Insurance is defined as an arrangement where a company provides a guarantee of compensation for a specified loss, damage, illness, or death in return for payment of a premium. As part of the Massachusetts Auto Insurance Policy, bodily injury coverage to others is compulsory (required by law). It is compulsory insurance because Massachusetts law requires you to purchase all compulsory insurance, including Bodily Injury to Others, before you can register your auto.
Generally, if the insured, or authorized driver of their car, is found legally responsible for causing a car accident, the bodily injury part of the insurance policy is available, up to the limits purchased, to pay for the costs associated with the injuries to other persons involved. In a perfect world, this sounds great. However, an insurance company will scrutinize the facts of the motor vehicle accident in hopes of denying coverage for personal injuries. This can occur even when liability appears reasonably clear and the accident victim sustained legitimate injuries. Having an insurance company deny your claim can be stressful and leave many people unsure of how to proceed. Understanding why an insurance company may deny a bodily injury claim may help accident victims avoid the pit falls and mistakes that many people make that can lead to a denial.
Filing the Claim for Bodily Injury
Following a car crash where someone was injured, a claim is filed against the negligent drivers’ insurance company. The injured party’s claim can seek financial compensation for lost income, medical bills, medical expenses, and pain and suffering. Filing a claim for bodily injury will prompt an investigation by the insurance company into the cause of the car accident and injuries the claimant sustained.
As part of the investigation, the insurance adjuster will, among other things, speak to their insured and witnesses, review photographs, and want to speak to the injured party and obtain their statement. Once the investigation is complete, the insurance company can accept liability or deny the claim.
Common Reasons Bodily Injury Claims are Denied
Various excuses are used by insurance companies to try to wane their way out of their financial obligation to provide compensation to the injured party. This can happen even when liability appears clear and when obvious damages and injuries have been sustained. Here are some of the common reasons a claim is denied.
The Insurance Company Blames You for the Accident
An insurance company may argue that you, and not their insured, caused the accident. Proving liability is an extremely important factor in a personal injury case. Liability determines who is at-fault and legally responsible for the accident and injuries. If the other driver is not found to have been liable for the accident, an accident victim may have difficulty obtaining a settlement to compensate them for their injuries and damages.
For example, assume a driver made a left turn in front of you and caused you to collide with them in an intersection that resulted in you sustaining a severe back injury and head injury. You file a claim for bodily injury. An insurance company speaks with their insured, who tells them that they had a green arrow allowing them to turn and you were speeding through the intersection. You contend, however, that you had the green light and were not speeding. Based on this, an insurance company may deny your claim, concluding that you were at fault for the accident.
The Driver of the Insured’s Car Was an Unauthorized User
An insurance company may deny a claim for bodily injury if the driver of their insured’s vehicle was not authorized to use it. The standard Massachusetts Automobile Insurance Policy provides that the insurance company will pay financial compensation to an injured person only if the insured or someone else using the insured’s vehicle with their consent is legally responsible for the accident. So, if the driver of the insured’s vehicle was not authorized to drive the car, and he or she caused an accident that injured someone, the insurance company may deny the claim.
For example, in a recent case we handled, our client was injured when he was involved in a car crash in Framingham with a commercial van. The van was clearly at fault, but the insurance company denied the claim, asserting that the driver of the van was an unauthorized driver. We were still able to obtain compensation for our client under his Uninsured Coverage portion of his own insurance policy.
Low Speed, Low Impact Collision
Insurance companies often deny bodily injury claims alleged to have occurred in low speed impact accidents with questionable injuries. Insurance adjusters are generally skeptical, but in low speed, low impact accidents, they often don’t believe someone could have been injured. Basically, they think the injured person is lying. This happens with soft tissue injuries, such as a neck sprain or whiplash injury. In these situations, an insurance company will refer these claims to their Special Investigations Unit (SIU). The SIU adjusters are often cynical and work hard to try and prove the claimant was not injured. They often deny these claims.
Delays in Seeking Medical Attention
An insurance company may deny a claim for bodily injury when the injured party delays in getting medical attention for their injuries. Often, people make the major mistake of waiting too long to get medical attention after being hurt in a car accident. Seeking medical treatment soon after the accident will lend credibility to the claim that you were actually injured. Upon the filing of a claim, an insurance company will want to know about the injuries and when and where the injured person treated. If the injured person did not get medical attention for their injuries for months after the accident it can create an issue with the bodily injury claim. A significant delay in seeking medical attention can result in a claim being denied. Basically, the insurance adjuster will not believe the claimant was injured in the accident. For this reason, if you are injured in a car accident, it is very important that you seek medical attention right away.
Late Filing of a Bodily Injury Claim
Another reason an insurance company may deny a claim is because the bodily injury claim was filed late. In Massachusetts, you have three (3) years from the date of the accident to file your personal injury lawsuit. This time limitation is called the “statute of limitations.” If a personal injury lawsuit is not filed within the three (3) year limitation, you will be forever barred from filing the lawsuit. If a claim is filed with an insurance company three years after a car accident that caused injuries, an insurance company will deny the claim. They know that a lawsuit cannot be filed beyond three years.
What can be Done if a Bodily Injury Claim is Denied?
If an insurance company denies a claim for bodily injury, it doesn’t end the pursuit for financial compensation. Just because the insurance company doesn’t accept liability, doesn’t mean they are right. The injured party has the option of filing a personal injury lawsuit. Our court system is designed to resolve legal disputes. Often, a denied claim is disputed by the injured party and he or she can file a lawsuit to seek compensation for their damages, including medical bills, lost wages, and pain and suffering.
Denials of coverage by an insurance company can be stressful and troubling, especially when you are trying to recover from your injuries. And no one wants to be called a liar. Therefore, anyone, whose claim for bodily injury is denied, should consult with an experienced personal injury attorney. A Massachusetts accident lawyer can properly advise the injured party on their legal options, protect their legal rights, and fight for fair and just compensation to hold the negligent person and their insurance company accountable.
If you have been injured in a car accident and the insurance company has denied your claim, feel free to contact us, or call (508) 879-3500 to schedule a complimentary consultation and see how we can help you.