If your personal injury claim has been denied by the responsible party’s insurance company, you are likely confused and angry. When you are injured due to another’s negligence, you deserve compensation for medical bills, pain and suffering and other issues that arise as the result of your injuries
Reasons Why Your Sacramento Injury Claim Could Be Denied
There are several common explanations for why insurance injury claims are denied, including:
- Policy Exclusion – Some types of injuries are intentionally excluded from insurance policies. These exclusions are usually hidden in the fine print. In some cases, these exclusions could be illegal, so be sure to discuss this type of denial with your attorney. In many cases, denials of coverage are based on a technicality that is very briefly or vaguely described in the policy which your attorney could argue against.
- Expiration or Lapse of Coverage – In some cases, a policy holder may forget to renew coverage, which could fail to automatically renew, leaving him or her uninsured.
- Low Amount of Property Damage – If your vehicle sustained minor property damage, the insurance company will usually take the position that it is impossible for you to have been injured. Many insurance companies consider anything less than $2,000.00 to be “minor.” This is a common reason why an insurance company will refuse to consider your claim for personal injuries.
- Incorrect or Incomplete Claim – If you submitted incorrect or incomplete information, or fail to comply with claim submission requirements, your claim could be denied. Simple mistakes could lead to a complete denial of a claim, so it is in your best interests to have your attorney do a thorough investigation into your claim denial and correct any mistakes that led to your claim dismissal.
- Delay in Treatment – The insurance company could deny a claim because you did not seek immediate treatment or did not make an immediate complaint.
- Limited or No Medical Records – Without submitting your medical records, the insurance company may claim that you did not suffer an injury and deny the claim.
- Preexisting Condition – The insurance company could claim that your injury did not occur on the date of the accident, but should actually be attributed to a preexisting condition.
- Failure to Avoid/Mitigate Your Injury – Your injury claim could be denied based on the insurer’s claim that you failed to avoid the injury or failed to “act reasonably” to avoid making the injury worse.
What Should I Do If My Sacramento Claim Was Denied?
If your personal injury claim was denied, start by thoroughly reviewing the denial with your personal injury attorney. If you thoroughly understand why your claim was denied, you and your attorney can begin working on a counter-argument. If the denial contains a mistake, is unclear or contains false or misleading information, start by writing a letter to the insurance company disputing the insurance injury claim denial. Write a letter that is both detailed and concise.
It is important to remember that the insurance company owes you a duty to act in good faith. However, the insurance company may breach this duty by failing to fully investigate the claim and issue an unwarranted denial of your injury claims. If the insurance company does not provide you with a valid explanation of the denial, speak with your personal injury attorney about the next steps you should take. Throughout this entire process, it is advisable to consult with your personal injury attorney to ensure you take the right steps to properly and fully dispute the denial.