Insurance companies sometimes deny motor vehicle accident and slip and fall claims for various reasons. In some cases, they may argue that the accident victim caused or contributed to the occurrence – or that coverage was not effective at the time of the occurrence.
In fact, insurance companies have a strong incentive to deny claims. These companies are big businesses, and they will do anything they can to keep their money in-house.
If an insurance company recently denied your claim for compensation, it’s important that you contact a skilled personal injury lawyer right away. Your lawyer can fight the claim denial by filing a lawsuit and litigating your case through the court system – or taking some other action on your behalf. Throughout the process, your lawyer will do everything possible to help you recover the compensation you need for your accident-related losses.
Common Injuries and Damages in Motor Vehicle Collisions and Slip and Fall Accidents
In motor vehicle collisions and slip-and-fall accidents, individuals can suffer from a wide range of injuries, including all of the following:
Motor Vehicle Collisions:
- Whiplash – This is one of the most frequent injuries in car accidents. It happens when the victim’s head jerks forwards and backwards suddenly, straining the ligaments and neck muscles.
- Fractures – Broken bones are common in car accidents due to the force of impact. Common fractures include broken arms, legs, ribs, and collarbones. These injuries often require immobilization, bracing, casting, and sometimes surgery to heal properly.
- Concussions – A concussion is a severe type of traumatic brain injury (TBI) resulting from a strong blow to the head. Symptoms may include headaches, dizziness, confusion, and sometimes loss of consciousness.
- Back Injuries – The spine can also become injured in a collision, leading to conditions like herniated discs or spinal cord injuries. These injuries can cause pain, numbness, or weakness in the back and legs and sometimes lead to long-term disability.
Slip-and-Fall Accidents:
- Sprains and Strains – These are common in slip-and-fall accidents, often affecting the ankles, knees, or wrists. A sprain involves stretching or tearing of ligaments, while a strain affects muscles or tendons. Both can be painful and limit mobility.
- Fractures – Like in vehicle accidents, fractures can occur in slip-and-fall incidents, particularly in the arms, legs, or pelvis. Falls often result in broken bones because the victim may try to catch themselves during a fall.
- Head Injuries – If a person falls and hits their head, it can result in concussions or more severe TBIs. Symptoms similar to those of a concussion may appear, such as confusion, memory problems, and headaches.
- Back and Spinal Injuries – Falling can cause damage to the spine or back muscles. This can lead to chronic pain, herniated discs, or even nerve damage, affecting a person’s ability to move freely.
- Soft Tissue Injuries – These include bruises, cuts, and scrapes. Though they may not be as severe as fractures or concussions, they can still be painful and require care to heal properly.
How do Motor Vehicle Accidents and Slip and Falls Occur Due to Others’ Negligence?
Motor vehicle accidents and slip and fall incidents often occur because of someone else’s negligence.
Motor Vehicle Accidents:
- Distracted Driving – One of the main causes of car accidents is drivers becoming distracted. This can include texting, talking on the phone, or adjusting the radio while driving. When drivers are not paying full attention to the road, they may miss important signals or react too late to sudden changes.
- Speeding – Driving over the posted speed limit is another major factor in accidents. Speeding reduces a driver’s ability to react to hazards quickly. If a driver is going too fast, they may not have enough time to stop for a red light or avoid an obstacle, increasing the risk of a crash.
- Driving Under the Influence – Alcohol and drugs impair a driver’s ability to make sound decisions and react quickly. This can lead to poor judgment, slower reaction times, and a higher likelihood of causing an accident.
- Reckless Driving – Aggressive driving behaviours, such as tailgating, weaving in and out of traffic, or running red lights, show a disregard for safety rules. Such actions can easily lead to collisions and endanger everyone on the road.
- Poor Vehicle Maintenance – Neglecting regular maintenance can result in vehicle malfunctions. For example, worn-out brakes or bald tires can cause accidents if the vehicle is not properly maintained.
Slip-and-Fall Accidents:
- Unsafe Property Conditions – Slip-and-fall accidents often occur because property owners do not address unsafe conditions. This can include wet floors, uneven surfaces, or poorly lit areas. When property owners fail to fix these issues or provide warnings, they significantly increase the risk of accidents.
- Negligent Cleaning – Sometimes, businesses or property owners do not clean up spills or messes promptly. For example, a wet floor in a grocery store that isn’t marked with a warning sign can lead to slips and falls.
- Faulty Repairs – If property owners or managers make faulty repairs, it can create dangerous conditions. Broken handrails, loose floor tiles, or uneven pavement are examples of how improper maintenance can lead to accidents.
- Inadequate Lighting – Poor lighting conditions can make it difficult for people to see potential hazards. For example, if a walkway is poorly lit, it increases the chance of tripping over obstacles that are not visible.
Why May the Insurance Company Try to Deny My Claim?
Insurance companies sometimes deny claims related to motor vehicle accidents or slip-and-fall incidents for various reasons.
Common Reasons for Denial:
- Lack of Sufficient Evidence – Insurance companies may deny claims if they believe there is insufficient evidence to support the claim. This may mean a lack of medical records, police reports, or other documentation proving the extent of the injuries and how the accident occurred.
