After an accident, you may expect the at-fault party’s insurance company to cover your medical expenses, lost wages, property damage, and other losses. Unfortunately, insurance companies do not do what they should in every personal injury claim.
Receiving a denial of a claim can be frustrating and confusing, especially when you believe another person clearly caused your injuries. You may wonder whether a denied claim means you cannot recover compensation or whether you have other options.
The good news is that an insurance company’s decision is not necessarily the final word on your claim. Depending on the circumstances, you may be able to challenge the denial, provide additional evidence, negotiate with the insurer, or pursue legal action.
If your claim has been denied, speaking with a personal injury lawyer in Hamilton, Ohio can help you understand why the insurer rejected your claim and determine what steps may be available to you.
Why Do Insurance Companies Deny Personal Injury Claims?
There are many reasons an insurance company may deny a personal injury claim. Some denials are based on legitimate coverage or liability issues, while others may result from disputes over the facts or the severity of an injury.
Common reasons for a denial include:
- The insurer claims its policyholder was not responsible for the accident.
- The insurance company disputes the severity of your injuries.
- The insurer argues that your injuries were caused by a pre-existing condition.
- The company claims you failed to seek medical treatment promptly.
- The insurer disputes the connection between the accident and your injuries.
- There is insufficient evidence supporting the claim.
- The insurance company argues that you were partially or primarily responsible.
- The insurer claims the policy does not provide coverage.
- The claim was not submitted within an applicable deadline.
- The insurance company believes the damages being requested are excessive.
Understanding the specific reason for the denial is an important first step toward determining how to respond. That said, most insurance adjusters are not attorneys. That’s where we come in.
The Richards Firm has previously addressed the question of why insurance companies deny claims, which can provide additional information about common insurance tactics and issues that may affect an injury claim.
Step 1: Read the Insurance Company’s Denial Carefully
If your claim has been denied, don’t immediately assume that the case is over.
Start by reviewing the denial letter carefully. The insurance company should generally explain the basis for its decision.
Look for information about:
- Why the claim was denied
- Whether the denial relates to liability or coverage
- Whether additional documentation is requested
- Whether you have an opportunity to appeal or reconsider the decision
- Any deadlines mentioned by the insurer
Keep the denial letter and any other correspondence you receive.
The reason for the denial can help determine what evidence or legal arguments may be needed to challenge the decision.
Step 2: Gather Evidence Supporting Your Claim
A denied claim may sometimes be challenged by providing additional evidence.
Depending on the type of accident, useful evidence may include:
- Police or accident reports
- Medical records
- Medical bills
- Photographs of the accident scene
- Photographs of your injuries
- Video or surveillance footage
- Witness statements
- Employment records showing lost wages
- Property damage documentation
- Communications with insurance companies
- Expert opinions
The more clearly the evidence establishes what happened, who was responsible, and how you were injured, the stronger your position may be.
If you are unsure what evidence matters most, an attorney can help identify gaps in the insurance company’s investigation and determine what additional documentation should be obtained.
Step 3: Continue Your Medical Treatment
If you were injured in an accident, continue following your healthcare provider’s recommendations.
Medical records can play an important role in establishing:
- That you were injured.
- The nature and severity of your injuries.
- What treatment you required.
- How the accident affected your health.
- Whether you may need future treatment.
Insurance companies sometimes point to gaps in medical treatment as a reason to question whether an injury was actually caused by an accident.
That doesn’t mean every delay in treatment invalidates a claim. There can be many legitimate reasons someone does not immediately seek treatment. However, following medical advice and keeping records of your treatment can help document your recovery.
The Richards Firm’s guide on how to document your injuries after an accident provides additional suggestions for keeping useful records throughout the process.
Step 4: Don’t Assume the Insurance Company’s Decision Is Final
An insurance company has a financial incentive to limit the amount it pays on claims.
A denial may reflect the insurer’s interpretation of the available evidence, but it does not necessarily establish that you have no legal claim.
For example, an insurer might deny a claim because it believes its policyholder was not at fault. Additional witness testimony, photographs, video footage, or accident reconstruction evidence could potentially provide a different picture.
Similarly, an insurer might argue that your injuries were unrelated to the accident. Medical records and testimony from healthcare professionals may provide evidence connecting your injuries to the incident.
