The Most Common Reasons Insurance Companies Deny Injury Claims

by Staff | August 3rd, 2022

injuries can cost you thousands in medical bills and lost wages, with little to no respite offered by insurance companies that you might file a personal injury claim with.

These profit-driven insurance companies stay in business by denying or reducing settlements. They cite various reasons to justify their decision and hope you don’t question their reasoning.

Met with physical pain, hefty medical bills, and denied insurance claims, it is natural to feel helpless and frustrated, but you shouldn’t have to deal with it all on your own. The experienced San Francisco car accident lawyers at Berg Injury Lawyers specialize in injury claims and can help you fight for the compensation you truly deserve. 

A crucial part of building a strong case is understanding why your insurance company might deny your injury claim ahead of time.

The Accident and Injuries Are Your Fault

Since California is an at-fault state, insurance companies decide who is to blame for the accident. They do so by considering police reports, witness statements, photos, and videos of the accident scene. The insurance company of the individual at fault then compensates the victim with a monetary settlement.

The insurance company can deny your auto accident claim if evidence shows you violated a traffic rule, such as speeding or drunk driving, and causing the accident. If you are liable for the accident, it may affect the amount of compensation you receive.

California’s pure comparative negligence means your settlement is reduced by the percentage of fault you hold. So, for example, if the insurance company can prove you are 60% at fault for the accident, you will only receive 40% of your settlement.

You Aren’t Really Injured

Insurance companies can deny claims for injuries by claiming that no injuries were caused during the accident. They might use evidence from your social media accounts and personal life to prove that you did not suffer injuries or that they are less severe than you claim.

If you post a photo on social media of yourself enjoying a party after claiming compensation for your injuries, the insurance company may use the image against you to deny your claim. Your social media accounts can also track your location, proving you were active after the accident to the insurance company.

A Pre-Existing Condition Caused Your Injury

Insurance companies can also deny injury claims because of pre-existing health conditions. They might argue that your injury is not caused by the car accident but is instead a result of a health problem, that you were already struggling with prior to the accident.

For example, your insurance company may attribute the crippling pain in your knee joint to arthritis instead of the trauma caused by the accident.


Your Injury Was Not Caused By the Car Accident

Insurance companies sometimes also deny claims by simply stating that the car accident did not cause your injury. If you suffer an injury such as a torn rotator cuff, they might argue that repetitive motions and heavy lifting from your job caused the injury. If the car insurance company does not have evidence connecting your injury to the car accident, you will not receive compensation for the injury.

Your Injury Was Avoidable

Insurance companies often cite failure to mitigate or avoid the injury as reason enough to deny you your rightful insurance claim. They may argue that you could have reasonably avoided the accident or prevented the injury by taking some necessary steps, making you responsible for the injury and hence ineligible for any compensation.

The same argument can ‌reduce, if not completely deny, your settlement. If the insurance company thinks you are equally responsible for the injury, your settlement could be negatively affected.

Injury Claim Denied: Now What?

Even though a claim denial can be prevented by building a strong case, a denied injury claim is common and does not mark the end of your settlement journey. You can work with your legal team to persist in pursuing your claim with more aggressive tactics.

Your attorney from Berg Injury Lawyers can negotiate with the insurance company, providing proof of your injuries and how their client was at fault for the accident. If the insurance company won’t make a fair settlement offer, your lawyer can threaten legal action and take the case to court.

Many insurance companies end up paying out a fair settlement to avoid costly litigation, so working with a lawyer who understands this element can help you get maximum compensation.

Schedule Your Free Case Review

If you suffer injuries in a car accident in California and face a denied claim, contact Berg Injury lawyers to help you reverse the decision and get a fair settlement. We will fight on your behalf and ensure you know your legal options.

Book a free consultation with our skilled car accident lawyers for a free case review to get started on your settlement.