Are You Stuck with a Denied Car Accident Claim? Apply These Strategies

Every year, thousands of car accidents happen across Canada. The aftermath involves serious injury recovery, medical expenses, lost wages, and other issues for which insurance companies can provide relief. However, filing an insurance claim can be complex, and even in cases of wrongful death, insurers easily deny claims. A recent report by the Kaiser Family Foundation revealed an average of 18% (and up to 80%) of federal, in-network health insurance claim denial. Additionally, data from 2021 indicates that the auto insurance industry suffered nearly $200 million in losses, primarily attributed to personal injury claims. There are tried-and-proven techniques that can help you break loose from a denied claim. From knowing the reasons for claim denial to employing strategies to overcome a denied claim to getting counsel from a “personal injury lawyer in Edmonton near me,” it’s essential to apply the following process.

Reasons for Health Insurance Claim Denial

Paperwork Errors

Improper coding, clinical validation issues, and patient registration errors can lead to denied health insurance claims. 

Limited Auto Insurance Coverage

If the at-fault driver in your car accident has minimal insurance coverage that doesn’t fully cover your claim, or if an uninsured driver hits you.

Missed Filing Deadline

Most insurers require claim filing within 30 days of the accident. 

Lack of Medical Treatment

You filed a claim for serious injury but haven’t sought documented medical care or professional diagnosis for your injuries.

Insufficient Proof of Liability

If you don’t have a filed police report or evidence to support your innocence in the accident, insurers will question your liability.

Adjuster Car Accident Claim Denial: Why?

Non-reporting

Insurers may deny claims in cases of wrongful death if their driver fails to report the accident. Lack of reporting puts coverage at risk and can lead to insurance issues.

Reasons for an Insurance Carrier to Contact Their Driver:

  • Verify if there’s another version of the accident.
  • Determine if there are witnesses to speak with.
  • Check for facts indicating other liability insurance coverage.
  • Ensure they have the complete story before making payment.
Responsible insurers usually make diligent efforts to contact their drivers and acknowledge potential errors on the part of the insurance company. However, some insurers neglect to contact their drivers and deny coverage based on the insured’s lack of cooperation.

Action Steps for Collision Victims

If the personal injury from the motor vehicle accident involves a collision, encourage the other driver to report it to their insurance company. If they refuse, call them yourself at the scene.

Liability Issues 

Another frequent cause for insurers to reject claims is disputes over liability, common in multiple motor vehicle accidents.

Reason for Claim Denials

Liability disputes are a common reason for insurers to deny claims. Here is a scenario example:
  • In a three-car chain reaction accident: Vehicle #3 (you) at the front; vehicles #1 and #2 behind, arguing about fault.
  • Dispute: Whether Vehicle #1 pushed #2 into you or if #2 hit you first and then #1 hit #2 after your vehicle collided.
  • Your Position: As the innocent victim, regardless of fault.
  • Resulting Issue: Both insurance companies may deny your claim and leave you without coverage.
In situations involving complex liability disputes among multiple parties (such as in the described three-car accident scenario), insurers may deny claims. This leaves innocent victims without coverage for damages incurred, regardless of fault.

The Blame Game

Insurers use finger-pointing tactics in an accident involving multiple vehicles to avoid an injury claim payout, even if the injuries are catastrophic. In personal injury cases, insurance companies may try to shift blame onto someone else’s negligence and leave the injury victim without compensation.

Excluded Drivers

Auto insurance policies have traditionally provided coverage to individuals granted “permissive use” of a vehicle and leave out those specifically listed as “excluded drivers.” These exclusions typically apply to a family member. In such cases, insurers may stipulate that motor vehicle accidents involving the named excluded driver will not be covered to stress the exclusion policy.

Example Scenarios:

  • A policyholder’s son lives in the household with a history of driving under the influence (DUI).
  • A policyholder’s husband, under the same insurance policy, was involved in multiple at-fault personal injury accidents.  
  • A household member of the policyholder has had their driver’s license suspended due to reckless driving. 

