Insurance companies are in the business of minimizing their payouts. While their advertisements portray them as your ally in tough times, the reality is often quite different. Many injury victims find themselves frustrated and confused when their claims are denied, even when the circumstances seem straightforward. At McGilberry & Shirer, we’ve seen firsthand how insurance companies operate, and we’re here to help you understand why claims are often denied and what you can do about it.
1. Common Reasons Insurance Companies Deny Personal Injury Claims
Lack of Evidence Supporting the Claim
One of the most frequent reasons for a denial is insufficient evidence. Insurance adjusters require clear documentation to validate your claim, including accident reports, medical records, witness statements, and photos. If this evidence is incomplete or inconsistent, your claim may be rejected.
Disputed Liability
Insurance companies often argue over who is at fault. If they believe you were partially or fully responsible for the accident, they may deny the claim or reduce the settlement amount under Texas’s comparative negligence law, which bars recovery if you are more than 50% at fault.
Delayed Reporting
Failing to report the accident promptly can give insurers a reason to deny your claim. Delays in notifying the insurer or seeking medical treatment can make them question the legitimacy or severity of your injuries.
Pre-Existing Conditions
Insurance companies may argue that your injuries existed before the accident and are not related to the incident in question. While pre-existing conditions don’t bar recovery, proving the accident worsened your condition requires solid medical evidence.
Policy Exclusions
Sometimes, the insurance policy may have exclusions for certain types of accidents or injuries. For example, some policies may not cover incidents involving certain activities, high-risk behaviors, or commercial vehicles.
Lowball Settlement Offers Disguised as Denials
In some cases, insurers deny the claim outright to pressure you into accepting a lower settlement. This tactic discourages victims from pursuing rightful compensation.
2. Insurance Company Tactics to Watch Out For
Insurance companies have extensive resources and teams dedicated to minimizing payouts. Here are common tactics they use:
Delay Tactics
Insurers may delay processing your claim in the hope that you’ll give up or settle for less out of frustration.
Misinterpretation of Policy Terms
Insurance adjusters may misinterpret or misrepresent your policy’s terms to argue that your claim isn’t covered.
Requests for Excessive Documentation
Asking for unnecessary documents can create delays and give insurers a reason to deny your claim if deadlines aren’t met.
Using Recorded Statements Against You
Insurance adjusters often ask for recorded statements shortly after an accident. They may use your words out of context to dispute liability or the severity of your injuries.
3. How Texas Laws Impact Personal Injury Claims
Comparative Negligence
Texas follows a modified comparative negligence system. If you’re found partially at fault for an accident, your compensation is reduced by your percentage of fault. If you’re more than 50% responsible, you cannot recover damages at all. Insurance companies often exploit this law by trying to assign undue blame to you.
Statute of Limitations
Insurance companies may use delays on your part as grounds to deny your claim entirely.
4. What to Do If Your Claim Is Denied
Review the Denial Letter
When an insurance company denies your claim, they must provide a reason. Carefully review their explanation and the evidence they used to reach their decision.
Gather Evidence
If your claim was denied due to insufficient evidence, start collecting additional documentation, such as:
- Medical records
- Photos of injuries and property damage
- Witness statements
- Accident reports
Consult an Attorney
An experienced personal injury attorney can evaluate your case, negotiate with insurers, and ensure that your rights are protected. Attorneys can also file a lawsuit if the insurer refuses to act in good faith.
File an Appeal
Most insurance policies include an appeals process for denied claims. Your attorney can guide you through this process to present a stronger case.
5. Why Having an Attorney Makes a Difference
Dealing with insurance companies can be overwhelming, especially when you’re recovering from an injury. Attorneys like those at McGilberry & Shirer have the expertise to:
- Analyze your case and identify weaknesses in the insurer’s argument.
- Negotiate aggressively to secure a fair settlement.
Having legal representation sends a strong message to insurance companies that you’re serious about pursuing your claim.
6. Real-Life Case Studies: How We Helped Clients Fight Denials
Case Study 1: Denial Based on Pre-Existing Conditions
A client came to us after an insurance company denied their claim, citing a pre-existing back condition. By obtaining detailed medical records and expert testimony, we proved that the accident aggravated the condition, securing a $250,000 settlement.
Case Study 2: Disputed Liability in a Car Accident
An insurer denied a client’s claim, arguing they were at fault for a T-bone collision. By gathering surveillance footage and witness statements, we demonstrated the other driver’s negligence, resulting in a $500,000 settlement.
Proactive Steps to Strengthen Your Claim
To avoid common pitfalls and strengthen your claim:
- Report the Accident Immediately: Notify your insurer as soon as possible.
- Seek Medical Attention: Document your injuries through prompt medical care.
- Avoid Recorded Statements: Consult an attorney before giving a statement to the insurer.
- Document Everything: Keep records of all communications, expenses, and evidence related to the accident.
- Contact an Attorney: Enlist professional help early to navigate the complexities of the claims process.
Why Choose McGilberry & Shirer?
At McGilberry & Shirer, we have over 60 years of combined experience in fighting for the rights of personal injury victims. With more than 10,000 cases successfully handled, our team has the skills and resources to hold insurance companies accountable.
- Proven Results: Our clients have received millions in settlements and verdicts.
- Compassionate Representation: We understand the challenges you face and are here to support you every step of the way.
- No Win, No Fee: You don’t pay unless we secure compensation for you.
If your personal injury claim has been denied, don’t face the insurance company alone. Let the experienced dallas personal injury attorneys at McGilberry & Shirer fight for the compensation you deserve.
