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What Defenses Do Insurance Companies Use To Avoid Paying Out On Claims?


First and foremost, insurance companies will use the liability defense, which is to claim that it was the injured party who caused the accident, not their insured. In making this argument, the insurance company will hire their own experts and investigators to find evidence that the injured party is to blame.

Another way that insurance companies will try to avoid paying out on claims is by reviewing the medical records and arguing that the injuries being claimed are either exaggerated or not attributable to the incident itself, or that the treatments given were not necessary nor reasonable. They will always argue that the costs associated with the treatment are excessive and will provide a number that they say their own in-house doctor said was reasonable. If the injured party does not get treatment in a timely manner or there is a gap in treatment, the insurance company will use that to argue that the injured party was not even very injured.

Having an experienced attorney is crucial to not only navigating the need for treatment and accessing the right doctors for that treatment, but also to understanding where the insurance companies are coming from so that you can stay one step ahead.

How Is The Value Of A Personal Injury Settlement Calculated?

The value of a case is determined first and foremost by the costs of the medical treatment that you’ve received. Pain and suffering, mental distress, and emotional stress associated with the incident can add value in the amount of two to five times the medical cost. Another key factor in the value of a case is lost wages, including the use of vacation days to cover missed days at work.

The cost of future medical treatment will also be included in the value of a case. This is determined by having a doctor provide the estimated cost of the treatment that will be needed. For example, if a surgery costing $50,000 will be necessary in the future, then $50,000 would be added to the value of the case. Ultimately, the insurance company will become beholden to the cost of past and future medical costs. It’s important to hire an experienced lawyer who can help put the numbers together and ensure that you walk away with the highest settlement possible.

For more information on Defenses Used By Insurance Companies, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (626) 385-6303 today.

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