10 Tactics for Motor Vehicle Accident Claim Denial by Insurance Companies

If the motor vehicle accident is due to someone else’s negligence, you can get the compensation you deserve for an accident involving serious injuries, medical expenses, and related costs. However, insurance companies use various tactics to deny or reduce claims, especially for victims without personal injury lawyers.
Tactic Action
Immediate Contact  After an accident, insurers may call to exploit your vulnerable, shocked state. The absence of injury lawyers may lead to a quick settlement.
Delayed Claim Processing Quick-to-contact insurers often drag their feet when processing claims to wear you down enough to accept a lower settlement or abandon the claim altogether.
Lowball Settlement Offers Insurers aim to negotiate settlements that appear to relieve your financial woes but are far below the costs of actual damages incurred.
Liability Dispute Insurers may challenge the extent of your claim or make you partially at fault to reduce the payout.
Injury Causation Insurers question the link between your injuries and the accident to validate if they happened before or after the collision.
Recorded Statements Insurance adjusters may request recorded statements before you furnish full medical care details so they can use them against you.
Medical Evaluations Insurers may require you to undergo biased doctor evaluations to jeopardize fair assessment.
Premature Release Signing Insurers might rush you to sign early release forms to limit your future compensation options.
Damage Misrepresentation Some insurers may falsely claim that particular damages, such as pain and suffering or lost income, are not fully recoverable.
Discouraging Legal Representation Insurers might dissuade you from hiring a personal injury lawyer to cut your chances of securing the compensation you deserve.

Strategies for Overcoming a Denied Car Accident Claim

Facing a denied personal injury claim adds further stress to an already challenging situation. However, there are steps you can take, especially with the assistance of an experienced personal injury law firm, to pursue appropriate compensation.

Reasons for Denial and Legal Solutions:

Basis Reason Legal Solution
Lack of Evidence or Proof Insurers dismiss claims lacking evidence, such as police reports and accident photos. Personal injury lawyers in Edmonton gather evidence for an appeal, including eyewitness testimonies, expert opinions, and relevant documentation.
Issues with Insurance Policy Coverage Insurers investigate to ensure accident circumstances align with policy coverage. Experienced injury lawyers from a reputable law firm help navigate complex legal systems and insurance policies.
Pre-existing Conditions Insurers may deny personal injury claims, even in wrongful death cases, if they allege pre-existing conditions disqualify individuals from compensation. Utilize records and expert testimony. Demonstrate how the personal injury accident exacerbated existing conditions. 
Shared Responsibility Insurers may deny or reduce compensation if you are partially at fault for the accident. Challenge assertions of shared responsibility. Increase the likelihood of fair compensation and success in the outcome of a personal injury claim. Make a driver accountable for a wrongful act of negligence.

What to Do About Your Denied Insurance Claim

Receiving a denial letter for an insurance claim can be discouraging, but you have options. Here are four steps to potentially reverse the personal injury case denial:
  • Contact your insurance company and ask questions to provide complete or accurate information.
  • Seek help from medical offices that can offer insights into claim denials and assist in navigating the legal process. 
  • Send necessary documents through email for inquiries and responses.
  • Educate yourself on procedure costs, contingent fee, and insurance coverage. 
 
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Personal Injury Lawyer in Edmonton: Your Way Out of A Denied Car Accident Claim

Insurers act in their best interests and will pressure you to accept a lowball settlement offer. While you can file a claim alone, the entire legal process can be challenging. Alberta personal injury lawyers have extensive experience in settlement negotiations to help alleviate your pain and suffering as an accident victim. Sidhu Personal Injury Lawyers Edmonton is a personal injury law firm with extremely professional senior lawyers. Our dedicated team of Edmonton personal injury lawyers offers a free consultation for personal injuries ranging from slip and fall and traumatic brain injuries to spinal cord injuries and catastrophic injuries.  With our expertise in personal injury law and the legal system, we offer legal assistance to injury victims and guide them through personal injury litigation to ensure they receive fair compensation.

Frequently Asked Questions

Evidence needed to challenge a denied car accident claim normally includes records, accident reports, witness testimonies, photos of the scene, and any other documentation supporting the version of events claimed by the injured person.

The time varies depending on factors such as the case’s complexity, the parties’ cooperation, and the legal process involved. Still, the legal process can range from several months to a few years.

The costs may depend on the following factors:

  • Experience of Edmonton personal injury lawyers
  • The complexity of the personal injury case
  • Fee structure (e.g., hourly rates, court filing fees, or contingency fee)
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