If injury claim is denied, take action
Texas personal injury law provides a procedure for people who have been injured in a car accident caused by another driver to receive compensation for injuries and damages. However, it’s not an easy process. After you have tried to represent yourself by filing your claim, you often will get a letter or phone call saying that the company has denied it. Is it allowed to do that? What should you do in response?
Why are claims denied?
It is obvious that the claims adjuster works for the other driver’s insurance company, not you. His job is to carefully review each claim and either (a) find a way to deny it or (b) pay out as little money as possible. It is in the company’s best interest to deny claims. A few small companies even seem to make it their business model to deny every claim, hoping injured people go away. Then they get to keep the money they had reserved as profit.
These are the main reasons a claims adjuster uses to justify denying a claim:
- The driver did not have liability insurance: Even though Texas law requires that all drivers carry minimum liability coverage of $30,000 for any one person’s injuries, $60,000 for all people’s injuries, and $25,000 for property damage, approximately one-fourth of drivers here are not insured. But a lot of these people have fraudulent identification cards or official insurance cards that have expired that they hand to the police officer or you at the scene. This is an old trick that can cost you a lot of money unless you have purchased uninsured motorist coverage or file a lawsuit against the other driver and hope to get him to pay your damages, usually not worth your time and money.
- The driver or vehicle was excluded from coverage under the policy: this is similar to the above, when the other driver claims he is covered but you later learn that he was excluded. This often happens with teenage drivers, older vehicles, or where people are trying to save money and only list one person or car on the policy.
- The policy does not cover the accident or excludes the location where the crash occurred. There are other exclusions, including vehicles used for business purposes, ride-sharing (Uber and Lyft), racing, out of country crashes, and intentional collisions.
- The adjuster claims that you were entirely or at least more than 50% at fault: We fight this a lot at Berenson Injury Law. But the adjuster did not witness the claim and only gotten his insured driver’s side of the story. The police officer who may have written a report that partially or entirely blames you for the crash didn’t see it happen either. The adjuster will ask you for a recorded statement. If he does, this should be a red flag that you need to consult with a personal injury lawyer.
- He claims that you did not timely report the accident to the police or his insurance company: Texas law does require a motorist to report a car accident within 10 days if the police did not write a report, but we have never seen that enforced. A good police report speeds up the claims process and the officer will be available to testify at trial if needed. The sooner an injured person reports the claim to all available insurance companies, the better, but there is no specific time deadline for doing so.
- He claims that another driver or condition caused the accident: If another driver is also at fault for causing the car wreck, you should also file on his insurance company and split the liability, say 70-30. This happens on a regular basis. If the adjuster tries to claim that the weather was to blame, e.g. that his driver couldn’t see because the sun was in his eyes or the roads were too wet, you need to call up a car accident lawyer because this is not a valid excuse.
- He claims that you were not injured in this accident: You will have to order and obtain your medical records and bills if you expect to be reimbursed for your medical expenses, pain, disfigurement, and other damages. The adjuster is not a trained medical professional but often acts like one.He may claim that you did not go to the emergency room immediately, and if you did, that you were not transported by an ambulance. He will quibble with the treatment you received or the test results. He may distort your prior medical history and say you were already hurt or had been hurt years ago and that is why you are now claiming you were injured. If he claims these reasons as an excuse for not compensating you, you need to have an injury lawyer review your file and advise you.
- He claims that your medical bills were paid by your own health insurance or another source: this is a complicated area of personal injury law. Between the “paid vs. incurred” statute, subrogation claims, and multiple sources of recovery, the value of a personal injury claim is affected.
- The claim exceeds policy limits: In the typical $30/60/25K policy, there is often not enough money to go around. Wait too long and the adjuster may have already paid out the available proceeds to other people involved in the crash.
- You are not represented by a good injury attorney: The adjuster knows that you don’t know insurance and legal procedures, that he can intimidate or confuse you, and you might drop your claim. Many people do.
Your next steps
If you are still trying to represent yourself, write a letter to the claims adjuster and submit your evidence rebutting his assertion. Request a detailed written explanation for the denial. File a complaint with the Texas Department of Insurance.
If and when he continues to deny the claim, hire a Fort Worth personal injury attorney who can give you the best advice on how to proceed.
Contact us if you need our help. We’ll fight to get you the compensation you deserve.