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Aventura Personal Injury Lawyers November 19, 2018 What Happens if You’re Injured and the Other Driver’s Insurance Company Won’t Pay Your Claim?

When you’re dealing with serious accident-related injuries, the stress levels increase when the liability adjuster refuses to pay your claim. You depend on medical care, physical therapy, medication, and other costs you need to recover from your accident. If you’re losing income due to a temporary disability, you need money for everyday expenses. If you don’t have the financial resources to pay for medical care and basic necessities, it delays your recovery and changes your lifestyle.

If you’re injured in an accident in Aventura, Florida, connect with the lawyers at Sibley Dolman as soon as possible. While our clients concentrate on their recoveries, our personal injury attorneys handle insurance company contacts and look for answers to legal and insurance questions.

Why Did The Adjuster Refuse to Pay Your Claim?

You can’t contest an insurance company’s refusal to pay if you don’t know or understand their reasons why. When an insurance company won’t pay your claim, it’s usually more complicated than a simple refusal. If insurance refuses to pay without explaining the reasons for the denial, those actions violate Florida’s Unfair Claim Practices Statute. When they explain your claim denial, get it in writing.

Unfortunately, some insurance companies use a refusal to pay as a negotiation tactic. When they deny your claim, you become anxious and more compliant if they eventually make an offer. If you need money to survive, they understand that the potential for financial gain manipulates you into cooperating—and you will then accept a much lower settlement than you need to pay for your injuries.

Was It a Denial of Liability or Some Other Issue?

Insurance companies have a right to investigate an accident. They can also refuse to pay if they believe their insured isn’t at fault. In Florida, liability insurance carriers deny injury claims for many reasons. Get their position in writing so you know the reason why and can decide how best to appeal.

Some reasons you may encounter include:

  • Your injuries don’t meet a PIP tort threshold: When an auto accident injures you, you must present your bills and wage loss claims to your own auto insurer or another PIP carrier designated by the Florida Personal Injury Protection statute. You may present a liability claim against the other driver only if your injuries meet a PIP threshold. These include significant and permanent loss of an important bodily function, significant and permanent scarring or disfigurement, and other conditions listed under Florida 627.737.
  • They believe you are 100 percent liable for the accident: Under Florida’s pure Comparative Fault statute, an injured person may recover a percentage of damages even when 99 percent at fault. If the other driver’s insurer denies payment based on liability, it’s saying that you caused the accident. The insurance company’s denial letter should explain why it believes its driver isn’t at fault.
  • Your treatment isn’t a legitimate PIP medical benefit: If your treating practitioner confirms that your condition meets a PIP threshold but the treatment isn’t “lawfully provided, supervised, ordered, or prescribed” by a medical professional designated in Florida 627.736 (A) 1, the insurer may refuse to pay your liability claim.
  • They suspect fraud: Carriers deny liability if they believe your accident was a fraudulent event, or you’re not as hurt as you claim.

Did the Insurance Company Decline Coverage?

Insurance companies won’t pay your claim if they find their insured had no coverage for the accident—maybe because the insured didn’t pay the premium or didn’t add the car to the policy in time.

A coverage declination is a private matter between the insured and the insurance company. The insurance company should explain to you that it can’t pay your claim due to coverage issues. It doesn’t have an obligation to share the reason behind the declination of coverage. If the company has verified that the insured has no coverage, the insurance company won’t change its position on paying your claim.

How Can You Dispute a Claim Denial?

When you’re seriously injured, dealing with an insurance company generates additional stress that you don’t need. To dispute a claim denial, you need a lawyer who understands the legal and medical issues. To ask the right questions and provide the right information, your lawyer will need to know whether an insurance company has legitimate concerns or if it’s just trying to minimize losses.

  • If your injuries meet a PIP threshold, your medical professionals must provide the documentation to help you dispute a refusal to pay. In the meantime, PIP statutes require you to submit your bills, lost wages, and expense claims to your own insurance company.
  • If you meet a PIP threshold and you believe the other driver was at fault in any way, the other company owes a fair percentage of your damages. If it refuses to acknowledge that its insured shares even a small percentage of liability, a lawsuit is often the only solution. The denial letter should provide enough information to understand why the insurance company won’t pay your claim. You can also determine if it made the decision based on accurate information.
  • If you received treatment from a legitimate medical professional and the insurance company insists that you did not, your insurance company can help. All PIP insurers have the same standards for medical treatment. When your insurance company pays for your medical expenses, it helps validate your choice of medical professionals.
  • If the other insurance company won’t pay because it suspects fraud, your attorney can explain your best options for resolution.

What Should You Do if the Responsible Driver Has No Liability Coverage?

When another driver causes your accident, that person’s insurance company pays your liability claim when your damages meet a tort threshold. If the other driver doesn’t have valid liability coverage, you may recover your damages under your own auto policy if you have Uninsured Motorist Coverage. UM isn’t mandatory in Florida, but if you have it, your own insurance company handles your claim as though it were the other driver’s insurance company.

Just as you would with the responsible driver’s insurance company, you must prove the nature and extent of your injuries and that you meet one or more PIP tort thresholds. As you should have involved your insurance company in your claim all along, it should already have information that verifies the other driver’s liability and documents your injuries.

Contact Sibley Dolman Law Group if an Insurance Company Stonewalls You in Aventura

If you were seriously injured in an Aventura, Florida, accident, or your loved one died, the Sibley Dolman Law Group wants to help. Our firm believes in giving injured people the personal attention they deserve. We’ve recovered millions in fair compensation for our clients. Let us determine if we can help you.

Call us at (954) 302-7068, or complete our contact form at Sibley Dolman online so we can schedule your free consultation.

Sibley Dolman
20807 Biscayne Blvd
Aventura, FL, 33160
(954) 302-7068

Aventura

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