When Might an Insurance Company Dispute a Personal Injury Claim?

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scale justice lawIf you were seriously hurt because someone failed to act with reasonable care, you’re probably planning on filing a third-party claim with his or her insurer. As long as he or she has liability coverage that applies to the incident in question, you should be able to seek up to the policy’s limit in compensation.

It’s important to keep in mind, however, that just because you have grounds for action doesn’t mean you’re guaranteed a payout. The outcome of any given case ultimately depends on a variety of factors, and there are a number of reasons why even a seemingly strong claim might be denied.

Read on to learn when an insurer is likely to dispute—or outright deny—a personal injury claim:

1. The Claimant Played a Role in the Accident

If you were partially at fault for the incident in which you were hurt, the compensation to which you’re entitled will be reduced accordingly. And if you’re deemed more liable than the defendant, you’ll be barred from recovering non-economic damages at all under Michigan’s modified comparative fault rule.

Because of this rule, insurances adjusters often try to shift at least some responsibility onto plaintiffs. As such, you should be prepared for them to challenge your claim if you insist the policyholder was 100 percent liable. 

2. The Claimant Has a Preexisting Condition

Recovering compensation for damages related to a preexisting condition is inherently challenging. If your condition wouldn’t have worsened but for the liable party’s negligence, you should certainly be entitled to seek a payout. Whether the carrier is forced to agree, however, will ultimately depend on the strength of the evidence you present.  

3. The Claimant Failed to Mitigate Damages

In order to recover a fair payout, accident victims must take reasonable measures to mitigate the damages they incur. For example, they shouldn’t put off getting treatment, nor should they ignore medical advice once they do.

If the insurance adjuster has reason to believe you failed to mitigate damages—based on your social media activity, for example—he or she will undoubtedly dispute your claim.  

4. The Claimant Does Not Present Sufficient Evidence of Damages

A successful personal injury claim can yield compensation for both economic and non-economic damages. Examples include medical bills, lost wages, replacement services, mental anguish, loss of enjoyment in life, and pain and suffering.

Naturally, before you can recover any such losses, you must prove that you did, in fact, incur them. The insurance adjuster will need to see legitimate receipts and invoices, as well as journal entries, psychological evaluations, and statements from friends, loved ones, and colleagues.

Speak with a Detroit Personal Injury Attorney

If you intend to file a personal injury claim in Michigan, turn to Seva Law Firm for strategic counsel and attentive guidance every step of the way. We have recovered more than $100 million on behalf of our clients. Call (248) 385-5704 or use our Online Contact Form to set up a free consultation with a personal injury lawyer in Detroit.

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