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What If the Insurance Company Denies My Claim or Offers a Low Settlement Amount?

A man who was hit by a car on his bicycle and is wondering what he will do if the driver's insurance tries to deny his claim.The insurance company always has the right to deny your claim in a personal injury case. Or, if they accept your claim, they may offer you a low settlement amount. However, receiving a low settlement offer isn’t the end of the road for you. Working with a personal injury lawyer may help you negotiate with the insurance company or insurance company lawyer so you can try to win a higher settlement.

Why the Insurance Adjuster May Deny Your Claim

Insurance adjusters may decide to deny your claim for numerous reasons, and it’s not always because the insurance company is acting in bad faith. While it’s true that the insurance adjuster may wish to avoid the insurance company having to pay out a large settlement, there are other reasons the insurance company might outright deny your claim.

The Liable Party Didn’t Report the Incident

If the person liable for the accident doesn’t report the incident, the insurance company usually refuses to pay.

Let’s use a car accident as an example of a personal injury case. In the case of a car wreck, the insurance company will usually refuse to pay out if the liable driver didn’t contact the insurance company to inform them of the car accident.

The company needs to speak to the driver they insure to hear that driver’s version of events. If that driver neglects to make a statement or insurance claim, the insurance company can’t just take your word. They need to do a proper investigation to determine whether or not an accident took place and to discover who was liable, and they need a statement from the driver they insure to do that.

There’s an Issue Determining Liability

You only receive compensation if the insurance agent believes you weren’t liable for the incident that caused your injury. This is why it’s so crucial for accident victims to talk to personal injury lawyers before making a claim. A personal injury lawyer may help prove that you weren’t liable for the accident.

There can also be an issue determining liability in a multi-car accident. So, car number one hit the back of car number two, causing car number two to hit you. Often, driver number one and driver number two’s insurance companies will both deny their drivers’ liability to avoid paying out. Each insurance company may attempt to blame the other driver involved, so each insurance company refuses to pay out.

The Other Driver Wasn’t on the Insurance Policy

If somebody lets a friend or family member drive their car, and that person hits you, there may be an issue recovering compensation.

If another driver was driving the car at the time and that driver was not on the policy or did not have permission to drive the car, then the insurance company will usually deny the claim. That driver was not insured to drive that car, so pip coverage and other forms of coverage won’t apply to accidents they caused.

Some insurance companies write into their policies that only the person named in the policy is covered in the case of an accident. So, even if the policy owner shares their vehicle, the person they share the vehicle with may be an “excluded driver” if they’re not named on the policy.

Why Insurance Adjusters May Offer You a Low Settlement

Receiving a lowball insurance settlement offer is a separate issue from your claim being denied. It’s good practice never to accept the insurance company’s first offer, as it may be significantly lower than what you’re actually entitled to.

However, some people can’t distinguish lowball offers from acceptable ones, so you should always contact a personal injury lawyer before accepting an offer. If you received a lowball offer, one of the reasons below may be why.

They Think You’ll Accept It

Most people are willing to accept a lower offer because the sum they’re being offered seems like quite a lot of money. Plus, many people don’t recognize a lowball offer when they see it. The insurance claims manager may believe you’ll take the bait of the low offer, so you need to outsmart them and show them that you see right through the insurance company’s offer.

Insurance companies want to protect their bottom line, so much of the time, they’re not above bad faith tactics like this. Having an attorney at your side may help you avoid bad-faith insurance practices.

You’ve Only Suffered a Minor Injury

It’s often not worth going to trial over a minor injury and minimal damage to your property. The insurance company knows this, and they’re aware that an attorney working on a personal injury claim may advise you to take a lower settlement offer to avoid going to trial.

If you go to trial, but you don’t have a particularly strong case, then you risk losing everything. Your attorney may actually advise you to accept this low settlement offer so you can settle your personal injury claim out of court and walk away with some money rather than none.

The Insurance Company Is Questioning the Credibility of Your Case

Sometimes an insurance company will question the credibility of your case and the value of your damages. This can lead to them refusing to give you a fair settlement and offering you a low settlement offer.

Insurance companies assume most accident victims won’t contact a law firm to help them, so don’t be like most other victims. Your attorney may challenge this lowball offer by building you a stronger case. Get legal aid, and never accept the low offer as a partial payment; once you’ve accepted an offer, the insurance company sees the matter as settled.

Getting legal representation may lead to you getting more compensation, so don’t give up hope. A higher offer may just be a few phone calls away.

There Are Facts Missing

The insurer going over your claim may not have all the information. There may be missing facts or files the insurer hasn’t considered, leading them to undervalue your damages or deem your case weak.

The accident may not have been fully investigated yet, so that you may be offered a higher sum later. However, being offered something larger later doesn’t happen in all claims, so working with a lawyer is typically your best bet to receive an offer for more money further down the line.