The key is understanding why the claim was denied and whether the evidence supports the insurer’s position.
Step 5: Determine Whether You Have a Case
An insurance claim and a personal injury lawsuit do not necessarily go hand in hand.
A personal injury case generally involves determining whether another party was legally responsible for your injuries and whether you suffered damages as a result.
Factors that may be important include:
- Whether another party owed you a duty of care
- Whether that party breached the duty
- Whether the breach caused your injuries
- Whether you suffered compensable damages
- Whether another party is disputing responsibility
- Whether applicable legal deadlines have passed
If you’re unsure whether your circumstances support a legal claim, reviewing the situation with an attorney can provide clarity. If a claim can be made, you may be able to resolve it in lieu of filing a lawsuit. Unfortunately, there are times where filing suit to protect your rights becomes necessary.
The Richards Firm also offers a helpful resource explaining how to know if you have a personal injury case in Ohio.
Step 6: Be Careful About Speaking With the Insurance Company
After a claim is denied, an insurance company may continue communicating with you.
As always, you should be cautious about providing statements or signing documents without understanding their potential consequences.
Insurance representatives may ask questions about:
- How the accident occurred
- Your injuries
- Your previous medical history
- Your current treatment
- Your ability to work
- Your daily activities
It’s important to answer questions truthfully, but you should avoid guessing, speculating, or making statements you don’t fully understand. Better yet, talk to an attorney and avoid responding to an insurer until you do.
If you have concerns about how to communicate with the insurer, an attorney can handle those communications on your behalf.
Step 7: Consider Speaking With a Personal Injury Lawyer
If your claim has been denied and you believe another person was responsible for your injuries, it may be time to seek legal guidance.
A personal injury lawyer in Hamilton, Ohio can review the circumstances of your accident and the insurance company’s reason for denying your claim.
An attorney may be able to:
- Investigate the accident
- Gather additional evidence
- Review medical records
- Identify potentially responsible parties
- Communicate with insurance companies
- Challenge disputed liability
- Calculate your damages
- Negotiate a settlement
- File a lawsuit when appropriate
Legal representation can be particularly valuable when the insurance company disputes fault or claims your injuries are not related to the accident.
Can You Sue After an Insurance Claim Is Denied?
In some circumstances, filing a lawsuit may be an option after an insurance claim has been denied.
However, whether litigation is appropriate depends on the facts of the case.
An attorney may consider:
- The strength of the evidence
- The reason for the insurance denial
- The extent of your injuries
- The amount of your damages
- Available insurance coverage
- Potentially responsible parties
- Applicable Ohio deadlines
A lawsuit is not always necessary. Many personal injury cases are resolved through negotiations between the parties and their attorneys.
However, having an attorney who is prepared to pursue litigation can help ensure that a denied insurance claim does not automatically end the discussion.
Don’t Wait Too Long to Act
If your claim has been denied, it’s important not to ignore the situation.
Evidence can disappear. Witnesses may become difficult to locate. Surveillance footage may be erased or overwritten. Medical documentation can become more difficult to obtain as time passes.
Ohio personal injury claims can also be subject to legal deadlines. Waiting too long could jeopardize your ability to pursue a lawsuit.
For these reasons, getting legal guidance sooner rather than later can help you understand your options and protect your rights.
A Denied Claim Doesn’t Necessarily Mean Your Case Is Over
Receiving a denial from an insurance company can be discouraging, but it does not necessarily mean you have no options. The next step is to understand why the claim was denied, gather evidence supporting your position, continue documenting your injuries, and determine whether additional legal action may be appropriate.
If you believe someone else’s negligence caused your injuries, an experienced personal injury lawyer in Hamilton, Ohio can help you evaluate the insurance company’s decision and determine how best to move forward.
At The Richards Firm, we understand how overwhelming it can be to deal with an injury while an insurance company is disputing your claim. Our goal is to help Ohio injury victims understand their rights, navigate the claims process, and pursue the compensation they may be entitled to.
If your personal injury claim has been denied, contact The Richards Firm to schedule a free consultation and discuss your legal options. We can be reached at 513-461-0084 or online at richardsinjuryfirm.com.
