A car accident can change your life in an instant and it can happen without any warning.  As if injuries aren’t enough, but you also might need to navigate the complex and lengthy process of an insurance claim. This can be both stressful and confusing, especially if you know nothing about car insurance claims.

But the question still remains. How do car insurance claims exactly work? Here’s what you need to know about car insurance claims, especially if you were injured in a car accident.

After the car accident that you were involved, you should notify the insurance company right away. In some states you can file the claim with the at-fault driver’s insurance company. And in other states, different rules will apply. For example, did you know that Kansas has a no-fault insurance system? This basically means that if you were in a car accident and you’re not the at-fault driver, you have to file the claim with your own insurance company.

After the accident, in most cases the insurance companies will contact you. Sometimes even while you’re recovering. Once the claim gets filed, the insurance company appoints an adjuster who will evaluate your claim and determine its worth.

You might think that the adjuster is here to work in your favor. Well, he/she isn’t. The adjuster appointed by the insurance company works for the insurance company’s interests. The sole goal of the adjuster is to minimize the amount that the insurance company will pay you for your claim.

Working with the adjuster

It’s often the practice that the insurance adjuster will contact you in order to get more information about the accident. The adjuster might even ask you to give a recorded statement. However, if you haven’t yet spoken to a personal injury lawyer, we strongly recommend that you don’t give a recorded statement to the adjuster or any other representative from the insurance company.

The recorded statement and any other evidence is collected for processing your claim. So when the adjuster asks you to give a statement, just politely decline and let him know that you will be willing to give a statement once you consult your personal injury lawyer. In case you’re still under some stress from the accident or you’re experiencing pain and take medication for it, allow yourself some time to pass before giving a statement. Also, you can rely on your personal injury lawyer to negotiate the process with the insurance provider.

Sometimes, the car accident will only cause property damage and no one will be injured. In cases like that, the insurance claim process is pretty simple. The insurance company will ask you to take your car to the mechanic, who will then assess the damage and provide the estimate to the insurance company. Car accidents that only end in property damage is something that you can handle. So you don’t really need a personal injury lawyer.

Determining who’s at fault

It’s the adjuster’s job to determine who caused the accident and who’s at fault. Sometime, even when the police record clearly state that you’re not at fault, the adjuster will try to dispute it.

Another practice is that insurance companies sometimes want to settle a claim rather quickly. If someone from an insurance company approaches you and makes you an offer, don’t accept it. It’s best to first speak to a personal injury lawyer who can evaluate your claim. Because when insurance companies make you an offer right away, the offer is usually extremely low compared to the realistic value that you should be compensated for (the insurance company is trying to pay out as little as possible).

Once your personal injury lawyer evaluates your claim, you will realize that the offer from before was really low. The lawyer will provide you a range of values and a fair offer from the insurance company should fall within that range.

When you agreed on how much you would request from the insurance, the lawyer will draft a letter, include additional proof and send the new offer to the insurance company. The insurance company can do three things: accept your offer, offer you a lower amount or just deny it.

As you can see, the insurance claim process is not as simple. The entire process can be a complicated maze you need to navigate and that’s why it’s important that you have a good and experienced personal injury lawyer who will support you.

In the past two posts, we have discussed what to do when insurance companies deny your claim and what tips and tricks insurance companies use in order to deny your claim.

This week we will be focusing on the potential reasons WHY insurance companies deny your insurance claim. So let’s get started.

Being in an accident is stressful enough. But learning that the insurance company has denied your insurance claim is very disconcerting.

There are several reasons why they refuse your insurance claim. Some of them can be valid, while others not so much but hey still use them in order to pay you as less as possible. So if you’re dealing with an insurance claim and it gets denied, it’s good do consult with a personal injury lawyer because they know the system and are more aware what tactics insurance providers use in order to either minimize your claim or just deny it.

