Five Key Reasons Why Insurance Companies Deny Personal Injury Claims.
Maryland Insurance companies deny hundreds of claims each week. Perhaps the principal reason insurance companies use to deny claims concerns their oft-raised contention that:
There was not enough property damage to the involved vehicles for any the occupants to have been hurt.
This is nonsensical in many ways, as there is no medical or scientific support for this position, i.e. that their is a connection between observable property damage and the likelihood or severity of injury. However it does have some common sense appeal. And indeed, insurance companies have been extraordinarily successful in selling this argument to judges and juries over the course of the last 20 to 30 years.
Insurance companies will frequently point to an alleged pre-existing or underlying condition as a reason to deny a claim. The argument here is that, although someone may have sustained trauma as a result of a motor vehicle accident
Their injury was really not related to that after all, but rather related to arthritis or a degenerative process at work in someone's body.
This can be also seen as nonsensical in many regards. Everyone of a certain age is going to have degenerative changes in their joints and their body, generally. I’ve had countless clients over the years how have had their claims denied based on this contention ask me: “If this was all pre-existing, why did it not hurt before”. I have always found this to be a great questions, posed by someone, suffering with pain they did not have before an accident, who is confused, perplexed, and likely angered by an insurance claims adjuster they have never met, contending this they actually, perhaps secretly, had the conditions all along.
Medical evidence is complex, and medical findings are subject to multiple interpretations. It is easy for an insurance company to find a doctor who will say “Ah ha”, this person's pain complaints come not from an accident, but rather because of degenerative changes in the affected body part -in his or her opinion.And the insurance company does find these doctors, who are most often skilled and seasoned professionals, who render competent, believable opinions.
Their insured did not cause the accident.
Of course an insurance company may always deny a claim by saying or contending that their insured did not cause the accident – the plaintiff did. The Plaintiff always carries the burden of proof, and part of that burden is to show the other, at-fault party, caused the loss.
The Plaintiff was contributorily negligent.
We often see a related denial. Of course an insurance company may always deny a claim in a contributory negligence jurisdiction, such as Maryland, by saying or contending that their insured did not cause the accident – the plaintiff did. Maryland law recognizes the archaic doctrine of contributory negligence which prohibits a plaintiff, who contributed to the happening of an event in even the slightest manner, from any recovery whatsoever. Where the insurance company asserts that injured person was contributory negligent, and therefore not entitled to recover, or where there is a factual dispute regarding the causation of a motor vehicle accident these matters typically must be resolved in court by trial.
Some insurance companies are known to deny claims, or make an offer that is so unreasonably low as to have the same effect as a denial, on the basis that:
The injuries involved are “merely soft tissue”.
“Soft tissue" in this context is an insurance company code phrase, meaning:
- not hurt
- not injured, or
- not believed.
The argument here is that the injuries are not broken bones, or severe lacerations, but rather injuries to the muscles, ligaments, and tendons and therefore, are not serious, and that a person that sustained them should not be appropriately compensated.
Insurance companies have valid reasons for denying claim. For example if they can prove fraud, and the person is feigning injury or has staged an accident, clearly that claim is appropriately denied. Likewise, if an insured person does not cooperate with his or her insurance company, then the insurance company is well justified in denying coverage, and therefore, the claim the injured person has brought.
I’ve prosecuted thousands of personal injury claims over the years. While I certainly cannot say I’ve seen every reason that an insurance company might use to deny a claim – I’ve certainly seen a lot of them. I invite all potential clients to participate in a no-cost analysis and strategy conference. Contact me today to arrange a time to meet. 410 591 2835, or simply complete the form at the bottom of this page.
-This Article was updated by Eric Kirk on 8/3/20.