Why Your Personal Injury Insurance Claim May Have Been Denied

by | Oct 22, 2023 | Injuries | 0 comments

Accidents are unexpected, and personal injuries can turn your life upside down in an instant. Naturally, you turn to your personal injury insurance for the support and financial relief you deserve. After all, it is there to catch you when life throws its curveballs. However, what happens when the lifeline you thought you had ends up slipping through your fingers?

Countless individuals in New Mexico have faced the dreaded denial of a personal injury insurance claim, leaving them feeling stranded and helpless. Whether you have experienced a car accident, a slip and fall, a workplace injury, or another unfortunate event, a Dominguez Law personal injury attorney may be able to help you recover the compensation you are owed.

Common Reasons Behind Personal Injury Insurance Claim Denials in New Mexico

Personal injuries often result in significant physical, emotional, and financial challenges. When you find yourself in such a situation, you may turn to your insurance to help cover medical bills, lost wages, and other related expenses. However, it is not uncommon for insurance claims to be denied, leaving you feeling frustrated and overwhelmed.

A few common reasons behind personal injury insurance claim denials in New Mexico include:

Failure to Report in a Timely Manner

One of the most critical steps in the insurance claims process is promptly reporting the incident to your insurance company. Failing to do so can give them a reason to deny your claim. Insurance policies often have specific time limits for reporting accidents or injuries. In New Mexico, this time frame can vary, but it is generally best to report the incident as soon as possible to avoid complications down the road.

Lack of Medical Documentation

Insufficient medical documentation is another frequent reason for claim denials. When you file a personal injury claim, your insurance company will require comprehensive records of your medical treatment related to the accident. This includes medical bills, diagnostic reports, treatment plans, and doctor’s notes. If you do not provide this documentation, or if it appears incomplete or inconsistent, your insurer may deny your claim.

Pre-Existing Conditions

If you have pre-existing medical conditions, the insurance company may argue that your injuries were not solely caused by the accident but were instead exacerbated by your existing health issues. While this does not automatically disqualify your claim, it can complicate matters. To avoid this issue, make sure to disclose any pre-existing conditions to your insurer from the outset and work with your healthcare provider to establish a clear link between your injuries and the accident.

Disputes Over Liability

In some cases, the insurance company may deny your claim due to a dispute over liability. If the insurer believes you were partially or entirely at fault for the accident, they may refuse to pay out. New Mexico follows a pure comparative negligence system, which means even if you were partially responsible for the accident, you may still be eligible for compensation, but the amount you receive could be reduced based on your degree of fault.

Missed Deadlines and Procedural Errors

Insurance claims involve various deadlines and procedural requirements that must be followed meticulously. Failing to meet these deadlines or making procedural errors can result in claim denials. It is essential to familiarize yourself with the terms and conditions of your policy and adhere to all the necessary steps to ensure a smooth claims process.

Low Policy Limits

Sometimes, claims are denied because the insurance policy has low coverage limits that have already been exhausted. This can be especially challenging if your medical bills and other expenses exceed the policy’s limits. In such cases, you may need to pursue compensation from other parties involved in the accident through a personal injury lawsuit.

Pursue Monetary Compensation for a Personal Injury Accident in New Mexico

Dealing with a denied personal injury insurance claim can be frustrating, but you have options. If your claim has been denied in New Mexico, a Dominguez Law personal injury attorney can help you understand your rights and explore avenues for appeal or pursuing compensation through legal action.

Contact us today for a free consultation by calling (505) 850-5854 or completing our contact form. Se habla Español.