treatment as evidence of a fraudulent claim.
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For this reason, we encourage all of our clients to seek immediate medical evaluation 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 medical records can sometimes be vague or inaccurate. This can especially 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.
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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
Texas is a fault-based liability state. This means that the law in our state holds negligent drivers and their insurance companies financially responsible for the damages that those drivers cause. However, if the driver who hit you failed to pay his or her insurance premiums on time, the insurance company might argue that the driver’s policy had lapsed and deny your claim.
Because a surprisingly large percentage (an estimated 14% in 2015) of Texas drivers are uninsured, it’s always in your best interests to purchase 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.
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 frequently try to take advantage of his or her 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.
RELATED CLIENT STORY: Crosley Law Firm Achieves $498,960 Verdict in Texas Car Crash Case Against Allstate
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
- Accidentally making statements that are harmful to their claims
- Not requesting compensation for the full extent of their damages, such as payments for attendant care or diminished property value
- Accepting an unreasonably low settlement offer
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.
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 free, no-risk 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.