Three Reasons Insurance Companies Deny Injury Claims in Georgia

Three Reasons Insurance Companies Deny Injury Claims in Georgia

After an accident, one of the most frustrating things a victim experiences is working with the insurance company to receive fair compensation for their injuries. The process can be confusing and intimidating, especially when an aggressive adjuster denies your claim for reasons you may not understand, and you don’t have a personal injury attorney working with you to fight back.

When you know the top three reasons insurance companies deny injury claims in Georgia, you can prepare a more substantial claim with a better chance of recovering the compensation you deserve.

Why an Insurance Company Would Deny a Georgia Injury Claim

The first thing accident victims must remember is that the insurance company is not on their side, no matter how helpful the adjuster seems during an initial interaction. Insurance companies are for-profit businesses and answer to their shareholders. They need to keep profit margins high, which often means keeping payouts low or denying claims altogether. Three of the most common reasons insurance companies deny claims involve:

Lack of Evidence or Documentation

Insufficient evidence or medical documentation is one of the most common reasons insurance companies deny claims. A solid claim must include proof of how the accident occurred, who caused it, and the extent of the injured person’s physical injuries and other losses. Without witness statements, a police report, or photographs of the scene, an insurer can claim it lacks the information it needs to establish liability and has no responsibility to pay a victim’s claim.

When an individual doesn’t seek immediate medical treatment for their injuries or fails to continue their treatment plan, an insurer can question the severity or validity of a person’s injuries. This can be the basis for a claim denial. Without medical documentation, an insurer can also claim injuries may have been a pre-existing condition not directly caused by the accident, offering them another option for denying a claim.

Disputed Liability

Insurance companies often deny claims by arguing that their policyholder wasn’t at fault. Another way insurers attempt to deny claims is by arguing that the victim was 50 percent or more responsible for the accident. Since Georgia follows a modified comparative negligence rule, when a driver is 50 percent or more at fault,  they are barred from recovering compensation in a personal injury lawsuit. While the rule only binds courts, many insurance adjusters use it as a guide to help them establish the value of a claim. The rule can incentivize insurers to shift blame onto you and diminish the value of or deny a claim.

Policy Exclusions or Lapsed Coverage

Sometimes, claims get denied because the at-fault party’s insurance policy doesn’t cover the specific type of accident. Policy exclusions can limit a driver’s coverage for particular accidents and situations. Insurers may also deny claims based on technicalities buried in fine print.

In some situations, the policy was inactive during the crash, or the driver let their coverage lapse and drove uninsured, allowing the insurance company to deny the claim and responsibility for covering the at-fault driver.

A Georgia Personal Injury Attorney Is There When You Need Them Most

Recovering compensation from an insurance company following an accident can be an uphill battle. At Kaufman Injury Law, our personal injury attorneys understand insurers’ tactics to deny and diminish accident claims. We help you counter these strategies by building a comprehensive, evidence-backed claim.

If an insurer has denied your claim, it is time to fight back. Contact us online or call our Georgia office and request a free consultation to discuss your situation and legal options for pursuing the compensation you need.