Seven Excuses Insurance Companies Use To Avoid Paying Claims

After handling personal injury cases for more than twenty- five years, I am convinced that most 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, their first instinct is NOT how to fairly compensate you for your loss, but rather how to deny or reduce what they may legitimately owe you. Their tactics and strategies are limitless – but below you will find the top SEVEN EXCUSES insurance companies use to limit payment of claims.

#1 “It’s not our fault, it’s ALL your fault”

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 this “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 a plaintiff or claimant is more than 50% at fault for the accident, the plaintiff gets NO recovery. This is the law of comparative negligence. Using this tactic, insurance companies will claim that the accident was more your fault, than their insured’s fault and will refuse to pay anything.

#3 Even if it is our fault, it’s PARTLY your fault, too”

This is the third variation of the “it’s not our fault” theme. Insurance companies will admit that it was partly their insured’s fault, but will also claim that it was partly your fault, too. Under this scenario, insurance companies will usually attempt to reduce their payment to you by your percentage of fault. For example, if your car has been totaled in an accident, instead of paying you the full $10,000.00 fair market value for the car, they will try to claim that you were 25% at fault, and reduce your payment 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. A chain reaction collision is a good example. 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. Using this excuse, insurance companies try to limit the amount they have to pay 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 responsibility for the accident, they will frequently claim that they don’t have to pay because you weren’t really injured. Time and time again, insurance companies will try to deny that there was any damage or injury caused by the accident in order to avoid payment.

#6 “Even if you were injured, you’re not injured that bad.”

When insurance companies cannot reasonably claim that there was 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 will say 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, where the plaintiff suffers whiplash-type injuries to the neck or low back. 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

The Law Offices of John J. LaCava can help with your 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 company to hold them responsible. 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. The lawyers at the Law Offices of John J. LaCava have experience in handling personal injury cases, and have a successful track record of obtaining compensation for our clients.

Client Testimonials

John LaCava has done a more than excellent job representing me in my personal injury law suit. His thorough and caring manner had me completely at ease throughout the process and gave me full confidence in my representation. I would highly recommend him to anyone going through the kind of painful accident I experienced, as the attorney who will ensure that your case is taken care of in a truly professional and very experienced way.
Patt C.