The Most Common Reasons Insurers Deny Injury Claims—And What You Can Do About It

Insurance offers financial protection in the case of an accident. However, receiving a claim denial from an insurance provider can leave you feeling helpless and facing the prospect of covering your medical expenses and other damages out-of-pocket.

If an insurer denies you coverage, you may have additional options for obtaining compensation. Hiring an experienced personal injury attorney maximizes your chances of receiving the settlement you need and deserve.

Injuries Not Covered by the Policy

Insurance companies often deny injury claims because it is in their financial interest to pay the least amount possible. As a result, insurers may argue that the policy does not cover your injuries. However, there are a couple of different ways to challenge this denial.

Review the policy’s language to see if it explicitly excludes your injuries from coverage. The insurance company may have to provide coverage if the policy does not expressly exclude your injuries. For example, they may say they won’t cover damage to your teeth or jaw, but most PIP insurance policies must cover dental services for injuries.

Even if the policy excludes your injuries from coverage, the insurance provider may still be liable if you can show that the exclusion is unreasonable or unfair. A skilled attorney can help evaluate the policy and determine whether the insurance company has properly denied the claim.

You Didn’t Receive a Medical Evaluation

One common reason for an injury claim denial is the lack of a medical evaluation. Insurance companies require evidence of injury to pay a settlement, including a documented medical assessment, treatment plan, diagnostic tests, and follow-up care. 

Without medical evidence, it can be challenging to prove that an injury occurred and was caused by the accident. If you were involved in an accident and did not undergo a medical evaluation, schedule an exam as soon as possible. If you work with a personal injury attorney, they can help you obtain the medical evidence you need to support your claim.

The Claim Exceeds Your Maximum Coverage

It can be frustrating to learn that your claim exceeds your maximum coverage, especially if you’re still dealing with medical bills and other expenses related to an injury.

A few options are available to you if your injury claim is denied. You can appeal the decision with your insurance company or try to negotiate a higher settlement amount. A personal injury attorney can negotiate settlement terms on your behalf and protect your rights as an accident victim.

If you cannot reach an agreement with your insurance company, your lawyer can discuss filing a lawsuit to recover damages beyond the policy limits.

No matter what course of action you decide, it’s important to remember that you have rights as an injury victim. Don’t let the insurance company take advantage of you; make sure you understand your options and take action to get the compensation you deserve.

There’s a Liability Dispute

A liability dispute is one of the most common reasons for injury claim denial. In other words, the insurance company doesn’t believe that you were injured in the way that you say you were, or they don’t believe that you were injured at all. In addition, the insurer may also argue that you are the at-fault party in the incident that caused your injury.

If this happens, it’s essential to stay calm and professional. The first step is requesting a copy of the insurance company’s denial letter so you can review their reasoning. If you disagree with their decision, you can appeal the denial by providing additional documentation or evidence. Finally, consult with a personal injury attorney with experience in insurance claims to find out if you have a case.

Your Claim Was Filed Too Late

There are strict deadlines for filing injury claims, and if you miss the deadline, the insurance company will likely deny your claim. In some cases, you may be able to appeal the denial, but you must act quickly. The sooner you file your appeal, the better your chances of success.

Injury victims must abide by the following filing deadlines in New York:

An Experienced Personal Injury Attorney Can Help with a Claim Denial

If you need help with your injury claim, a skilled Syracuse personal injury lawyer at Catalano Law can answer any questions you may have and guide you through the process.

We can ensure that all claims and paperwork are filed on time and aggressively pursue a fair settlement so you receive the compensation you are owed. If the insurance company refuses to pay, we can take your claim to court and help you pursue damages in a civil case.

Contact us today for a free and confidential consultation concerning your injury claim denial so we can help you find an alternative path to compensation.

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