What to Do If Your Personal Injury Claim Is Denied by Insurance

What to Do If Your Personal Injury Claim Is Denied by Insurance

Personal injury claims are a ray of hope for New York accident victims. A successful personal injury claim can free you from suffocating medical bills, lost wages, and costly vehicle repairs. What should you do if your claim is denied by the insurance company?

A rejected insurance claim can feel shockingly unfair. You might feel like giving up, especially while recovering from serious injuries and psychological pain. Yet, a claim denial does not mean you cannot eventually collect damages for your personal injury claim.

At Hill & Moin, our compassionate lawyers understand the urgency of getting the compensation you deserve as soon as possible. Our experienced legal team can inform you of your options and help dispute unjust insurance company practices. We are ready to protect your rights with the same care as if you were a member of our family.

Obtain your free, no-obligation case review. Our lawyers look forward to exploring personalized solutions to your legal problems. Contact a representative today at (212) 668-6000 to schedule an appointment.

Investigate Why an Insurance Company Denies Claims

Denied claims often blindside accident victims expecting fair compensation for losses. The first question in your mind after a denial is likely: Why? Your next concern might be what to do next.

According to PBS News, claims denials are increasing. Insurance companies deny applications for legitimate reasons, but some rejections “seem arbitrary and absurd.” The following sections discuss why an insurance company might deny your claim.

Insurance claim maximums

Insurance policies dictate the maximum amount an insurer will pay for any claim. If losses exceed these limits, the insurance company may deny a claim or offer a settlement. A personal injury lawyer can help you maximize the compensation for an injury by identifying qualifying expenses.

Missed deadlines

Many states have statutes of limitations that dictate the maximum amount of time you have to file a legal claim. These statutes vary by state, but they are generally just a few years from the date of the accident. You must follow the deadlines to avoid being barred from pursuing your lawsuit in court or appealing a denied claim.

Insurance companies also set strict internal deadlines for filing and submitting documentation. Insurers can deny even valid claims if they are late. At Hill & Moin, our satisfied clients appreciate how our legal team meticulously handles deadlines, ensuring important paperwork is completed on time.

Disputed liability

The importance of accountability varies according to the type of insurance coverage. The insurance company should provide coverage for a no-fault insurance policy if you pay premiums. So a no-fault insurer should never deny a claim based on who caused the accident.

You qualify to file a no-fault claim if you bought personal injury protection (PIP) or another policy with no-fault benefits. For other types of coverage, policy exclusions can bar you from collecting damages. Often, the difference between being paid or rejected depends on who is liable and what percentage of fault he or she carries.

Insurers might reject cases if they suspect the policyholder shares more than a certain percentage of fault. Some disputes are resolved when a personal injury attorney presents evidence and documentation to identify the other party as liable. In other cases, negotiations result in better settlements even if the client is partially at fault.

Pre-existing medical conditions

An insurance adjuster sometimes scrutinizes medical history, looking for pre-existing conditions. He or she may allege that some previous accident, injury, or healthcare condition caused your current situation. You should consider enlisting the help of a personal injury attorney to ensure your accident-related medical treatment is covered as it should be.

Insufficient evidence

An insurer can deny your claim if you don’t provide enough evidence. Contacting a personal injury lawyer before you file is a good way to avoid problems before they start.

Even after a denial, a lawyer can help you build a strong appeal by collecting additional documentation, such as:

• Photographs
• Videos
• Witness statements
• Forensic analysis
• Testimony from accident reconstructionists, doctors, and other professionals

You can bolster your chances of approval by sharing relevant documentation with your personal injury lawyer and clearly communicating the extent of your losses.

Inconsistent statements

Discrepancies in your statements or between your claim and other evidence are common grounds for claims denial. Conflicting information can raise red flags regarding the credibility of your claim. Minor errors, like missing forms and miscalculations, could cause significant problems.

Taking the time to carefully review all documentation and ensure accuracy can significantly enhance your chances of a successful claim. It is best to leave communication with insurers up to your experienced legal team to avoid unintentional mistakes. Yet, sometimes even a perfectly submitted claim might be rejected unexpectedly.

Impersonal computer algorithms

Some insurance companies use computers to process claims and appeals, sometimes leading to automated denials. While these systems aim to streamline the process, algorithms may not consider the nuances of individual cases. Lawyers who understand insurance technology can build specific language into your claim and avoid terms that could trigger a negative outcome.

Inexperienced claims adjusters

Claims adjusters play a pivotal role in determining the outcome of a claim. Inexperienced or untrained insurance adjusters may lack the skills necessary to evaluate complex cases. If you suspect your claim has been mishandled, seeking a second opinion or escalating the matter may be necessary to ensure fair treatment.

