What to Do When Your Insurance Company Refuses to Pay Fair Compensation After an Injury

Unfortunately, claim denial happens far too often. Insurance companies are in the business of making money; personal injury and property damage claims after accidents hurt their bottom line, so they will do as much as they can to deny them.

When you deserve fair compensation, but the insurance company denies it, they’re acting in bad faith. The good news is that you can fight back to get the compensation you deserve.

Why Would Your Insurance Company Deny Your Personal Injury Claim?

Insurance is supposed to pay fair compensation for claims arising from covered causes. When they don’t, the reason is typically to save money. However, there are other reasons, beyond an insurance company acting in bad faith, that would result in a claim denial:

1. The Accident Isn’t Covered

Most insurance policies will have types of accidents they don’t cover in their policy documentation. If yours falls into one of these categories, your insurance provider can deny your claim.

2. Delays in Filing

If you wait too long to file your claim, your claim may be denied. Notice requirements, contractual deadline requirements, and statute of limitations laws protect insurance companies by placing time limits on these cases. In addition, delaying your claim can cause a loss of important evidence relating to your claim and injuries or losses. This is why it’s so critical to submit a claim as soon as possible.

3. The Policy Doesn’t Cover the Responsible Party

If the person or entity that caused the accident isn’t covered under a policy, the claim may be denied. An example of this might be if you are injured in a store due to another customer’s actions, not the negligence of the store personnel. The store’s insurance company may attempt  to deny your claim since the policy owner didn’t cause the accident, but that may not be the whole story. 

4. You Were At Fault

If you were at fault, or allegedly at fault for your accident, the insurance company may try to deny your whole claim. However, your claim could still be valid based on comparative negligence principles.

5. You Have a Pre-Existing Condition

If you have a pre-existing condition that flared after your accident, the insurance policy may refuse to pay even though the law allows compensation for aggravation of preexisting conditions.

6. You Delayed Treatment

If you wait weeks or months after the accident before seeking medical care, the insurance company may claim the injuries aren’t covered as a result. This is true, even though many people wait to be treated, thinking their injury will get better, but it doesn’t.

7. The Policy Limits Are Exhausted

If the policy has claim limits that have already been reached, they could also deny your claim. But there may be more than one applicable policy or excess or umbrella coverage.

So Your Claim Has Been Denied — What’s Next?

If you get notice that your personal injury claim is denied, don’t think that your case is over. There are steps you can take to ensure you get fair compensation. Here’s what you need to do:

1. Read Your Policy

If it’s your policy, read it carefully. If it’s another party’s policy, ask for documentation. Make sure that the injury is actually a covered type of claim. If so, there may be a filing error or another issue that caused the denial.

2. Keep Careful Records

Keep detailed records of everything related to your claim. For personal injury claims, this would include your doctor’s visits, bills, and out-of-pocket expenses. For property damage insurance claims, receipts and information about the damaged items, including video records of your home and belongings, can help. Records should also include documentation related to your claims.

3. Constantly Follow Up

Be persistent with your follow-up. Talk to the insurance company regularly to confirm the status of the claim. Make follow-up contact in writing, at least digitally, so there is a record. Sometimes the proverbial squeaky wheel gets the grease, so the more you stay on top of your follow-up, the better.

4. Get Legal Help

If a fair claim was denied and should be covered, we recommend taking legal action. The first step is to file a complaint with the state’s insurance regulator. For high-value claims or claims that the state insurance regulator won’t take, you’ll want to get legal help from an experienced personal injury attorney as soon as possible.

Submitting a Claim: What You Shouldn’t Say to an Insurance Agent

• I’m sorry/It’s my fault: Many people are too quick to apologize or admit something even though they were not really at fault or completely and solely at fault. 
• I’m fine: Many people say this too early on believing they will be fine, or before they have seen a doctor or undergone tests. 
• I think…: Your opinion doesn’t matter in these claims. Stick to the facts.
• Your friends and family: The insurance agency may ask for their contact information so they can ask about your injuries. You shouldn’t give this information to them.
• Excessive details: Only answer the specific questions asked, and as succinctly as possible. 
• You may record me: Just say no—you are not obligated to say yes. Note: The insurance company may record you anyway, so be careful!
• Description of injuries: Don’t self-diagnose your injuries or try to downplay them. Refer them to your doctor or attorney if they ask for these details.

Remember, insurance agents are trained professionals who know how to get you to say things that put your claim in jeopardy. They will make you feel comfortable and safe when you talk to them, but avoid these mistakes.

Can You Sue the Insurance Company?

If the company has acted in bad faith, yes. If your insurance company denies your injury claim, but the policy indicates it should be covered, you may be able to sue them for bad faith. To win a bad faith claim, you must be able to prove the following:

• The insurance company acted unreasonably or dishonestly
• The claim was a covered claim type
• You filed the claim on time
• The claim warrants fair compensation

Proving these factors requires the right legal knowledge and documentation, which is why we recommend working with a skilled attorney who understands insurance regulations and personal injury law. Working with an attorney also means you will have a professional to help you gather the right documentation to prove the extent of your injuries and the reality of bad faith.

Have You Had a Claim Denied? Talk to Our Personal Injury Attorneys Today

If you’ve had a claim denied, contact Giroux Pappas Trial Attorneys. Our large number of successful personal injury cases has earned us national recognition for our legal services. We’re known for providing aggressive and compassionate legal representation to individuals and families throughout Michigan.

You deserve fair compensation. Schedule a free case evaluation today to see how we can help you.