Why Do Insurance Companies Deny Personal Injury Claims?

If you stop and think about things for a moment, personal injury lawyers and their staff of assistants would have to practice in other areas of the law if the insurance companies approved every accident claim and paid the maximum allowable compensation. In a perfect world, if insurance companies were paying out the total value of a personal injury claim, why would the claimant bother with hiring a Toronto personal injury lawyer? The answer is they wouldn’t need to.

However, this is not a perfect world and the reality is that ALL insurance companies want to be profitable and that means operating in their own best interests and not yours. Many of the major insurance companies located in Ontario Province and throughout Canada trade on the TSX (Toronto Stock Exchange), some of which sell shares of their stock for a lot of money. Regardless of how well a company’s stock shares did during the year, the value of them would drop significantly if they paid out on every claim.

So if your personal injury claim was recently denied and you are wondering why, or if your insurer refused to believe your doctor’s account of your injuries, you can safely assume that their reasoning is purely financial in nature. While your claim and what your physician has said about your injuries may indeed be 100% truthful and valid, there have been numerous cases where adjusters were incompetent or negligent as well. While this may seem unfair, it is the primary reason you should always talk to a lawyer. With plenty of lawyers available who have been successful in navigating through the myriad of obstructions posed by the insurance companies and have successfully been able to win compensation for their clients, they need to be contacted.

In many cases, the main reason that insurance companies deny personal injury claims or do not believe your disability claim may be attributed to independent medical exams or independent medical reviews. While these should be done on an in-person basis, they are oftentimes conducted as a simple paper review. In paper reviews, insurers will send all of the documentation and related information over to one of their physicians or rehabilitation therapists to assess a claim’s merits.

Unfortunately for the injury victim or plaintiff in the case, the assessment is conducted without anyone meeting or even speaking to you. Seems rather strange doesn’t it? For something as crucial as a personal injury claim and the medical documentation to back it up, why would this be done without an interview, meeting, or physical examination? You may be entitled to compensation for your injuries and a personal injury lawyer will ensure that your right to that compensation is always protected.

In addition to the above, there are other reasons why your insurer may have denied your personal injury claim such as:

  • Claim was incomplete or contained discrepancies and errors
  • Coverage expired or lapsed
  • Failure to mitigate or avoid the accident altogether
  • Insurance policy exclusions
  • Medical records were very limited or there was none at all
  • Treatment delays
  • You had a preexisting condition

Believe it or not, many personal injury claims are denied for reasons listed above on a fairly regular basis. While your injuries are very real and you may feel that you have a valid personal injury claim, it is difficult to predict whether or not the insurance company is going to approve or deny you compensation. However, as evaluation is done at different levels, only an experienced lawyer will be able to work on it and find a solution so that you can be compensated.

So what are your options? First and foremost, your insurer must always act in good faith where these types of claims are concerned. That duty is breached when the denial of a claim is unwarranted or the insurer fails to investigate a claim or negotiate a settlement. Furthermore, if the insurance company fails to provide the claimant with a valid reason for the denial to their claim, the claimant’s best option is to contact an experienced personal injury lawyer. Visit here for more info.