Cause of the accident

Many insurance companies have denied insurance claims to their policyholders simply because the accident you were in could have been avoided OR because your behavior caused the accident. Furthermore, claims have also been denied if your conduct was in conflict with your insurance policy. This practically renders your policy ineffective. And if the vehicle was operated by someone who is NOT included on the insurance policy or didn’t have a driver license when operating the vehicle…well that’s another potential reasons insurance claims get denied.

These are the most common reasons and mostly logical and valid. But what about if the insurance provider is using not valid reasons and starts acting in bad faith?

Insurance claim denied over previous injuries / surgeries

It’s a common practice that insurance companies ask their prospective policyholders to sign so called ‘medical authorization forms’. The important thing to point out about these forms is that you shouldn’t (under ANY circumstance) sign them until you’ve spoken to a personal injury lawyer. You must ask yourself ‘What’s the big deal about those forms?’. Well, when you sign those forms, you’re basically giving the insurance company permission to dig through your medical history and to look for previous injuries or surgeries.

If by any chance, you had injuries and surgeries for those injuries before, the insurance company could use that as a possible (but not really valid) reason for the accident and thus deny your insurance claim. Another example is that insurance providers may use previous injuries as an argument to diminish your injuries from the accident i.e. to present as less severe than they really are.

Pre-existing conditions

Another reasons why insurance companies require you to sign the medical authorization forms is so that they could see if you have any pre-existing conditions. Let’s say that you have pre-existing back injury and that you suffered new injuries in the accident. Since your back injury is a pre-existing condition, the insurance company can argue that the accident was cause because of your back problems and deny your claim.

Time of accident and time of seeking treatment

When you’re in a car accident it’s important that you seek medical treatment immediately. Waiting to seek treatment, may be another reason why your insurance provider refuses your claim. The lapse of time between the accident and treatment, can give ‘ground’ to the insurance provider to argue that your injuries are actually caused another even, not the accident.

Insurance companies go so far that they even state in their insurance contracts a specific time frame in which you need to seek treatment for your accident-related injuries. Of course, there are cases when it’s good to wait before seeking treatment and you can learn more about that from your personal injury lawyer.

Right after the accident, while on the scene, make sure that you don’t deny any injuries until you have been thoroughly checked out by a medical professional. Denying injuries at the scene of the accident may also be another reason why they deny your claim. So if you get into an accident seek medical evaluation at once.

What do to if your insurance claim is denied?

We must be clear on one thing. Insurance companies make profit from taking higher premiums from their policyholders than what they pay in claims. So their interest in denying insurance claims is quite significant.

In the event that your claim gets denied, you will need help from an experienced personal injury lawyer. Furthermore, policyholders that have a lawyer are taken more seriously.

Have you even wondered that paying for insurance is a waste of money?

Well, a lot of people have. Especially those who’s claims the insurance company denies. They have given their hard earned money for years and when they need help from the insurance company, they turn the other cheek.

Not sure if you know, but in the U.S. the insurance industry is one of the largest businesses in the world when it comes to revenue. So how do insurance companies deny claims in order to increase their profit?

1. Making your claim as confusing as possible

When you want to get new insurance, the insurance company is giving you a contract to sign. We all know about these and we read them thoroughly and carefully like the Terms & Conditions of our ne Apple iPhone i.e. we don’t. The insurance companies used so many technical terms in their contracts making them virtually impossible to understand for a common citizen who doesn’t have a Law degree. Things were so bad, that some states have passed the ‘plain English’ rule for consumer contracts.

2. Your credit score

You most likely know that insurance companies determine your premium that you’ll pay based on your credit score. Someone, due to a bad credit score can’t even get insurance because, from the insurance company’s point of view, they are a high liability. This type of discrimination is actually affecting the poor and senior citizens, since they have a little credit and also those that had a financial crisis because of someone else.

Insurance companies have also often refused someone a policy because they have no credit score, even though the person is paying his / her bills on time. On the other hand, some car owners have received a rate that is increased by several times, even though they have a clean and perfect driving record.

