Denied Claim

While we trust our auto insurance companies to treat us fairly in the event of a crash – especially when we were not to blame for what happened – the reality is insurers don’t make money by paying out claims. That means they have a vested interest in denying claims.

Some denials are for legitimate reasons. However, the Boston auto injury attorneys at Jeffrey Glassman Injury Lawyers know that, too often, denial of claims is baseless.

Sometimes, legitimate claims may be denied on technicalities or for some small reason.

This is why we recommend reaching out to an experienced legal team as soon as possible after a crash, before engaging in negotiations with the insurance company. We understand what adjustors are looking for, and the loopholes they work to exploit.

We can help provide the necessary proof of claim that will reduce the chance a claim will be denied in the first place. Further, if the claim is still denied, we have a jump start on the appropriate response, which may include engaging in further negotiations, filing an appeal to the insurance board or initiating personal injury lawsuit.

In many cases, claimants may be dealing with more than one insurance company, and keeping track of your rights and obligations to each can be overwhelming.

Deep frustration can take hold when a claim is denied, especially when injuries are serious and there is pressure to pay medical bills and cover other expenses. An experienced Boston injury lawyer can help ease that frustration by ensuring your rights are protected at each stage of the legal process.

Reasons for Denial

Insurance companies have a laundry list of grounds on which to deny claims.

Some of those are based on instances of presumed fault, as outlined in 211 CMR 74.00. These instances outline cases where the operator of a private passenger motor vehicle is presumed to be more than 50 percent at fault (which would prohibit compensation for anything beyond what health insurance and personal injury protection benefits cover). These include (but are not limited to):

• Rear-end collisions, where you were the rear vehicle
• Out-of-lane collisions, in which you crashed while partially or completely out of your proper lane
• Crashing into a parked vehicle, whether that vehicle was parked lawfully or not
• Wrong-way crash, in which you were traveling in the wrong direction
• Collision while backing up
• Single-vehicle crash
• Failure to obey traffic laws
• Crash while merging onto the highway, when you were the driver who was merging

Beyond findings of presumed fault, an insurer may also assert the claim has been denied for one or more of the following reasons:

• Injuries related to a prior injury, accident or illness
• Failure to seek immediate medical treatment or no indication of pain at the scene
• History of involvement in prior collisions
• No objective sign of injury (i.e., broken bones, cuts, bruising, etc.)
• Credibility challenged due to an inaccurate recollection of times, speeds and distances involved
• You were not covered under the policy
• Insurance coverage lapsed (failed to pay the bill on time)
• Claim involves a new vehicle that had not yet been placed on the insurance policy
• Claim exceeds policy coverage

In some cases, these denials are warranted. Often times, they are not. An experienced Massachusetts injury attorney can help you discern which settlement offers are best accepted and which claims are worth pursuing further.

Challenging a Claim Denial

In some cases, disputing reasons for a denial may be fairly straightforward. If the insurance company claims the individual or vehicle was not covered, that could be quickly remedied with a careful review of the policy. It could be a matter of simply correcting or supplementing inaccurate or incomplete information.

Usually, at this point, insurance companies are presented with full and complete evidence of liability by an injury victim’s attorney will at least resume negotiations, if not extend a settlement offer.

In other cases – particularly those involving assertions of fault for the crash or causation of injuries or failure to abide by the duty to mitigate injuries – challenges may require more involvement.

This process could include obtaining/presenting additional medical records and witness statements.

Understand that even in cases where there may have been a pre-existing injury, claimants may still be entitled to damages if the crash exacerbated those injuries, requiring more intensive treatment or medication.

If the insurance company still does not relent on the denial and your attorney believes your claim is valid, he or she may advise you to take one or more of the following actions:

• File an appeal with the state insurance commission (if you were found more than 50 percent at-fault and received an auto surcharge)
• File a personal injury lawsuit
• File a bad faith insurance claim

Your recommended course of action will depend heavily on the individual facts of your case.

Contact Jeffrey Glassman Injury Lawyers today for a free and confidential consultation.