October 26, 2023
Can My Insurance Deny My Personal Injury Claim?
By Jonathan Damashek
When insurers deny or devalue a personal injury claim, victims often give up on their pursuit of compensation. They might accept defeat and pay for their injuries out of pocket without realizing they can challenge the denial.
You can—and should—fight an unfair insurance denial after an accident in New York City. Work with a seasoned personal injury lawyer to ensure you understand the claims process. Your lawyer can help you identify red flags, work on a denied claim, and fight for the compensation you deserve.
Types of Insurance Policies in an NYC Accident Claim
For workplace accidents, you can file for workers’ compensation, another type of no-fault insurance. The insurance carrier for state employees is the New York State Insurance Fund (NYSIF).
No-fault insurance covers medical treatment, lost wages, death benefits, and other economic losses. This coverage is limited. For more significant injuries and property damage, no-fault insurance may fail to cover your losses. You may be able to pursue a third-party liability claim to recover fully.
For construction accidents, various insurance policies could cover your injuries. General contractors and site owners are required to carry commercial general liability (CGL) insurance. There’s also product liability insurance, disability insurance, premises liability insurance, commercial auto insurance, and other insurance policies to consider.
Why New York Personal Injury Claims Get Denied
You may have received a “denial form” from your insurance company stating that some or all of your claim has been rejected. In car accident cases, the form looks like this. Insurance companies are required to tell you why they denied your claim.
There are various reasons for denial they might use, such as:
- Your policy lapsed due to unpaid premiums
- You weren’t covered under the policy
- A personal vehicle was being used for a business purpose
- Lack of or late notification
- You failed to receive immediate medical care
- The third-party policyholder is not at fault (for a third-party liability claim)
- Your claim is allegedly fraudulent
- Lack of medical records establishing an injury
- You had a pre-existing condition
Many of these issues can be resolved or even prevented when you by working with experienced personal injury attorney.
If you are notified of a claim denial, a legal professional can review the insurer’s reasoning for denial. They can evaluate if it is valid. Insurance companies often take advantage of personal injury victims who do not know their rights. Your attorney can fight back against a wrongful claim denial.
How NYC Insurance Companies Devalue a Claim
Insurance companies use many tactics to deny personal injury claims. They might argue that your injuries are not as severe as you make them out to be, or that you had a pre-existing condition. These insinuations can be difficult to hear as a survivor of a traumatic accident. Don’t let their lies discourage you from seeking full relief.
Here are some sneaky ways an insurance company might try to devalue your personal injury claim.
Offering a Lowball Settlement
Insurance companies want you to settle for as little as possible, as soon as possible. They might pressure personal injury victims to accept lowball offers, so the company can quickly resolve the claim and pay substantially less than the victim deserves.
Never accept an initial settlement offer, no matter how good it might sound. Your attorney can negotiate a higher offer for you.
Delaying Your Claim
Your insurance company might try to delay your claim. They’re looking for ways to get you to back down or accept their first offer. They might pass your claim to multiple insurers in to prolong the process, or repeatedly request documents you’ve already provided.
Disputing Third-Party Liability
In third-party liability claims, insurers might argue that their policyholder is not the liable party, thus not required to cover your damages. This can be another way to avoid paying you what you deserve after an accident. Your attorney can take your personal injury case to court when a stubborn insurance company refuses to pay.
Independent Medical Examinations
Insurers might refer you to an independent medical examiner for an evaluation after a workplace accident. Insurance companies often seek out these medical professionals themselves, opting for those with a record of disagreeing with victims. Remember: insurers want to control the outcome of your claim, regardless of what they tell you.
Bad Faith Tactics
According to New York Consolidated Laws Ch. 28 § 2601, an insurance company should act in “good faith. That means they should approach your claim reasonably, honestly, and fairly.
Unfortunately, this does not always occur. Insurance companies want to pay as little as possible. Sometimes, their tactics are unlawful.
There are ways an insurance company might act in bad faith, such as:
- Intentionally misrepresenting the facts or clauses in your coverage policy
- Failing to acknowledge communications related to your claim in a timely manner
- Lacking the proper standards to investigate your claim
- Not informing you whether your claim was approved or denied within 30 weekdays
- Tampering with your cost data, or using data that is inapplicable to your accident’s location
If your no-fault insurance company denies your claim in bad faith, you can take action against them.
How to Resolve an Insurance Claim Denial in New York
If you hope to reverse your claim denial and pursue the compensation you are owed, there are a few routes you can try, like:
File a Complaint
An effective way to challenge a claim denial is to file a complaint through the New York State Department of Financial Services (DFS). Your attorney can help document evidence that proves the extent of your injuries. You can use records like photos, medical documents, and police reports from your accident. This evidence backs your side of the story and allows the DFS to address your complaint appropriately.
File an Arbitration
Arbitration is a process where an independent party can resolve a dispute between two entities or individuals. You can file an arbitration against your insurance company to settle the issue. Your attorney can help you file a claim and, from there, help you file an arbitration through the American Arbitration Association (AAA).
Your lawyer will gather documentation of your contention to support your arbitration, such as medical bills, police reports, and affidavits.
File a Lawsuit
A lawsuit against the insurance company might be your only option. You can sue a third-party’s insurance or your own company if they refuse to uphold the law and pay what you deserve.
Contact a New York Personal Injury Attorney at HKD Today
After a personal injury accident in New York City, you deserve to have as smooth of a recovery as possible. If an insurance company adds to your stress by denying your valid claim, seek out an aggressive and experienced personal injury attorney. The legal team at Hecht, Kleeger, & Damashek, P.C. can push back on your claim denial and help you secure the full amount of compensation you need.
Contact HKD at (212) 490-5700 today to schedule a free consultation with our dedicated firm.