After handling personal injury cases for more than twenty- five years, I am convinced that insurance companies are not in the business of paying claims - they are in the business of denying claims. Whether it's a car accident or a slip and fall case, the insurance companies' first instinct is not to investigate a case and determine how to fairly compensate you for your loss, rather their first instinct is to figure out how to deny or reduce what they owe you. Their tactics and strategies are limitless - but below you will find what I consider to be the top seven ways insurance companies try to limit payment of claims.
#1 "It's not our fault, it's ALL your fault"
Personal injury cases can be broken down into two parts - liability and damages. By liability, I am referring to the concept of fault. In a successful personal injury claim, the defendant (the person against whom the claim is made) must be at fault or legally responsible for the injuries. The first tactic insurance companies use is to deny liability outright. They will say "the accident was not our insured's fault, it was all your fault." They will refuse to pay anything. Companies call it "a no-pay" case.
#2 "It might be our fault, but it's MORE your fault"
If insurance companies cannot totally deny fault, they will do the next best thing - claim that the accident was more your fault than it was their insured's fault. Under Connecticut Law, if an injured person is more than 50% at fault for the accident, the injured person gets NO recovery. This is the law of comparative negligence. Therefore, insurance companies will argue that it's more your fault, than their insured's fault and, because of the 50% rule, the insurance companies will refuse to pay.
#3 Even if it is our fault, it's PARTLY your fault, too"
This is the third variation of the "not our fault theme." Insurance companies will admit that it is their insured's fault, but will claim that you are also partly at fault. Under this scenario, insurance companies will usually attempt to reduce their payments by claiming that if their insured was 75% at fault, you were 25% at fault. The effect of this is to reduce the claim by 25%, which is your percentage of fault. For example, in an auto accident case, if you car has been totaled, instead of paying $10,000.00 as fair market value, by arguing comparative negligence, insurance companies can reduce their payment by 25% to $7,500.00.
#4 "Even if it is our fault, it's SOMEONE ELSE'S fault, too."
This tactic is an attempt to get another party to pay part of your damages. In an automobile accident case, this situation usually arises when there are more than two vehicles involved in the crash. Insurance companies will admit that their insured has some responsibility, but will claim that another party involved in the collision has to pay a portion of the damages, too. In a slip and fall case, insurance companies for the owner of the premises will sometimes claim that the maintenance company is also partly responsible for the condition causing the slip and fall. In any event, insurance companies are attempting to limit their payment by claiming someone else is also responsible.
#5 "Even if the accident is our fault, you weren't injured."
If insurance companies cannot get out from accepting liability for an accident, such as a car accident or a slip and fall, they will frequently claim that they don't have to pay the claim because there is no injury. The insurance companies will often attempt to deny the extent of damage or injury, and claim that there is no damage or injury, in order to reduce their claim.
#6 "Even if you were injured, you're not injured that bad."
When insurance companies cannot reasonably claim that there is no injury, they will often attempt to minimize the injury. For this reason, it is important that you receive prompt medical attention as soon as possible after an accident in order to document your injury. Insurance companies have lists of doctors that they use to conduct independent medical examinations. These doctors are paid by the insurance companies to examine people who are making personal injury claims. It is not surprising that these doctors are usually very conservative in their examination reports and frequently resolve any doubtful issues in favor of the insurance companies. The use of independent medical examinations to minimize the extent of injury is a very common insurance company practice.
#7 "Even if you were injured, we didn't cause the injury."
In this variation of the "no injury" theme, insurance companies claim that any injuries you have were pre-existing and not caused by this accident. The classic use of this tactic is in an automobile rear-end collision case. These types of accidents can frequently cause serious whiplash injuries to the cervical (neck) region or the lumbar (low back) region. It is a common fact that most people have had some type of neck or low back pain at one time or another in their lives. Insurance companies will frequently obtain information regarding your prior treatment for neck or low back pain, and claim that the pain that you are now experiencing is, in fact, related to your prior condition and not to your automobile accident. In some cases, insurance companies may even find a doctor who will support their position.
How An Experienced Personal Injury Lawyer Can Help You
An experienced injury lawyer can help with a personal injury case by making sure that both the liability and medical treatment aspects of the case are properly documented. The liability part of the claim needs to be properly developed and presented to the insurance companies to show that they bear responsibility. The medical treatment and damages part of the claim must be appropriately documented, showing that all treatment is reasonable and necessary. The type and extent of treatment must also be appropriate to the case. An attorney who has experience in handling personal injury cases can be of great value in bringing these types of accident cases to a successful conclusion.