While accident victims do often get the help they need after a traumatic brain injury (TBI), claim denials are more common than you may expect. Having your insurance claim denied can be disastrous, especially if you are unable to work and need help covering your regular bills while handling massive medical costs. You don’t have to just accept the denial, however. There’s still hope for a successful outcome when you work with an experienced brain injury attorney.
A Lawyer Can Help After Insurance Denies Your Claim
Unexpected problems that frequently pop up when interacting with an insurance adjuster are one of the top reasons why you should call an experienced TBI attorney after an accident. The more claims an insurer pays out, the less profit is made. Unfortunately, that means the at-fault party’s insurance company has a clear interest in paying as little as possible or even denying claims outright.
When your claim is initially denied, it’s in the company’s best interest for you to give up and stop pursuing the matter. Instead, here’s what you should do:
Remain calm and don’t respond emotionally
Anger is justifiable in this situation, but yelling and hurling insults at the adjuster won’t help reverse an unjust decision to deny your brain injury claim.
Contact the adjuster and request the denial reasoning in writing
If the company already mailed you a denial letter but it is no longer in your possession, you can ask for a replacement copy.
Present the letter to your attorney
Your lawyer can go through the complex legal terminology to find out specifically why the claim was denied and if that decision can be reversed.
In some cases, the issue is as simple as improperly prepared paperwork without enough information, which can be fixed. Other reasons for a denial present a larger problem, however. Your claim could be denied because of a number of technicalities, like:
- The policy wasn’t active at the time of the accident because the policyholder was behind on payments.
- The policy doesn’t cover the specific situation involving your accident and injury.
- The amount you are owed may exceed the policy limits.
- The driver at the time of the wreck wasn’t actually listed on the insurance policy.
In addition to those common problems, other issues may arise from mistakes you didn’t know to avoid. For instance, you may see a denial because you:
Didn’t seek medical attention quickly enough
Many car accident victims don’t fully grasp the extent of their injuries after the crash due to an adrenaline surge, which is why it’s important to see a doctor as soon as possible after any head wound.
Released your full medical records or provided a recorded statement to the insurance company
An adjuster can use medical records and comments you make to claim your injury actually stems from some past event, or deny claims on the basis that specific doctor appointments were unnecessary.
Used social media improperly after the accident
An insurer can take social media photos out of context to argue you aren’t as hurt as you claimed.
After going over the reasons for the denial, an attorney can additionally gather evidence of your claim’s validity and take over communication with the insurer. Simply retaining an attorney lets the adjuster know you intend to continue pursuing the matter, which can be a massive help towards getting approved.
Besides negotiating with insurance, your attorney can pursue other sources of compensation if necessary. In some cases, an insurance settlement won’t be the best route to go if you are struggling financially. You may instead need to file a personal injury lawsuit against the negligent party who caused your TBI.