Personal Injury Claim Denials and How to Appeal

According to the legislation, the negligent party that accidentally, directly or indirectly caused harm to the victim can be demanded to pay for the victim’s loss. The defendant’s insurer can also handle the process and cover the defendant. However, not every accident can be considered negligence as the claimant’s action can also be the reason for the accident. On a similar occasion, if the claimant’s complaint is rejected and if the claimant believes it was a mistake and he/she was treated unjustly, a lawsuit can be filed, and the personal injury claim will be carried to the court.

Also Read: How to Receive Compensation if You Are Injured in a Car Accident Involving Bad Weather Conditions

Not on every occasion, the other party is at fault

Suffering the consequences of an unexpected accident are surely frustrating and can leave the injured party with permanent health conditions that can be hard to deal with. However, the victim should acknowledge the fact that not every accident that occurs in a public place, at work or in traffic is someone else’s fault. Generally, such claims take around a year to be concluded. But the result might not satisfy the claimant if he/she is missing sufficient knowledge on how the process works. On the other hand, on some occasions, the victim can be wronged. The insurer will act in good faith whilst evaluating the claim and will make a fair decision most of the time. Though, mistakes can be made, and, in such a situation, the final decision will be made by the court.

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Motor accidents claim denials and unsatisfactory results

Victims can be in the opinion of being treated unjustly after a denied claim or after the compensation settlements if the amount offered by the insurer seems insufficient. In motor vehicle accidents, this situation can be problematic as at least, the victim’s medical expenses and income loss should be replaced by the insurer without needing further investigation, as motor vehicle accidents are partially based on the no-fault scheme. Under the scheme, both parties can benefit from income replacements and payments for medical expenditures regardless of faultiness.

On the other hand, the insurance payout will also reflect the victim’s contribution to the accident. Even if the claimant is found innocent and earned the compensation payment, the victim’s lack of personal care and contribution to the severity of his/her medical condition will be taken into evaluation whilst finalising the claim.

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Workers compensation denials

Workers compensation is fully based on the no-fault scheme, which means the injured workers have every right to take legal action if their claims are denied. Although the faultiness isn’t taken into consideration for the eligibility for compensation, a different procedure applies to the employer if his/her negligence played a part in the accident. Legally, employers’ obligations are to keep their workers away from harm. Breach of this duty can lead to a separate judgement in which the employer can be found guilty.

Although it is not a common occasion, employers can try to avoid liability in case an accident occurs. Mostly the reason for such behaviours is the missing compulsory insurance in the workplace – which means the workplace is illegally working-, employer being aware of violating the laws and employers that are unlawfully trying to prevent insurance premiums.

Also Read: Tips to Manage Your Expenses in a Personal Injury Case

Public liability claims denials

One’s public liability claim can be denied for many reasons and mostly, the reason is that the accident occurs from the claimant’s own recklessness. If the defendant party –which can be a restaurant, shopping centre or a business- sufficiently performs their tasks and takes the necessary care, the claimant may not be eligible for compensation. As an example, in a coffee house, if the customer was warned that the beverage was hot and could cause harm, either with a caution label or any other sufficient way, the customer is expected to be aware of that risk. Therefore, proceeding to purchase means that the customer took the risk, and the business fulfilled its duty.