Common Reasons for Personal Injury Claim Denials

Injury claim denials are often a shock to the system. The programs and policies supposed to protect us after an injury fail to deliver the expected support. When providers, employers, or liable parties deny claims, they leave people in the lurch. 

A personal injury claim denial is not, however, the end of your claim. Typically, it’s a bump on the road that an expert personal injury lawyer will help you overcome. 

Injury victims quickly realize liable parties and insurance companies frequently try to limit their legal exposure (deny or minimize the claim), regardless of injury severity or negligence. It’s unfortunate when victims and their loved ones are stuck covering medical costs, lost income, and other related expenses. 

Reasons for claim denials vary by case, but there are common causes for denials that can be avoided with the help of an expert legal team. 

Your actions after an injury or accident will profoundly impact your claim and, if necessary, your legal case against liable parties. Knowing what to say and do protects you from delays in compensation and essential medical care. 

Here are some main reasons for injury claim denials and what you and your personal injury lawyer can do to avoid or overcome them. 

5 Reasons Your Claim Is Denied

Claim denials can feel like they come out of nowhere, but insurance companies and businesses build language into policies designed to protect them. 

In many cases, accident victims with a reasonable expectation of financial reimbursement encounter problems when they realize their situation is tied to some eventuality that allows the liable party to deny responsibility for damages or compensation. 

Delay in Medical Treatment

Insurers sometimes claim injury victims delayed seeking medical care to undermine disability claims or that an injury is as severe as they say. Expert personal injury lawyers frequently tell accident victims to seek medical care as soon as possible after an injury. Visits to the hospital, physical therapist, counselor, etc. create an evidence paper trail that tilts things in the victims’ favor. Many times people who are hurt do not realize that they are hurt badly enough to need medical care, and often the injury takes days or weeks to completely manifest itself. This is particularly true of herniated or bulging disks in the spine.  They may not immediately cause pain but will within days.

Lack of Proof

At-fault parties will often claim the injury has nothing to do with their negligence. For example, they’ll say there is no evidence their mistakes led to someone’s injury or wrongful death. A trucking company can say their drivers were under their maximum allotted hours at the time of the accident when, in fact, they were working much longer than they should have been. A strong case against liable parties is essential to any successful personal injury claim.  Skilled personal injury trial lawyers know how to investigate and prepare cases so that the best case can be made to an insurance company or a jury.

Incorrect Information

Unfortunately, many claims are denied because of formalities like misspelled words, missing records, and other incomplete information. Victims receive form letters saying their case was denied and feel like there is no recourse. The legal system and insurance companies have strict claims and case information requirements. Working with an experienced personal injury lawyer offers better quality control. 

Failure to Mitigate Risk

Insurance companies, businesses, and other liable parties may claim the victim failed to avoid injuries and thus bears responsibility for the accident. For instance, a construction company may claim that a construction accident victim was working outside their scope of work or failed to see an obvious safety issue. Combatting these types of denials typically requires high-quality legal support to examine the conditions at the scene and gather other evidence. 

Policy Exclusions

People rarely read the fine print inside their insurance policies. Unfortunately, insurance agents or human resources departments sometimes fail to give enough coverage details, so people assume they’re good after an accident. Ambiguous language is a tool used to deny claims after workplace, vehicle, and vacation accidents.  Insurance policies are, in reality, a series of exclusions from insurance coverage strung together.  A highly skilled personal injury lawyer can review the insurance policy to determine the best way to approach the case and determine whether there really is an exclusion from coverage.

What Happens When Personal Injury Claims Are Denied?

Insurance companies hold a position of strength. They have resources and systems that make them seem like their words and actions carry weight. The insurance industry is the wealthiest industry known to mankind.  They have vast assets and stores of cash and investments.  They make their money on their investment portfolio which is funded from insurance premiums.  By not paying claims, they make profits.  Every dollar they shave off a claim is a dollar in their pocket.

For example, after a boating accident, the boat owner’s insurance company may try to contact the victims. They’ll say you must speak to them, and they need to take a recorded statement. Many people agree, which exposes them to legal repercussions.  Rule: Never give a statement to an insurance company or opposing party, investigator or lawyer without speaking with your lawyer first.  Even if you think you were 100% in the right, this will come back to hurt you.

Situations like these underscore the significance of knowing what to do after an accident that injures you. In addition, who you meet with and what you say impact the outcome of your claim and can influence your case if it goes to court. 

