Top Reasons Why Insurance Companies Might Deny Your Injury Claim.

Since 1994, I have been helping injured Texans handle their injury claims throughout the Dallas area. Through the years, I have also heard almost every reason why insurance companies deny claims. Here are some reasons why an insurance company might deny your injury claim and what you can do to avoid it.

1. No Fault in the Accident

This is probably the most common reason why insurance companies deny claims. Under Texas law, every automobile operated on the public roadways must be covered by a minimum amount of liability insurance. The purpose of liability insurance to make sure that money is available to compensate the innocent person for any injuries or damages caused in the accident.

But, in order for the insurance company to pay, they have to agree that their driver was at-fault in the accident. Sometimes, there are different versions of the accident. Therefore, the adjuster will conduct an investigation to determine fault. The adjuster might talk to each driver, as well as any witnesses, and also review the police report and vehicle photos. If the accident appears to be their driver’s fault, then the insurance company will accept liability and proceed to handle the injury and damages claims. If, however, the adjuster does not agree that their driver is at fault, then the claim will be denied.

It is very important to get the advice of an experienced car accident attorney as early as possible so that you avoid doing something that can hurt your case. One major mistake people make is giving the insurance adjuster a recorded statement. Insurance adjusters try to get your statement very early before you contact an attorney. This is a big mistake and can make the difference between winning and losing your case.

So, the moral or the story is gather as much information as you can, call an attorney as early as possible, and do not talk to the insurance company or give any sort of recorded statement about the accident until you have consulted with an attorney.

2. Not Believing You Were Injured.

If you were injured in the accident, the adjuster might not believe you. There might be several reasons for this:

Minor Collision.

If the damage to your vehicle is minor, then the adjuster might think that you were not injured. However, even though the damage to your vehicle may look minor, the damage to the other vehicle may be major. Therefore, your vehicle alone may not tell the whole story. That is why it is important to get pictures of both vehicles while you are at the accident scene.

Delay in Seeking Medical Treatment.

It is important to seek medical treatment for your injuries as soon as possible. This may include a trip to the emergency room, or even a visit to a minor emergency clinic. You can also try make an appointment with your primary doctor. Another option would be to call a car accident attorney. Your attorney will be able to get the medical treatment under a “letter of protection” without any money out of your pocket.

However, waiting too long to see a doctor can result in your claim being denied. The longer you wait, the harder it is to blame the accident for your injuries. Therefore, it is important to seek medical attention as soon as possible, preferrably within the first week of the accident.

Pre-Existing Injury.

In the event you have been injured in a prior accident, the adjuster might deny your claim. That is because the adjuster may believe that your injuries were really the result of the prior accident and not the present one.

Just because you had a prior injury does not automatically mean that your claim should be denied. What matters is whether you were fully recovered from the prior injury and released from care. If not, then the next issue is whether the present accident aggravated your previous injury. This is why it is important to hire an attorney to investigate your injury claim and present it in the best possible light.

3. No Insurance Coverage.

Even if the other driver is totally at fault in the accident, if there is no insurance coverage, then it is unlikely you will be unable to collect any money for your case. The cruel reality is that 1 out of every 5 vehicles on Texas roadways are uninsured for some reason or another. Here are some of the most common reason why there may not be insurance coverage for your claim:

Excluded Driver.

Sometimes, the insurance company will get notice that an accident was caused by an excluded driver. If that is the case, your claim will likely be denied. An “excluded driver” is someone who is specifically named in the policy as being excluded from coverage. This is done in order to keep the insurance premiums low in the event someone in the household is a high risk.

For instance, a family who cannot afford to pay insurance for their teenage kids may have to exclude the kids from the policy in order to avoid paying the higher premiums. The effect of this exclusion is that the kids are not covered if they are driving the vehicle and get into an accident. Moreover, there may not be any coverage whatsoever if the kids are driving the vehicle, not even for the vehicle itself.

Other Driver Not Cooperating.

This happen more often than you think. The other driver is not cooperating with the insurance company’s investigation of the claim. This can be a problem. Under every liability policy, there is a duty for the driver to cooperate with the investigation of the claim. It doesn’t take much: Just a phone call or two in order for the adjuster to get all sides of the story. However, if the other driver fails to do this simple task, the adjuster might deny coverage for the claim.

But many unscrupulous adjusters and insurance companies use this as an excuse to deny or delay your claim. So, it is important to protect yourself by properly documenting the accident as best as you can. Also, hiring a good injury attorney will help get the other driver to cooperate, especially if they fear that they might be held personally responsible for your losses.

Failure to Pay Insurance Premiums.

Another common reason why there may not be valid coverage for an accident is that the premiums were not paid. Insurance is not free. Rather, it is a contact between the policy holder and the insurance company. The insurance company agrees to provide coverage and the policy holder agrees to pay the premium in full and in a timely manner. Failure to do this might result in your insurance getting cancelled and having no coverage.

What if Your Accident Claim is Denied?

Uninsured Motorist Coverage.

If the other driver does not have valid liability insurance coverage, you might be able to file an uninsured motorist claim under your own policy. It would be wise to purchase this coverage in the event you are involved in an accident with someone who is uninsured. In such a case, your insurance policy will step into the shoes of the insurance policy that the other drier should have had.

Other Person Liable for the Accident.

In some cases, you might have a claim against someone else for the accident even if the vehicle wasn’t technically covered. For instance, the other driver may have been working at the time of the accident. If so, then the driver’s employer would be liable if the driver was performing the duties of employment at the time. This is called, respondeat superior” or “vicarious liability.”

Another option might be to determine if the vehicle is owned by someone else at the time of the accident. Under Texas law, the owner of a vehicle may be liable if they lend their vehicle to an unlicensed or incompetent driver This is called negligent entrustment.”

Get the Legal Help You Need.

Whether you live in Dallas, Fort Worth or the surrounding areas, get the legal representation from an attorney who calls the DFW area home. If you’ve been involved in an accident and don’t know where to turn, let an experienced attorney take your case in the right direction.

Since 1994, Robert C. Slim has been helping victims of wrongful death and serious personal injuries get the justice they deserve. Let his knowledge and experience help you too.

Call or message me now for a personal and free legal consultation.

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