It is common for insurance companies to reject personal injury claims, and the reasons are varied. While some are valid, the fact remains that these companies do their best to reduce payouts, either by minimizing their liability or by denying claims. After all, claim adjusters have their employers’ interests at heart and not yours. So, if you hope to seek fair compensation for your damages, you must know why personal injury claims get rejected.
Delay in Seeking Medical Treatment
If you’re wondering what can cause a claim to reject, this reason sits on top of the list of most personal injury attorneys. If you delay getting medical attention soon after an accident, the opposing party’s insurance company can argue about the severity of your injuries, indicating that you felt they did not warrant immediate medical attention.
The longer you take to get medical attention, the more difficult it might become to link your injuries to the accident. Besides, an insurance company can also argue that your injuries did not result from the accident in question.
The answer to this problem is to seek medical attention soon after you meet with an accident even if you think your injuries are not severe. While this ensures that you start getting the treatment you require, the medical records serve as evidence.
Waited Too Long to File a Claim
This is not the most common reason why personal injury claims get denied, but it restricts your ability to pursue your case legally. In New York, the statute of limitations to file personal injury lawsuits is three years, which applies to insurance claims as well. After all, no insurance company will entertain your claim if you cannot do anything about it from the legal point of view. There can be exceptions to the statute of limitations for personal injury lawsuits in some scenarios.
The Discovery Rule
According to the discovery rule, the time limit to file a personal injury claim can increase depending on when a claimant discovers an injury or a medical condition. For instance, if a traumatic brain injury comes to light six months after an accident, the statute of limitations comes into effect on the date of the discovery.
Tolling
Tolling involves pausing or delaying the statute of limitations either if a defendant is not present in the state during the given time period or if the claimant is mentally incapacitated or a minor.
Suing the Government
If you plan to sue the government, it’s fair to wonder, “What is a common reason for claim denials with government agencies?” Not surprisingly, ignoring this exception in the statute of limitations is one reason why people have to deal with rejected claims. For starters, you typically need to file a Notice of Claim with the relevant agency before being able to file a lawsuit.
If you wish to sue a New York state government agency, you have 90 days from the injury’s date to file your claim, be it against a city, town, municipality, or village. If the agency does not resolve the matter in the following 30 days or if you find the resolution to be unsatisfactory, you get one year and 90 days to file a lawsuit. Once this period ends, you lose your right to seek legal recourse.
Pre-Existing Injuries/Conditions
Not being upfront about pre-existing injuries or other medical conditions after you suffer injuries in an accident is another common reason why personal injury claims might get rejected. This is because an insurance company may access your medical records and show that you have received treatment for the same injury/condition in the past.
This does not mean you cannot file a claim if an accident results in aggravating an existing injury/condition. What’s important is for you to be honest about it from the time of your initial medical examination.
Inadequate Evidence
The evidence you present serves as the backbone of your case, and while it needs to substantiate your claim, it also needs to be rock solid. Evidence that insurance companies and courts look for typically include:
- Medical records.
- Photos, videos, and CCTV footage.
- Witness statements.
- Expert testimonies.
- Police reports.
- Financial records that demonstrate all damages.
Your Role in the Accident
There are instances when people who suffer injuries in accidents are partially at fault for the accidents. The law refers to this as comparative negligence. For example, if you meet with a car accident and were not wearing a speed belt at the time, it might be possible to assign a percentage of the fault to you. In case an insurance company can pin the blame largely on you, it might be in a position to deny your claim.
Other reasons why personal injury claims get rejected based on your role in the accident include:
- Driving with a valid driver’s license.
- Driving under the influence (DUI).
- Not holding valid insurance.
Problems With Insurance
The amount you may claim from an opposing party’s insurance company depends on the coverage the individual in question holds. Unfortunately, treatment and other related costs for severe injuries might exceed the other party’s maximum insurance coverage. If you wondering, “Why can a claim be rejected or reduced in value on this front?” common reasons include:
- The compensation you seek exceeds the maximum coverage mentioned in the other opposing party’s insurance policy.
- The opposing party has used all or most of the coverage limit.
- The insurance policy does not cover the damages in question.
If you meet with an accident that involves an uninsured/underinsured motorist, you may file a claim with your own insurance company to cover damages up to the limits of your policy.
Tips to Minimize the Possibility of a Rejected Claim
Following a few relatively simple steps can help you minimize the likelihood of an insurance company rejecting your personal injury claim. This is what you need to do.
- Report the accident to the concerned authorities and/or the police.
- Even if you seem fit and able, seek medical attention at the earliest.
- Gather and preserve all the evidence you can find.
- Get contact details of all possible witnesses.
- Don’t give anyone a recorded statement.
- Don’t post about the accident on social media.
- Keep the statute of limitations in mind.
- Contact a personal injury attorney as soon as possible.
What You Can Do if a Personal Injury Claim Is Rejected?
Not all is lost if an insurance company denies your personal injury claim because as long as you don’t exceed the statute of limitations, you still hold the right to file a lawsuit. Depending on the specifics of your case, you may initiate legal proceedings against an at-fault party or an insurance company. Depending on how the case proceeds, it might end up in a settlement or a verdict.
Conclusion
Now that you know why personal injury claims get rejected, make sure you do everything that’s required to strengthen your case and nothing that may jeopardize its outcome. Keep in mind that trying to battle it out on our own might not lead to the desired result because different legalities are usually at play, so it’s best that you use the services of an experienced personal injury attorney. Then, you may focus on getting the medical treatment you need.