What are the Top 10 Reasons for Personal Injury Claim Denials?

Charlotte Personal Injury Attorney Matt Arnold answers the question: “The insurance adjuster is saying I am partially negligent what does that mean?”


Insurance claims are denied for a multitude of reasons, but the denial of your claim is not necessarily the end of the story.

denied-Charlotte-Monroe-Lake-Norman-Insurance-claim-attorneys-267x300If the insurance company denies your coverage, you should work with an experienced personal injury attorney to appeal the claim denial and fight for the compensation you deserve.

Contact our personal injury attorneys at Arnold & Smith, PLLC, to discuss the denial of your claim and find out how you can appeal the insurance company’s decision. We offer a free initial consultation. Call (704) 370-2828 for a case review.


Top 10 Reasons for Personal Injury Claim Denials in North Carolina

The reasons behind personal injury claim denials vary on a case-by-case basis. Some of the most common reasons why an insurance company may deny your claim include:

  • Policy exclusions. Insurance companies intentionally exclude certain accidents or injuries from their policies. These are known as “policy exclusions.” Insurers often use ambiguous language to exclude a greater number of accidents and injuries.
  • Lack of proof. When bringing an injury claim against the at-fault party’s insurance company, you are required to prove that the insured was responsible for causing the accident. If you fail to present a strong claim supported by conclusive evidence to prove liability, your claim could be denied.
  • Missing or incorrect information. When submitting your personal injury claim, you must make sure that the information you provide is correct, accurate, and complete. Also, you must follow the insurer’s strict submission requirements. Even a seemingly insignificant error could result in the denial of your claim.
  • Delay in medical treatment. Many personal injury claims are denied because the claimant did not seek medical attention immediately or they otherwise delayed getting treatment for the injury.
  • Location restrictions. Many auto insurance policies have strict location restrictions and do not cover accidents that happen outside the United States or the state where the motorist purchased the policy.
  • No connection between the accident and your injury. The insurance company could refuse to pay your injury claim if there is insufficient evidence to establish the link between the accident and your medical condition.
  • Pre-existing injuries. A large percentage of personal injury claims are denied because of a prior injury or condition. The insurer may deny you coverage if it believes that your injury is attributable to a pre-existing condition. Also, your claim could be denied if you lie about or fail to disclose pre-existing injuries when submitting the claim.
  • Lack of medical records. Medical records are arguably the most important element of a personal injury claim. If you fail to present any medical records or submit incomplete records, the insurer may have grounds to deny coverage.
  • Expiration/lapse of coverage. Policyholders often forget to renew their insurance policy, while failure to pay premiums can result in a lapse of coverage. If your insurance policy has lapsed or expired, the insurer might deny your claim if the injury occurred when your insurance coverage was not active.
  • Failure to mitigate injuries. If the insurance company believes that you failed to take all reasonable steps to mitigate the extent of your injuries, it could refuse to provide coverage.

No matter why your injury claim is denied, the denial is not the end of the world. You may still have the right to obtain compensation. Seek the help of our personal injury attorneys at Arnold & Smith, PLLC, to determine your best course of action.

Our Charlotte personal injury attorneys have years of experience dealing with insurance claim denials in North Carolina. Schedule a free, no-obligation consultation with our lawyers to help you get compensation for your claim. Call (704) 370-2828 to receive a video, phone or in-person consultation with our lawyers to explore your legal options or fill out our contact form. Now taking cases throughout North Carolina with offices in Uptown Charlotte, Mooresville and Monroe.







The skilled personal injury attorneys at Arnold & Smith, PLLC are dedicated to maximizing the financial recovery and obtaining justice for every personal injury client injured by another party’s negligence. The issues our personal injury clients may be facing include, but are not limited to, slip and fall injuries, wrongful death, product liability, catastrophic injuries, dog bite claims, car and truck accident injuries, motorcycle injuries, traumatic brain injury (TBI), nursing home negligence, spinal cord injury, boating accidents, and defective medical device injury. Our personal injury attorneys understand the devastating impact such an injury can have on a person’s life, and that the effects so often go beyond physical pain and suffering. The personal injury attorneys at Arnold & Smith, PLLC are dedicated to helping clients determine the strength of their claims, and to aggressively pursuing the means necessary to achieve the best possible end result for each client’s particular situation.






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