- Pre-existing Conditions – If the insurance company argues that your injuries were due to pre-existing conditions rather than the accident or fall, they may deny your claim. They may scrutinize your medical history to find evidence that your injuries did not result from the incident in question.
- Disputed Liability – Insurers often deny claims if there is a dispute about who is at fault. In motor vehicle accidents, if the insurance company believes the accident resulted from your own negligence or if liability is shared, they may refuse to fully compensate you.
- Policy Exclusions – Insurance policies often have specific exclusions. If your situation falls into one of these categories, such as an accident involving an unapproved driver or an excluded activity, your claim may be denied based on these policy terms.
- Failure to Follow Policy Terms – Insurance policies have specific requirements for filing claims, such as reporting the accident within a certain time frame or cooperating with the insurer’s investigation. Failing to meet these requirements can result in a claim denial.
How a Lawyer Can Help:
- Gathering Evidence – A lawyer can collect and organize the necessary evidence to support your claim. This includes obtaining medical records, accident reports, witness statements, and any other relevant documentation to build a strong case.
- Negotiating with Insurance Companies – Lawyers are skilled negotiators who can engage with insurance companies and their adjusters on your behalf. They can argue against unjust denials, counter low settlement offers, and ensure that the insurance company adheres to fair practices.
- Understanding Policy Terms – A lawyer can review the insurance policy to understand its terms, including any exclusions or requirements. They can identify if the insurance company is incorrectly interpreting the policy or if they are inappropriately denying your claim.
- Filing Appeals – If your claim is denied, a lawyer can file an appeal with the insurance company. They can present additional evidence or arguments to challenge the denial and push for a fair resolution.
- Representing You in Court – If negotiations fail, a lawyer can represent you in court. They can file a lawsuit if necessary and advocate for your rights to ensure that you receive the compensation you deserve.
What are my Options if the Insurance Company Denies my Claim?
If your insurance claim for a motor vehicle accident or slip-and-fall incident is denied, you have several legal options to consider, including litigation. Here’s a breakdown of your options and the steps involved in each:
- Request a Review or Appeal – Start by requesting a formal review or filing an appeal with the insurance company. This process involves presenting additional evidence or clarifying misunderstandings about your claim. Provide any new information or documentation that may support your case. Sometimes, the insurer may overturn the denial or offer a more favourable settlement.
- Negotiate a Settlement – Before resorting to litigation, you may engage in settlement negotiations. This involves discussing your claim with the insurance company to reach an agreement outside of court. An experienced lawyer can negotiate a fair settlement on your behalf, leveraging their knowledge of insurance laws and practices to advocate for your interests.
- File a Complaint with a Regulatory Agency – If negotiations fail and you believe the insurance company acted unfairly or violated regulations, you (through your lawyer) can file a complaint with an insurance regulatory agency. These agencies oversee insurance practices and can investigate complaints, potentially leading to a resolution without going to court.
- Pursue Alternative Dispute Resolution (ADR) – ADR methods, such as mediation or arbitration, offer alternative ways to resolve disputes outside of court. Mediation involves a neutral third party helping both sides reach a mutually acceptable agreement, while arbitration involves a third party making a binding decision. ADR can be less formal and faster than traditional litigation.
- File a Lawsuit – If other options fail, you can file a lawsuit against the insurance company. This legal action involves presenting your case in court, where a judge or jury will make a determination. Litigation can be time-consuming and costly, but it may be necessary to obtain fair compensation. Your lawyer will help prepare your case, gather evidence, and represent you throughout the legal process.
By exploring these legal options, you can effectively address a denied insurance claim and pursue the compensation you deserve.
What Happens During a Trial Where the Insurance Company Denies My Claim?
During a trial where the insurance company has denied your claim, the process unfolds in several important stages. The trial itself begins with opening statements, where both sides present their initial arguments to the judge or jury. These statements outline what each side will try to prove and set the stage for the evidence they will present.
After the opening statements, the plaintiff accident victim will present their case first. This involves introducing evidence and calling witnesses to support your claim. For instance, you may bring in experts to testify about why the insurance company should have paid the claim or witnesses who can speak to the effects of the denial on your life. The goal is to convince the judge or jury that the insurance company acted unfairly or improperly.
Once your side has presented all its evidence and witnesses, the defence will have a chance to present its case. The insurance company will introduce its evidence and call its own witnesses to argue that the denial was justified. They may present documents, expert opinions, or other evidence to support their position.
After both sides have finished presenting their cases, the next phase is the closing arguments. This is where each side summarizes its main points and tries to persuade the judge or jury to rule in its favour. Your lawyer will have an opportunity to argue why the evidence supports your claim and why the insurance company’s denial was wrong.
Finally, the judge or jury will deliberate. They will review all the evidence and arguments presented during the trial and make a decision. If the decision is in your favour, the court will order the insurance company to pay the claim or provide the compensation you are seeking.
Contact an Experienced Personal Injury Lawyer Right Away
If an insurance company recently denied your motor vehicle accident or slip and fall claim, it’s essential that you have skilled legal representation in your corner as soon as possible. A knowledgeable personal injury lawyer can take on the insurance company directly and, if necessary, litigate your case to a successful resolution in the court system.
