When you file a personal injury claim, it is understandable that you might experience a small measure of comfort. After all, you’re anticipating a payment that will cover your losses and pay for any related pain and suffering. What could go wrong?
Actually, a lot.
That’s especially true when you receive a denial letter stating that you won’t be receiving your funds. What can you do if your personal injury claim is denied?
You can appeal the denial.
That’s where things can get complicated. Fortunately, you can call on the services of a skilled West Virginia personal injury lawyer to step in and become your advocate.
An attorney with experience negotiating with insurance companies will know the right approach to reverse that denial.
Common Reasons Insurance Companies Deny Personal Injury Claims
If you’ve received a denial letter from an insurance company, your quest for compensation does not have to be over. Before your attorney can enter into negotiations, they need to understand the reason for the denial.
Which of the following reasons did your insurance company use for its denial?
Disputed Liability: There could be a situation where the insurance carrier for the person who caused your injury disputes who was at fault for the accident. West Virginia applies a modified comparative fault system. That allows both parties involved in an accident to be held liable.
It would also reduce the amount that the insurance company would be obligated to pay out. That makes it in their best interest to dispute liability.
Lack of Medical Documentation: Despite what you submit, the insurer could claim there is Inadequate proof of your injuries or gaps in treatment. Even if you waited to see a doctor after the accident, they could assert that your injuries aren’t as bad as you’re making them out to be.
Pre-Existing Conditions: Insurers will comb through your medical history to look for any potential injuries that could be tied to your current injuries. They will argue that your preexisting condition is to blame for the pain, not the accident.
Missed Deadlines: West Virginia has a strict statute of limitations law that requires a complaint to be filed within two years of the date of the accident. If you fail to meet that deadline, the insurer will move for a dismissal, which they will most likely be granted.
Policy Exclusions: There may be a scenario in which the at-fault driver is not insured.
Insufficient Evidence: The insurer could claim that you can’t prove what happened because there is a lack of police reports, photos, or witness statements.
Insufficient or Incorrect Information: If you make a mistake with your documentation or forget to sign the claim document, the insurer can deny the claim on a technicality.
Alleged Fraud or Misrepresentation: The insurance adjusters might suspect that the incident was staged or that you have exaggerated your injuries. That might happen if the recorded statements are inconsistent.
Immediate Steps to Take After Receiving a Claim Denial
Receiving a claim denial does not automatically mean the end of the process. There are certain steps to follow in order to move towards an appeal or possibly litigation. Here are the immediate steps to take after receiving a claim denial:
- Review the denial letter to look for any policy exclusions or specific language that is cited for your denial.
- Document all communication with your insurance company and adjuster. That includes the dates, names, and summaries of any conversations.
- Gather all the relevant evidence that supports your claim, such as medical records, photos, videos, and proof of employment for lost wages. If the personal injury involves a serious car accident, you’ll want to include a police report and repair invoices or replacement costs for your vehicle.
- Check the deadlines to ensure you haven’t missed any filing dates.
- File a formal appeal in the form of a written letter explaining why you believe the denial is wrong, and include all your supporting evidence.
This is clearly a process you want to involve an experienced personal injury claim attorney.
They will be in the best position to help you conduct a deep dive and identify the possible inconsistencies with the insurance company’s actions.
When to Transition From an Insurance Claim to a Lawsuit
Sending in an appeal doesn’t mean you’ll automatically receive a reversal. The insurance company will most likely dig in and stick to their denial in the hope you’ll just walk away.
At that point, you might consider transitioning your insurance claim to a lawsuit.
As intimidating as that sounds, it is not uncommon, and it is the exact type of situation the attorneys at DiPiero Simmons McGinley & Bastress, PLLC are fully prepared for.
We have over 150 years of combined litigation experience taking on big insurance companies. We will use the same evidence from a client’s initial filing, along with the specific issues that triggered the denial. If we believe the client’s claim has merit, we’ll file the civil complaint, which activates the court proceeding. The insurance company is obligated to respond and move forward with the defense of its denial.
Of course, a claim denial is not the only instance in which we might suggest taking the case to court. We might also suggest that option if the insurance company makes a low settlement offer or engages in delay tactics.
There could even be a situation where the at-fault party’s insurance exceeds your damages. That would mean filing a complaint directly against that person. It’s been our experience that filing a civil complaint becomes a genuine motivator that shifts the power dynamic and forces the insurance company to reconsider its actions.
The goal will always remain to achieve the maximum settlement.
If you’ve been harmed in any kind of accident caused by someone else’s negligence, you are entitled to seek a remedy. Reach out to the DiPiero Simmons McGinley & Bastress, PLLC office to schedule a free consultation.
Let’s find some answers together about what should happen next.