Software Generated the Offer

Sometimes software is used when formulating an offer in an insurance claim. The software uses data to analyze claims and formulate a settlement offer for these claims.

However, the software will never be as accurate as dedicated work by a human. There are many aspects of claims that software simply can’t factor in, leading to a lowball offer.

You May Be Entitled to a Substantial Sum

Insurance companies wish to save money and make a profit, so they may attempt to settle for as little money as possible to avoid paying out the full value of your damages. However, a good lawyer may keep fighting and negotiating with them until they offer you reasonable compensation.

If the adjuster thinks you’ll accept a lower amount, then they’ll likely do everything they can to avoid paying the true value of your damages and letting you recover total compensation. This is common with large claims.

Sometimes your lawyer may simply write a demand letter, which may be enough to get the insurance company to act in good faith and pay out. However, other times you’ll need to go to court if you want to settle your case.

Not all cases will hold up in court, however, so your lawyer may advise you to settle out of court and accept a lower offer. Most personal injury cases settle outside of court, and your lawyer will always advise you on what’s best to do in your situation.

Damages That May Be Covered After an Accident

There are many types of damages you may be entitled to if you’ve been injured due to someone else’s negligence. Both insurance companies and lawyers are aware of these damages. The insurance company’s offer won’t always reflect the total value of your damages, and it may take a demand letter or even a trial to get them to make a reasonable offer that covers your damages. The demand letter will also typically outline which damages you’re entitled to based on the details of your claim.

Medical Bills

It may be harder for the insurance company to make a lowball insurance settlement offer when reimbursing you for your medical treatment. If your medical treatment is the only thing you need to be reimbursed for, the insurance company may even make a fair settlement offer immediately. This is often true of cases involving minor injuries.

However, more extensive injuries often lead to higher medical expenses. Fair compensation is supposed to include reimbursement for all of your medical expenses, including future expenses.

Everything should be covered, from the cost of your medical appointments to imaging tests to your temporary and long-term treatment needs. This is one of the most common economic damages covered in almost every settlement.

Loss of Earning Potential

Another form of economic damages you may recover is lost wages and earning potential. Lost wages are wages you missed out on while taking time off to recover after an accident. Lost earning potential describes your lost potential for earning if you had to quit full-time work due to a permanent disability.

Your claim may pay out substantially if you’ve been left unable to work for the rest of your life, as the amount you’re entitled to in lost income could be large. Large claims like this may make it less likely for the insurance company to make a reasonable offer without you contacting a lawyer.

Property Damage

Damage to your property is typically covered in your economic damages. Property damage may include damages to a vehicle you were driving during a car accident and the contents of the vehicle.

The cost of repairing your damaged property may be covered. If your property can’t be repaired, you may be offered a sum intended to cover the property’s value.

Pain and Suffering

There are numerous types of noneconomic damages covered by pain and suffering. You may be awarded compensation for mental anguish, ongoing physical pain, and a drop in your quality of life. Numerous other things may be considered when calculating pain and suffering damages, such as loss of household services, loss of enjoyment of life, and much more.

Noneconomic damages are generally calculated using the multiplier method, multiplying your economic damages by a number between one and five. The worse your pain and suffering are, the higher the number used to calculate the value of your noneconomic damages.

Loss of Consortium

Loss of consortium is generally factored into wrongful death cases. The sum is intended to reimburse the decedent’s loved ones for the loss of emotional and physical benefits that their relationship with the deceased brought them. Loss of consortium may also be referred to as loss of companionship, and it may be paid out to the loved ones of somebody who lost their lives in an accident.

Punitive Damages

You may be awarded punitive damages if the person who caused your injury acted with malice or gross negligence. Not every case involves punitive damages, but your lawyer should be able to advise on whether or not they may apply to your case.

How to Get the Insurance Company to Increase Their Offer

Negotiation is the primary way for the insurance adjuster to raise their offer. Your lawyer will generally negotiate until the adjuster has made an acceptable offer to settle the claim, and the company should then pay out this amount.

Your attorney may have to use various types of evidence to build you a stronger case, such as:

  • Your medical records
  • Evidence of your medical bills
  • Doctor’s notes
  • The results of a medical assessment
  • Evidence of how much you were earning
  • Proof of liability
  • Proof of your pain and suffering

Do you need a lawyer to help you recover compensation after an accident? You may have found an attorney to help you recover the compensation you deserve, so don’t hesitate to get a free case evaluation. Get in touch with Brian C. Gutierrez at 979-271-5338 for a free consultation.

Your College Station, Texas Personal Injury Lawyer

If you have been hurt in a car accident, a fall, or another type of accident, don’t hesitate to contact a trusted law firm to help you get the justice you deserve. Call Gutierrez Accident Injury Lawyer at 979-271-5338 and schedule your free consultation. 

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