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Common Reasons Insurance Claims Are Declined in Personal Injury Cases

Personal injuries can happen under a variety of circumstances. When they are caused by the reckless or negligent conduct of others, you may be entitled to compensation through the at-fault party’s insurance company. Unfortunately, these companies have a financial motive in undervaluing or outright declining your claim. Below are some of the most common reasons insurers use to avoid making payments, along with actions you can take to protect yourself and to help ensure you get compensation for the losses you have suffered.

Why and How Insurance Companies Decline Claims

According to a report by the American Association for Justice (AAJ), the insurance industry is one of the most profitable in the U.S., making more than $30 billion per year and paying CEOs more than in any other field. There are two basic tactics these companies use in increasing their profits: one is increasing the cost of their insurance, and the other is by decreasing the amount they pay out in settlements.

The AAJ reports that some of the largest insurers in the nation routinely pressure employees to find reasons why a claim can be denied. Among the most common include the following:

  • Disputing the circumstances under which the accident occurred;
  • Claiming their client is not responsible, or that the victim is partially to blame;
  • Disputing the nature, extent, and impact of the injuries you suffer;
  • Disputing the amount of medical expenses and lost wages you are claiming;
  • Disputing the amount or type of insurance coverage their client has;
  • Claiming that the proper procedures were not followed.

With the threat of losing their job over paying out to much in claims settlements, even otherwise honest insurance representatives are likely to engage in these practices.

What You Can Do If Your Claim Is Declined

There are certain actions you can take to help ensure your claim is paid when personal injuries occur. This includes:

  • Alerting law enforcement or a security guard immediately;
  • Making sure an accident report is filed;
  • Getting contact information for any witnesses at the scene;
  • Getting medical attention as soon as possible and following all doctor instructions;
  • Keeping accurate records as to the various expenses you incur.

Contacting an experienced personal injury lawyer to negotiate with the insurer on your behalf is always a smart idea. If your claim is denied or a settlement cannot be reached, your lawyer can assist you in filing a personal injury lawsuit against the insurer or the at-fault party. Under Section 746.230 of the Oregon Revised Statutes, insurance companies can be found guilty of unfair claims settlement practices based on the number of lawsuits filed against them or their insured. As a result, they could face heavy fines and the potential loss of their business license.

Protect Yourself Against Unfair Insurance Industry Practices

When injuries occur, you have only one chance to get the compensation you need to recover. To protect your rights, call or contact the Johnston Law Firm online. Request a free consultation to discuss your case with our Portland personal injury attorney before taking any actions that could end up working against you.


Marc Johnston

Lead Attorney at Johnston Law Firm, P.C.

Based in downtown Portland, Marc A. Johnston is the owner and managing attorney of the award-winning, internationally-known personal injury law firm, Johnston Law Firm, P.C. Marc's career has been dedicated to representing the injured and individuals who have been treated unfairly by an insurance company. His focus on trial law creates the backbone of the Johnston Law Firm — a firm that is ready to go the distance in seeking justice for its clients.