3. Delaying insurance claims

It’s not uncommon that insurance companies deliberately take a long time to finalize your claim. They do this because they are aware that many policyholders would rather give up than to wait for the insurance to finalize the claim. And it’s not uncommon that this type of ill practice is present at long-term care insurers who take advantage of the policyholder’s age and poor health.

4. Hanging the sick out to dry

As we know, healthcare in the U.S. can be expensive and that’s why we opt in for health insurance. Because of extremely high healthcare costs, some insurance companies have even provided bonuses for their employees that meet so-called ‘cancellation goals’. These situations involve insurance sales reps that target patients that are in the middle of their treatment(s) and when they are most vulnerable. When the healthcare for these patients becomes too high for the insurance company to cover, they cancel the policy retroactively and basically leaving the policyholder without insurance

5. Call and get your policy cancelled

A lot of people even fear calling their insurance provider and asking about for a claim because often, insurance providers quickly after, suddenly decide to cancel their insurance. If not cancelling, the next time they refuse to renew your policy OR even crank up your insurance premiums. Insurance companies often consider an inquiry about the possibility of making a claim as ACTUALLY making a claim and they will spare no resource to quickly ‘drop’ the policy holder, all in order to avoid paying them their insurance.

So what to do?

When an insurance company denies you’re your claim, they are basically leaving you out to dry.  In situations like that, you need to have a good legal representative by your side. So if your insurance is denying your claim, make sure to call Schenk Podolsky and let us help you with your insurance claim or if you have a personal injury claim.

Accidents are traumatic enough. But when you’re a victim of an accident, aside from the trauma, you’re also going through weeks and sometimes even months of treatment and rehabilitation, depending on what type of injury you suffered in the accident. Car accidents are painful enough, but then you even have to deal with the insurance company which can also be frustrating and long. Insurance companies serve and work in their best interest and it’s often the case that they reduce or even deny you claim to receive payment for the accident.

Insurance companies are not there to protect your rights, but their interests. They do this my presenting your injuries as small as possible and all that in order to reduce the amount they are owed to pay you as compensation.

What you need to know when working with insurance companies

When you have an insurance claim, the insurance company will give to an adjuster. The adjuster’s job is to take statements regarding the accident. Statements are taken from both drivers and furthermore, the adjuster will also review the accident report.

It’s likely that the adjuster will find that you had prior injuries or he/she might even deem that you’re the one responsible for your acceded which will surely further reduce your compensation. It’s also very common that the adjuster disagrees with your medical report and present your injuries as less severe that they really are. All these thing, make negotiations with the insurance company extremely difficult and very complicated.

Resolving an insurance claim

More than one factor influences how long it takes to resolve an insurance claim. If the outcome is favorable for the insurance company, they will tend to wrap up the process and quickly as possible. But it’s typical that tan insurance claim takes several weeks before it’s complete. And since the process can sometime be long and not to mention stressful, it’s beneficial to have a personal injury lawyer who can help with negotiations. Having a personal injury lawyer that knows the system can make things pretty straightforward. And in case the outcome of the insurance claim is not favorable for you, the matter needs to be handled by a court.

The insurance company denied my claim. What can I do?

Let’s assume that the insurance company denied your insurance claim or gave you a compensation that it’s not really what you deserve. In cases like these, there are a few things that you can do. The first thing is that you don’t sign any release or settlement check before you have a consult with your personal injury lawyer. Once you do speak to him/her, you have the right to waive taking any further legal action. Your personal injury lawyer will review all the details of the accident report and try to work with your insurance company in order to get you a better settlement. Proving your injuries are severe as claimed (if the insurance company presents them as not so severe) might require further medical documentation from your doctor. And in order to further support your case, accidents reconstruction can be used which will prove how the accident occurred. Your personal injury lawyer will send a demand package to your insurance company and in the even that they don’t agree / accept then you may sue and take the matter to court.

Working with insurance company is complicated and can be stressful if you don’t know how the system works. That’s why, in order to ensure best results and highest compensation, we recommend that you work closely with a personal injury lawyer.