Having your personal injury claim rejected can be devastating, especially when you’re facing mounting medical bills and lost wages. Understanding why an insurance claim may get rejected and knowing how to prevent these issues can make the difference between a successful settlement and a claim denial.
Let’s explore the common reasons for a rejected accident claim, and learn how to strengthen your case.
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Claim Denial: Common Reasons for Personal Injury Claim Rejections
Delayed Medical Treatment
One of the most frequent reasons for a personal injury claim rejected is waiting too long to seek medical care. Insurance companies often interpret delays in treatment as evidence that your injuries weren’t serious or weren’t related to the accident. Always seek medical attention immediately, even if you think your injuries are minor.
Incomplete Documentation
Insurance adjusters require thorough documentation to process your claim. Missing or incomplete records can lead them to deny your claim from the get-go. Important documentation includes:
- Medical records and bills
- Police reports
- Witness statements
- Photographs of injuries and accident scene
- Employment records for lost wage claims
- Correspondence with insurance companies
Missing Filing Deadlines
California has a strict two-year statute of limitations for personal injury claims. Missing this deadline almost always results in claim rejection. Insurance companies also set their own notification deadlines that must be met.
Pre-existing Conditions
Claims adjusters frequently reject by arguing that your injuries existed before the accident. While having a pre-existing condition doesn’t disqualify you from compensation, failing to disclose it properly can harm your chances.
Liability Disputes
A rejected accident claim happens if there’s insufficient evidence to prove the other party’s fault. California follows comparative negligence rules, meaning your compensation can be reduced based on your percentage of fault in the incident.
How to Strengthen Your Personal Injury Claim
Act Quickly and Document Everything
- Seek immediate medical attention.
- Take photographs of injuries and the accident scene.
- Gather contact information from witnesses.
- Keep detailed records of all medical treatments and expenses.
- Save all correspondence with insurance companies.
Maintain Consistent Medical Care
- Follow all doctor’s recommendations.
- Attend all scheduled appointments.
- Keep a detailed journal of your recovery process.
- Document how injuries affect your daily life.
Be Careful with Communications
- Avoid giving recorded statements without legal representation.
- Don’t accept early settlement offers without review.
- Limit social media posts about your accident or injuries.
- Direct all insurance company communications through your attorney.
Organize Your Documentation
- Create a systematic filing system for all accident-related documents.
- Keep copies of all medical bills and records.
- Save receipts for accident-related expenses.
- Maintain a log of missed workdays and lost wages.
Work with an Experienced Personal Injury Lawyer
- Consult with a personal injury attorney early in the claims process.
- Have professional help reviewing insurance policies and offers.
- Make sure all deadlines are met.
- Get expert guidance on claim valuation.
By following these steps, you can avoid common mistakes that may result in a personal injury claim rejected or a rejected accident claim, improving your chances of a successful settlement.
When Insurance Companies Act in Bad Faith
In some cases, a personal injury claim denial may result not from valid reasons, but due to the insurance company acting in bad faith. Insurance providers have a responsibility to handle claims fairly and with transparency.
When they fail to meet these obligations, it can severely impact the claimant’s case. Below are common signs that an insurer may be acting in bad faith:
Unreasonable Delays in Processing Claims
Insurance companies are required to process claims in a timely manner. Delays without a valid reason may indicate bad faith. For example, if the insurer does not respond to your claim within a reasonable timeframe or repeatedly asks for unnecessary documentation, they could be attempting to avoid paying. This can happen when a claim is delayed for months, with no proper justification or explanation.
Failure to Investigate Claims Properly
A major indication of bad faith is when the insurance provider fails to conduct a thorough investigation into the claim. For example, the company may ignore key evidence, such as witness statements, medical reports, or police records that support the claim.
By not fully investigating the circumstances surrounding the incident, the insurance company may attempt to reject or minimize the claim without valid reasoning.
Misrepresenting Policy Terms
Insurers may mislead claimants about the terms of their policy. This could include providing incorrect information about coverage limits, exclusions, or the steps needed to submit a claim.
For example, an insurer might wrongly inform a claimant that their injuries are not covered under the policy, even when the policy clearly covers such incidents. Misrepresentation is a tactic to prevent fair compensation.
Making Unreasonably Low Settlement Offers
A common bad faith tactic is offering settlement amounts that are far below what is needed to cover medical expenses, lost wages, and pain and suffering.
For instance, if a person is offered a settlement that only covers a small fraction of their medical bills or other expenses, the insurance company might be trying to close the case for much less than its true value. These offers are often made quickly, before the claimant fully understands the scope of their injuries.
Claim is Denied Without Explanation
In some instances, insurance companies may deny claims without providing a valid reason or clear explanation. For example, after submitting all the required documents and following the correct procedures, the claimant may receive a denial letter stating simply that the claim is “not covered,” without offering any specifics. This lack of explanation makes it difficult for the claimant to understand why their claim was denied and what their next steps should be.
When insurance companies engage in these practices, it harms the claimant and violates their legal responsibility. If your personal injury claim rejection seems unjust, consult with a personal injury law firm who can help address the situation and pursue legal remedies, including filing a lawsuit. Courts take bad faith insurance practices seriously, and claimants have the right to hold insurers accountable for their actions.
Is Your Claim Rejected? RTM Law Personal Injury Attorneys Can Help
If your personal injury claim rejected has left you feeling discouraged, know that you still have options to seek the compensation you deserve.
At RTM Law, our experienced attorneys specialize in personal injury cases and are knowledgeable in California’s personal injury laws. We understand how to build strong cases that withstand challenges and lead to favorable outcomes.
Our team can help by:
- Reviewing Your Rejected Claim.
- Gathering Necessary Documentation and Evidence.
- Handling Communications with Insurance Companies.
- Meeting Legal Deadlines and Requirements.
- Fighting for Maximum Compensation
Personal Injury Claim Rejected? Take Legal Action Today. Call Our Injury Claim Lawyers for a Free Consultation. No Win, No Fee.
Don’t let your personal injury claim rejection prevent you from pursuing justice. Contact RTM Law today for a free consultation with our skilled personal injury attorneys. We will review your case, explain your rights, and help you create a strong strategy for seeking compensation.
Call us today to schedule your free consultation. Let us guide you toward a successful resolution and the compensation you deserve.
Do you need compassionate support and effective representation?
No fees until we win. Available 24/7.