Legitimate Reasons Why an Insurance Company Can Deny Your Personal Injury Claim
When you’ve been injured in an accident, filing a personal injury claim with the at-fault party’s insurance company is often the first step toward getting compensation. But what happens if your claim gets denied? While some denials may be based on bad faith or error, there are several legitimate reasons an insurance company might refuse to pay out. Understanding these reasons can help you better prepare your case and avoid costly mistakes.
Lack of Medical Evidence
Insurance companies require proof that you were injured and that your injuries were caused by the accident.
If you did not seek medical treatment soon after the incident, or if your records do not clearly link your injuries to the event, your claim could be denied.
As a result, make sure you clearly document your injuries. If no documentation, the insurer may argue that your injuries are minor, unrelated, or nonexistent.
Delayed Reporting of the Accident
Timely reporting is crucial. If you wait too long to notify the insurance company of the accident or your injuries, they may view the delay as suspicious.
The insurer might claim they were deprived of the chance to investigate your accident properly or question the severity of your injuries.
Policy Exclusions or Lapses
Insurance policies have exclusions, or types of incidents or damages that are not covered or cannot be paid out on.
For example, injuries resulting from intentional acts, criminal behavior, or being under the influence of drugs or alcohol are often excluded.
Additionally, if the at-fault party’s policy had lapsed due to non-payment or cancellation, there may be no coverage available at all.
Disputed Liability
Sometimes, an insurance company denies a claim because it believes their policyholder was not at fault.
If there’s conflicting evidence or no clear indication of who caused the accident, the insurer may reject the claim pending further proof—or deny it altogether.
Pre-Existing Conditions
Insurers may try to deny or reduce claims by arguing that your injuries were pre-existing and not caused by the accident.
While you can still recover compensation if an accident worsens a pre-existing condition, you’ll need strong medical evidence to show the aggravation is real and significant.
Contributory or Comparative Negligence
Depending on your state’s negligence laws, if you were partially or mostly at fault for the accident, the insurer may deny your claim or offer a reduced payout.
In some states, being even 1% at fault can bar recovery entirely. Others allow partial compensation based on your share of the blame.
Inconsistent Statements
If your story changes over time or does not match the evidence, insurance companies may question your credibility and deny the claim.
This applies to statements you make to police, the insurer, medical providers, or in legal filings.
Always be truthful and consistent when describing the incident and your injuries.
Failure to Mitigate Damages
After an injury, you have a legal duty to “mitigate” your damages. That is, you have to take reasonable steps to recover and not make your condition worse.
If you skip follow-up appointments, ignore medical advice, or delay treatment, the insurer might argue you failed to minimize your losses and deny or reduce your claim.
Contact Justice Through Compensation for Help
If you or a loved one was injured in an accident, please know that the law firm of Justice Through Compensation is here to help. Our legal team is skilled, experienced, and passionate in their representation. Let us shoulder the burden of an injury claim or lawsuit while you focus on healing from your injuries. Contact us today for the quality legal help you deserve.
* Main image at top by freepik