What Defenses Do Insurance Companies Use To Avoid Paying Out On Personal Injury Claims?
If you have a personal injury claim, you may be experiencing difficulty with making a claim with the insurance company of the at-fault party. As insurance companies typically fight paying out fair and reasonable compensation every step of the way, it is important to be as proactive as possible when dealing with your personal injury claim. This article will discuss some of the most common defenses that insurance companies use in personal injury claims and how to combat them.
Prior Similar Injuries
Even when liability or fault is clear, insurance companies will defend the case on injuries. When a lawsuit is filed, an insurance company will hire an attorney on behalf of the at-fault party to defend the case. In the answer to the lawsuit, it is common practice for an insurance company to admit that the incident, whether it be a slip & fall, a wreck, or something else, is the defendant’s fault, but deny that the incident caused the plaintiff’s injuries.
The defense is basically that your injuries were already there. In order for the insurance company to substantiate these claims, it dig into your personal medical history to look for any prior complaints of similar injuries. Of course, this defense does not really make sense if the insurer cannot find anything in your medical records to suggest that you had a pre-existing injury. However, if there is any inclination of a past similar injury, the insurance company will capitalize on this defense. Nonetheless, even if you had a prior similar injury, it does not mean that you do not have a case. If there is a reasonable explanation, then you can still explain why and how this particular incident caused this injury. For example, let’s say you had a prior car accident 5 years in the past and treated conservatively via physical therapy for a back injury and went 5 years with no other complaints of back injuries. If you are involved in another wreck where you sustained back injuries, then it is still reasonable to assume that the prior back problem was resolved before the second collision.
Gaps in Medical Treatment
Another popular defense tactic is arguing that gaps in medical treatment means no there is no injury. That means that at the time of the incident, you may not feel pain yet, may think that time will heal the pain, or may not be able to afford the medical treatment, the insurance company will claim that if you were really hurt by that incident, then you would have gone to the doctor immediately. Thus, it is important to seek medical treatment as soon as possible after an incident involving an injury occurs in order to combat this defense.
No Objective Findings in Reports
Whether it be a back injury or a traumatic brain injury, insurance companies often use imaging reports, such as x-rays, CT scans, and MRIs, where there are no findings to argue that there is no injury. For example, you may have neck and back pain, go to the hospital, and get an x-ray where the x-ray is normal. Similarly, you may have suffered from a traumatic brain injury with post-concussional syndrome as a result of an incident, but a CT scan at the hospital was normal. There are two arguments that the insurance company or defense can make. The first is that there is no injury. The second is, because there was no injury shown, they are not responsible for paying for the diagnostic testing. What is the solution to this issue? Keep going to the doctor if you have symptoms. A medical doctor can make a clinical assessment and diagnosis to explain the symptoms based on your medical history and his or her professional expertise.
Reasonableness of Medical Bills
Another popular defense is the reasonableness of the medical bills you have incurred. The law allows you to recover for the medical bills incurred, without any regard to whether health insurance or medical payments insurance covered the bills. Typically, insurance companies attempt to reduce medical bills submitted in a pre-suit settlement negotiation, arguing as to the reasonableness of the billing. This argument is more difficult when it comes to the actual trial of the case, but is a possible defense used to lower the award for medical expenses.
Low or No Property Damage
One of the classic defenses in a car accident case is the argument that low property damage cannot cause injuries. If there is a wreck and there is no damage to your car at all, the insurance company will suggest that you cannot possibly be injured. If this is the case, the first thing I would do is to get a photograph of the other person’s car to see if their car sustained significant damage. Looking under the car is also important, as sometimes a wreck can damage a vehicle underneath without causing damage to the body of the car. With the way that cars are built, it is possible and common for property damage to be low in a wreck that causes injuries.
Disputed Liability Car Wrecks
In car wreck cases, insurance companies sometimes will suggest that both parties are at fault for the collision or that you had the “last clear chance” to avoid the collision, even if you had the right of way. You should have turned your brakes on, slowed down, or you shouldn’t have been driving so fast. Whether or not that is a legitimate defense is something that an attorney can help you with.
For more information on Defenses Used By Insurance Companies, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (404) 382-9926 today.
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