Denying claims can keep profits high for insurers. However, a rejected claim does not have to end your journey to a fair settlement. An experienced personal injury lawyer can review your denial letter and help you take legal action to fight for your due compensation.

Respond Appropriately After a Coverage Denial

Insurance claims can be tedious, with confusing terms and conditions along with a mountain of paperwork to submit. When insurance companies deny claims, accident victims can find the appeals process even more complex. Thankfully, you don’t have to handle insurance claim denials alone.

Consult a personal injury lawyer for effective guidance

Sometimes, insurance companies wrongfully deny claims. But how would the average person know whether or not their injury claim is valid? The lawyers of Hill & Moin invite you to schedule a free consultation.

During your appointment, you can ask the members of our New York law firm questions about your denied personal injury claim. After you learn what options are available, you can decide whether you would like the help of insurance law professionals to mount an appeal.

Competent personal injury lawyers offer valuable services, including:

• Contacting the workers’ comp board for work-related injury cases
• Explaining the written explanation of your denial provided by the insurance company
• Gathering evidence to support your appeal (e.g., medical records, detailed information about your treatment and recovery, indications of bad faith insurance practices)
• Researching similar cases to establish precedents of compensation and punitive damages
• Reviewing the fine print of your insurance policy for untapped benefits
• Writing a dispute letter to the insurer clearly stating the source of the problem and the requested solution

If lawyers discover that the insurance company made an error or acted unethically, they can take legal steps like those described below.

Combat bad faith insurance practices

Bad faith is when an insurance company fails to fulfill its obligations to policyholders.

Examples of cause for a bad faith claim could include:

• Denying claims without a proper investigation
• Refusing to pay claims without justification
• Failing to explain the reasons behind a denial
• Intentionally delaying approved payments

Recognizing bad faith can help protect your rights. Look for patterns of unjustified delays or repeated requests for unnecessary information. Not providing clear reasons for denying a claim could indicate bad faith on the part of the insurer.

If you suspect bad faith practices, take action to address the situation – document all communications with your insurance company, including dates and details of conversations. Your legal representative can help you file a complaint with your state’s insurance department if the insurance company is in violation of insurance laws.

A personal injury lawyer can support victims of bad-faith insurance practices. He or she can help gather evidence, negotiate with insurers, and pursue necessary legal action. Seeking compensation for bad faith practices can hold insurers accountable and ensure you receive the benefits you deserve.

Weigh your options

When an insurer denies a claim, you have options. Each choice takes a different approach to resolving the issue.

Which method is suitable for you depends on your unique circumstances, but here are some alternatives to consider:

• Mediation: A neutral third party helps both sides reach an agreement without going to court
• Arbitration: A more formal process where an arbitrator makes a binding decision after hearing both sides
• Internal appeal: The victim requests the insurance company to conduct a review of the denial, providing additional evidence or information as needed
• External review: An independent third-party organization reviews the case and makes a binding decision on whether the claim should be paid
• Lawsuits: Often as a last resort, the victim sues the insurer for breach of contract

Exploring these options can empower victims to fight back against a claim denial. Your lawyer can help you find the strategy that is in your best interest. Whatever you decide, there are actions you can take that can contribute to a favorable resolution.

Build a Personalized Strategy With Experienced Help

Many accident victims find it impossible to pay for the medical bills associated with a hospital stay or extensive rehabilitation without insurance coverage. The entire process of filing a claim seems exhausting, but the prospect of a settlement offer gives them hope. However, their faith in their policy is destroyed when the insurance company denies their claim.

Assuming that an insurance company will act in good faith is a common mistake. Personal injury lawyers know all too well their tactics to deny coverage and save on compensation. If you give up when an insurance company refuses to pay, it could mean a lot of profit they can keep for themselves.

Our New York law firm is ready to protect your legal rights if an insurer fails its duty. Sometimes a simple review of your insurance company and stern negotiations with insurance companies can produce great results. In other cases, a lawsuit is the best tool to motivate the insurance company to pay what it owes.

Winning a lawsuit does not occur by chance. An experienced personal injury lawyer must know current laws and use intelligent strategies to get the most from an insurance policy. However, solutions are not universally effective. What works for one injury claim might not work for another case. 

At Hill & Moin, our Personal Injury Recovery SolutionsⓇ can help you discover why your claim was denied and what you can do about it. Call us at (212) 668-6000 to schedule your no-obligation consultation today.

Don’t wonder about your rights!