Why Do Personal Injury Claims Get Denied?

Why Do Personal Injury Claims Get Denied?

Filing a personal injury claim can feel nerve-wracking. You’re putting in so much effort, hoping for justice, but there’s always that fear it could all be for nothing. What if your claim gets denied after all the time and energy you’ve spent? It’s overwhelming, and the uncertainty can make the process even more stressful.

Our team at SAM LAW OFFICE, LLC has spent years representing personal injury victims and has secured over $1.5 million in settlements – we have learned a lot about what hurts claims. In this post, we’ll dive deep into the common reasons personal injury claims get denied and, more importantly, what you can do to strengthen your case. If you’re worried your claim might face rejection or you’re seeking ways to increase your chances of success, keep reading for actionable insights.

Common Reasons for Claim Denial

Understanding why personal injury claims are often denied helps claimants take proactive measures to avoid these pitfalls. Below are some of the leading causes of denials and how you can address them:

1. Insufficient Evidence

A lack of substantial evidence is one of the most frequent reasons claims are rejected. Insurance companies require clear proof linking the accident to the injury, and without it, they may argue that:

• Your injuries were pre-existing or unrelated to the accident.
• The severity of your injuries doesn’t align with the evidence provided.

To combat this, compile compelling documentation, such as:

• Medical Records: Include doctor’s notes, imaging results, and prescribed treatments.
• Accident Reports: Obtain police reports or incident records that detail what occurred.
• Photographs: Capture images of your injuries, the accident scene, and any property damage.
• Eyewitness Statements: Secure testimonials from those who witnessed the accident.

Detailed evidence strengthens your case and demonstrates the validity of your claim.

2. Missed Deadlines

Claims are subject to strict timelines. If you fail to report the incident or file your claim within the stated timeframe, your case could be invalidated.

Each state has its specific statute of limitations for personal injury claims, so it’s critical to:

• Report the accident to insurance providers immediately.
• File your claim as soon as possible, considering any deadlines in your policy.

Consult an attorney to ensure you don’t miss any crucial submission dates.

3. Policy Exclusions

Insurance policies often include exclusions that outline specific scenarios not covered under your plan. These exclusions, which can be ambiguously worded, might result in a denied claim if:

• The injury occurred outside of the policy’s designated coverage zone.
• The policy doesn’t explicitly cover the type of accident that occurred.

Carefully review your insurance policy and discuss any unclear exclusions with a professional. This ensures you understand what will and won’t be covered before submitting a claim.

4. Disputed Liability

If the insurance company disputes who was at fault for the accident, they may deny your claim. This is common in cases involving:

• Unclear accident details.
• Multiple parties with conflicting accounts of what happened.

To address liability disputes, gather supporting evidence that shows who is responsible. This may include:

• Dashcam footage or surveillance videos.
• Witness statements corroborating your side of the story.
• Reports detailing traffic conditions or other relevant circumstances.

Presenting a clear picture of the accident strengthens your ability to prove liability.

How to Strengthen Your Personal Injury Claim

Knowing the reasons for claim denials is only half the battle. Strengthening your claim with proactive steps can help ensure a successful outcome.

1. Comprehensive Documentation

Proper documentation is your most powerful asset. Beyond the essentials like medical records and accident reports, consider adding:

• Employer Statements for missed work and lost wages.
• Treatment Reports tracking your recovery progress.
• Journals detailing your pain levels, emotional toll, and daily challenges post-accident.

Thorough documentation serves as undeniable proof of your experience and helps refute any attempts by insurers to undervalue or deny your claim.

2. Consistent Communication

Maintaining an open line of communication with claims adjusters is vital. Promptly respond to their inquiries and keep them informed of any updates regarding:

• New medical reports.
• Changes in treatment plans.
• Discovery of additional damages.

This ongoing dialogue demonstrates your commitment and understanding of the claims process.

3. Seek Legal Representation

Navigating a personal injury claim on your own can be challenging, especially if you’re up against large insurance companies. Hiring an injury attorney offers several advantages:

• Guidance: Lawyers understand the legal system inside out and can advise you on the best course of action.
• Negotiation Skills: Attorneys know how to counter low settlement offers and push for fairer compensation.
• Support During Disputes: If your claim involves contested liability or other issues, your lawyer will fight for your rights on your behalf.

Attorneys can also identify legal strategies you may not have considered, ensuring you don’t leave money on the table.

Take Action Today

The stakes of injury claims are high. Understanding the common reasons for denials and implementing strategies to strengthen your claim are essential steps toward success. However, you don’t have to tackle this alone.

If you’re concerned about your claim, contact SAM LAW OFFICE, LLC. With years of experience and a proven track record, our team could help you avoid denial and secure the compensation you deserve. Contact us today and take control of your case.