The Second Blow: Being Denied Medical Care After Suffering a Car Accident Injury

In 2012 more than 165,000 people were badly hurt on Canadian roadways.  This includes automobile drivers, occupants, pedestrians and cyclists. In spite of these high numbers, studies show that serious car accident injuries are lower now than they have been for the last twenty years. People who suffer serious injuries have their lives irreversibly changed in an instant.  Automobile insurance is meant to help seriously injured people heal and build a fulfilling life as close to pre-injury state as possible.  People who have been badly hurt through no fault of their own are astonished to find that their trusted insurance professional fights them.  It is a terrible blow to be seriously hurt. While it is common for insurance companies to refuse care for any variety of reasons, it is a cruel second blow when the insurance company –  thought to represent peace of mind and relief, is outright refusing or limiting necessary medical care and rehabilitation.

Insurance companies have a staff of professionals who are well acquainted with automobile insurance policy wording and Canadian law as it pertains to car accidents and personal injuries.  They are not responsible for educating clients on this information and cannot be expected to share it if not in their business interest to do.

What Reasons Do Insurance Companies Give to Deny or Limit Personal Injury Claims?

Client signed off
Depending on the injuries insurance company might offer an enticing compensation cheque, encouraging a client to sign off the case. The effects of certain injuries such as traumatic head injuries become more obvious as time goes on.  Unsuspecting clients who sign off are distressed to find pain and disability worsening and the costs of medical care impossible. The benefit package which seemed generous at the time, turn out to be far below the amount required. Always see an experienced personal injury lawyer before or signing any paperwork.

Not eligible based on the evidence in client statment
People who report the accident to their insurance company may be asked for a detailed account of the accident either verbally or in writing.  In many cases the reports are given verbally by the plaintiff and transcribed by the insurance agent. These reports are commonly written in a way that is incriminating to the client and biased against their rights to benefits.  In many cases the written report is very different from the client’s actually testimony.

Speak to your lawyer before giving the insurance company a verbal or written report of any kind. When you are asked to do a report or sign anything, read it carefully and have your lawyer look at it before adding your signature.

Insurance companies may deny benefits based on “their” evidence
They may say that their evidence indicates the accident could not have been serious enough to cause the injuries expressed by you, so they are not responsible for paying for medical bills or rehabilitation

Their photos indicate you were at fault or partially at fault for the accident.

Photos of the accident taken by the insurance company do not take the place of police investigations or photos taken by eyewitnesses. Evidence collected by the insurance company is usually biased in their favor not yours. Do not explain the details of the accident to the insurance company, before getting legal advice. Your personal injury lawyer should be notified as soon as possible after the accident to preserve and document evidence before it is contaminated or removed. Even if you are fully or partially to blame for the accident, you may be eligible for compensation through no fault insurance or a tort claim.

They say you are exaggerating, faking or malingering
Even after a client has launched a personal injury claim, the defense (on behalf of the insurance company) will often accuse the client of exaggerating injuries or malingering, for the purpose of financial gain. Unfortunately in some cases clients do not have the financial ability to pay for treatment before the case settles, and are treated as malingerers or liars by the defense.

There is no medical proof of your injuries
Many serious injuries take a while to diagnose and prove. The defense will deny benefits based on “supposed” or “actual” lack of medical evidence and deny the level of serious pain and disability expressed by the client.

If you launch a lawsuit, lawyers for the defense will be highly critical of your doctors’ reports and usually arrange for you to have an independent medical examination or IME. This supposedly “independent” medical, is arranged by the defense and biased on their behalf. Winning compensation from the insurance company is a massive struggle. On your own it is next to impossible. An experienced injury lawyer knows the tricks and excuses used by insurance companies and will confidently help you win the compensation you are entitled to.

You did not get immediate medical care after the accident
Insurance companies often use the excuse, that if you did not get medical attention immediately following the accident, you could not have been injured.

If you were injured and in pain it would make sense that you would have gone for treatment. The insurance company will focus on this point. It is recommended that you get medically examined after being in a car crash, even a minor one. However, many of our clients, who sustained traumatic brain injuries and other invisible or psychological damage, did not get medical care immediately, because they did not realize they were hurt until hours or days after the crash.

Your injuries were pre-existing
Insurance companies often say there is no evidence your injuries were caused by the car accident and were pre-existing or caused by some other reason.

You are denied because of what you said on Facebook
If your personal injury case goes to court, your character will be strongly considered by the judge and jury. Insurance companies check out social media. Although you may be doing your best to stay positive and upbeat, by posting a photo of you smiling, it can work against your chances of getting fair compensation. Be very careful with what you post on line. Innocent photos or comments can be easily misconstrued by some one who is trying to discredit your honesty and good reputation.

File Closed
The insurance company might say your file is closed because it has been several months and they had not heard from you. There is a statute of limitations for a personal injury claim. Usually it is 2 years in Ontario. Your lawyer can give you specific information on this, and the steps to take to file a claim.

You do not meet the legal criteria for the compensation you seek
There are legal guidelines and limits for serious injuries and the types and amount of benefits available for each. There is a huge difference between the amounts of support required for catastrophic injuries and non-catastrophic injuries. Insurance companies often, minimize client injuries to severely limit the financial payouts they are responsible for. Your personal injury lawyer understands these laws and how they affect your rights to compensation amounts. With competent guidance the insurance company will not be able to close the door on your legal rights.

Fight For Your Rights To Compensation
Regardless of the size of your car accident injury claim, it is extremely common for insurance companies to deny compensation based on biased accusations. When insurance companies deny claims, many people are shocked and not sure what to do next. Some even give up. This works out very well for insurance companies.

If you or a family member has been injured in a car accident and their accident benefits or insurance claim has been denied – don’t give up. Our lawyers will assist you in getting the rehabilitation and financial compensation you deserve.