Insurance Companies’ Favorite Tactics to DENY, DISPUTE, or DEVALUE Your Injury Claim:
Insurance companies frequently accuse people of faking it in an attempt to devalue an individual’s claim. Now they won’t come right out and say that, but it comes out in a “read between the lines” kind of way. Does that mean that there are some people who don’t lie to try and get a settlement? Of course not, however, in my 14 years of practice doing exclusively injury law, I can say that those type of people are few and far between. Most people are genuinely injured, hurting, and inconvenienced by an accident. The most common way the fraud defense comes up is after a case is in litigation. A defense attorney who represents an insurance company will take the injured person’s deposition. The deposition is sworn testimony or statements that are provided under oath. Once they have your statements that you made under oath, they will scour your medical or employment records and find facts or circumstances that contradict what you said in your testimony. For example, they may ask you in a deposition whether you have ever had any treatment for a back injury before in your lifetime. If it is later discovered that you did actually have treatment for your back during your lifetime but told them the contrary in your deposition, don’t be surprised when they use it to deny, dispute, or devalue your claim.
This is a common tactic that is more commonly seen in workers’ compensation cases than it is in personal injury cases. Basically, the insurance company, rather than putting money in your pocket, will hire a private investigator to follow you around or sit outside of your home and tape you doing physical activity in an attempt to show: 1) That you are not injured at all; 2) That you are not as injured as you say you are, or 3) That you are just a plain liar. If you are in a deposition in an injury case and the defense starts asking you specific questions about the extent of your physical activities, for example, “Are you able to mow your grass?” or “Can you lift a gallon of milk?” WATCH OUT! They either have surveillance or they intend to get some to contradict your testimony and pull one of the three D’s on your claim. Also keep in mind that content placed on social media has become a hot spot for defense attorneys for surveillance purposes. I recently had a client who was a well-known “influencer” and the defense attorney had a field day with all of that content.
3. Delay of Lapse in Treatment
Here is the scenario, you get into a car accident on a Thursday. It is early evening and you are heading home where you have kids to care for. You have worked the whole day and you have to work again the next morning. You turn down an ambulance at the scene, deciding to sleep on it to see how you feel in the morning. The next morning you get up, take the kids to school, and head to work. You start feeling pain at work but you take a Tylenol and push through. It’s a Friday and you figure you will rest over the weekend and hopefully you will feel better by Monday. You spend the weekend laying low only to find that you are still in pain on Monday. You want to go to the doctor but you just started a new job and are afraid to ask for the time off. You attempt to deal with the pain, but by Wednesday you realize something is wrong and you have to be seen. By then you have waited SIX days to be evaluated medically! Insurance companies love this, they say “how bad could he have been, he waited almost a week to go see someone.” The best way to avoid this is to not let it happen in the first place. Get checked out. Sometimes you are injured and don’t feel the pain until the next day or even a week later! It never hurts to get it checked out, but it can hurt if you don’t. Another way we see this come up is when a client gets tired of seeking treatment or life gets in the way and they get too busy to keep up on it. In this situation, the insurance company attorney will usually say something like this: “if it was as bad as he says it is, why did he not see a doctor for four months.” Avoid this trap or one of the three D’s may find a place in your claim.
4. Prior Accidents or Injuries
Let’s face it, you would be hard pressed to find someone who has NEVER sustained an accident or injury of any kind. It is a rare situation indeed when I have a client who has never had a prior accident or received treatment for one thing or another at some point in time. We cannot change our past. The facts are the facts and the best way to deal with prior accidents or injuries is to disclose them and let your attorney know why your symptoms now are different than they were before. Again, the best thing to do is to be honest and open. Trust me, whatever it is, they will find out about it anyways. So come out with it and don’t let them use it not only for the purpose of showing that your physical or mental condition was already compromised before the accident, but also to show that you are dishonest and untrustworthy.
5. You Just Have Arthritis/Degeneration
Most of the time, with the exception of disputed claims, the insurance company will accept fault or a portion of fault but deny or argue about the extent damages. They will usually say something like, “We agree Mr. X was injured in the accident and that some treatment was reasonable or necessary, but we disagree that the surgery he got after the accident was necessitated by the accident because Mr. X had arthritis.” To be clear, everyone, even young people, have some form or extent of natural aging of the joints or the spine. Aging is a normal physiological process and should be expected. In Mr. X’s situation, let’s assume he is 55 years old and he required a back surgery as a result of a car accident. ANYONE who is 55 years old is going to have signs of aging in their spine. If they don’t, they are not human and have bigger problems to deal with. So, what the insurance company will generally try and argue is that it is the aging of Mr. X’s spine is what necessitated the surgery, not the accident.
6. You are Not as Injured as You Think You Are
Your MRI shows disc bulges. According to the insurance company, disc bulges are minor and not something that should or could cause symptoms for an extended period of time. The insurance company hires an orthopedic surgeon to evaluate you. Their doctor gives the opinion that the disc bulges you have are not significant enough to cause you pain for any period of time after six weeks following the accident. But you are still in pain, and it is week eight! The insurance company will use that doctor’s opinion to try and discredit your complaints of pain and say that any complaints or treatment should be limited to the six weeks following the accident, because you could not possible be having issues after that point!
7. Why Weren’t You Looking?
This is the one we hear the most on slip and fall type cases. In this type of case, our clients are generally injured because of falling on something. Some examples are the puddle of liquid on the floor at Publix, the large pothole on the sidewalk of your housing development, the loose bricks on the walkway to the restaurant you were going to have dinner at, and so on. Insurance companies love the concept of personal responsibility and if it is a visible defect that you fell on, you can bet that you will hear the words “You should have been paying better attention,” or “How could you miss that?” The reality is that people do not walk around staring at the ground, but the expectation of the insurance company is that they should be and, if not, then they should be held responsible for their own injuries. This defense becomes more adamant in this position the larger or more obvious the defect is.
These are just a few of the most common ways or reasons that insurance companies will DENY, DISPUTE, or DEVALUE your claim. This is by no means an exhaustive list. Remember one thing, insurance companies are in the business of risk management, and they benefit directly when they get to settle a claim for as little as possible. Once you understand that this is their objective, it becomes clear what factors they will try to use to cut your claim down.
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