Claim denials cause enormous stress, especially for innocent victims of car accidents, cruise ship slip and fall injuries, and other similar incidents. Some common effects include things like:

• Inability to work
• Disability
• Wrongful Death
• Pain & Suffering
• Trauma
• Medical Bills

The more severe the injuries, the higher the cost of adjusting to life after an accident. 

What Should You Do After a Personal Injury Claim Is Denied? 

First, you should speak with an experienced personal injury lawyer dealing with your type of accident. 

Ideally, you’ll hire a lawyer immediately after the incident to help manage your claim to avoid denial and ensure you receive appropriate compensation. A lawyer can help:

• Manage correspondence
• Document communications
• Find and compile evidence
• Investigate the case and develop facts, evidence and testimony
• Prepare you on what to do and say
• Help avoid unnecessary risks to your claim
• Recommend medical and other resources
• Handle settlement negotiations
• Reach a faster resolution

Accident personal injury claims are usually complex. A lot is at stake. At-fault parties wish to limit their financial and legal exposure, and victims rightfully want maximum compensation for injuries that weren’t their fault. 

Hiring a top personal injury lawyer protects your claim and prevents those liable from taking advantage of the situation. 

Legal Expertise Matters in Personal Injury Claim Denials

Leighton Law is a leading Florida personal injury team that helps victims fight for justice after injuries or wrongful death. 

Their lawyers hold insurance companies, large businesses, and other liable people accountable for negligence, poor security, improper maintenance, and malpractice. Frequently, they help clients overcome claim denials to get the compensation they deserve. 

For example, Leighton Law led the way to help businesses recover losses when insurance companies denied their claims related to COVID-19 business interruptions. 

More often, Leighton Law works to determine the extent of insurance coverage and prove their client’s case prior to and in court.  Most cases are settled prior to trial, but each case is prepared as if it will be tried.

Imagine if people simply accepted claim denials. Most cases would end and injured victims would never received the compensation and financial reimbursement for their losses.

Find Lawyers with Proven Success

The best legal teams have a proven track record of winning large settlements and judgments for their clients. In many instances, the negligence associated with an accident and the related costs exceeds insurance coverage limits. 

Lawyers aggressively pursue personal injury claims to seek appropriate damages when this happens. Here are some examples of how Leighton Law provides support for accident victims. 

Here’s a look at some personal injury settlements and judgments John Leighton, Max Panoff and his team recently won for clients.

Court Verdict – $1,007,000 – Leighton law represented a woman injured at her local Costco. As she attempted to move some toilet paper from the shelf, the entire carton fell on her, knocking her down and fracturing her leg. The injury required surgery and several months of recovery. Costco initially denied responsibility, and the case went to trial. 

Settlement – $250,000 – John Leighton negotiated a payment for a child victim who suffered a broken arm at daycare. After reviewing the surveillance footage, John proved supervision failed to prevent the accident, directly leading to the fall. 

Court verdict – $7,400,000 – John Leighton won a $7.4 million verdict for a man who was on his way to work one morning when a trucker traveling in fog slammed into him and seriously injured his leg.

Settlement – $4,750,000 – Leighton Law obtained a settlement for the family of a woman who was the victim of a medication error when she went to a hospital emergency room with an asthma attack.  She left two young children, who are now being taken care of financially.

Court verdict – $1,510,000 – When a man chased after a man who mugged and elderly woman’s purse – and was shot by the robber – John Leighton went to trial and obtained a $1.510 million verdict based on negligent security of the premises.

Settlement – $5,000,000 – John Leighton and his legal team litigated a case for a teenage victim who suffered severe orthopedic injuries in a truck collision. 

Settlement – $450,000 – Leighton Law helped a man reach a sizeable settlement after an electrical injury in a construction project. He was shocked working on a home construction project when the power was on, resulting in significant neurologic injuries. 

Court verdict – $668,000 – When John Leighton’s client was burned by a mistake by a theme park restaurant in spilling very hot coffee in his lap, he went to trial against Disney and won a $668,000 verdict.

Discussing Your Claim with an Expert Personal Injury Lawyer

Leighton Law is here to help you decide how to best pursue your claim after a severe accident or injury. Take action now to start reaching a settlement or taking your case to court. 

Our team offers free consultations to help clients win the compensation they deserve. In addition, we’ll provide the support you need in the face of significant injuries, lost time from work, and other costs related to your accident. We treat each client as an individual, not a number.