Why Won't The Insurance Company Pay My Claim?

"Why won't the insurance company pay my personal injury claim when "the other guy" was clearly at fault?" is a question that crosses and boggles many people’s minds after they were injured as the result of an accident. The simple answer is this: Insurance companies do not exist to pay benefits or compensation to you – the injured party. Insurance companies exist to earn profits and pay dividends to their shareholders.

They earn money for their corporate shareholders by collecting insurance premiums (the money we all pay to obtain insurance coverage) from their insureds. The insurance company then invests that money with the goal of earning profits from their investments. If done properly, over time, their money grows and produces profits. When an insurance company pays out a claim, it is taking money that it can be using to invest and earn more money and giving it to you, thereby reducing its ability to invest and earn greater profits.

Insurance Company Defenses

How They Justify Not Paying Your Claim

Delay, delay, delay is the name of the game. The longer the insurance company can hold onto its money and keep it invested, the more it will earn in profits. They justify delaying, or many times these days, outright refusing to pay your claim for the following reasons:

The accident was not the fault of its insured;
The accident was the injured person’s fault;
The accident was caused by someone other than its insured;
You stopped short, causing their insured to hit your car in the rear;
You did not stop quickly enough;
You did not observe and obey a stop sign or red light;
Although their insured had the stop sign or red light, they were already in the intersection when the collision occurred;
You should have avoided the collision;
Their insured has a different version of how the accident occurred that places blame on you;
You were not wearing your seat belt;
The accident was not reported to the police;
You did not sustain a “serious injury” as required by law;
You were not transported from the scene of the accident by an ambulance;
You did not receive emergency room treatment;
There was a delay before you sought medical care;
In your initial medical visit you did not make complaints of pain to the body parts you now claim are injured;
There was not much damage to your vehicle (despite the fact that there was significant damage to their car);
There was not much damage to their insured’s car (although there was significant damage to your car);
You had pre-existing injuries;
You have been involved in prior accident or worker’s compensation claims;
You have gaps in treatment;
You have stopped medical treatment;
You did not have enough treatment;
Your did not miss a significant amount of time from work;
You had too much treatment;
Your injuries are not supported by the medical diagnostic testing;
Their doctors interpret your medical diagnostic testing differently from the treating doctors;
Their doctor’s examination did not reveal any injuries or limitations;
Their doctors state that you have healed and have no permanent condition;
You are asking for too much money

Dealing with these "Defenses"

Each of these “defenses” must be met with intelligent, logical and well prepared responses. Sometimes there may by an element of truth to the defense but that does not necessarily bar your claim entirely. A well prepared plaintiff’s attorney can oppose or mitigate most defenses in the effort to obtain fair and reasonable compensation for your injuries. Your attorney must obtain all relevant information and documentation and must constantly oversee the development of your case to ensure success. If you need further information, contact The Noll Law Firm, P.C. at (516) 307-1199 or at rnoll@lawnoll.com.

From the author: New York Personal Injury Trial Attorney

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