You have options if the insurance company denies your slip and fall claim. Learn why your claim was denied and what you can do to get paid.
Total injuries due to slip and falls in the U.S. cost accident victims a combined $13-14 million per year.¹
Most of these victims will file an injury claim with an insurer to receive compensation for their losses.
Insurers, though, and the claim adjusters that work for them, are in the business of looking for any reason to deny a claim or provide a lowball settlement offer.
Sometimes a company will support a denial by saying that you failed to prove that the property owner caused your accident. An insurer might also say it has to deny your claim because the policy lapsed or you didn’t comply with all of the filing requirements.
No matter the insurer’s reason, don’t stop fighting for the compensation you deserve. While you may have to hire an attorney for help, you can still try and recover payment for the damages you suffered in your accident.
Insurance Bias Towards Denial
If your slip and fall claim was denied, don’t give up. It’s important to know that insurance companies operate to make a profit. Insurers handle injury claims every day, and they do their best to reduce the victim’s settlement or avoid paying a slip and fall claim at all, if they can get away with it.
Claims adjusters work to deny claims because no payouts mean greater profits for the insurance company and bigger bonuses for the adjuster. In short, there is a bias towards claim denial inherent within the insurance claim system.
In fact, insurance companies and adjusters use several different tactics for paying less on slip and fall claims or denying them in their entirety.
Beware of Adjusters Acting Like Your Friend
Claims adjusters will often try to buddy-up to you when they initially get assigned to your claim. One main reason for this is that they want you to provide a recorded statement to tell your side of the story.
In the course of these statements, adjusters will try to trick you into saying things that can hurt your claim. If they succeed, they can use your statements to stand behind a low offer or a claim denial.
Slip and fall lawyers generally advise injury victims against giving a recorded statement to an adjuster without legal representation.
Think long and hard about giving a recorded statement. Do your homework, and take the time to prepare yourself if you decide to go ahead on your own. Once something potentially harmful is said, there is no taking it back.
Expect Lowball Slip and Fall Settlement Offers
Adjusters almost always start off by providing claimants with extremely low settlement offers.
Once the offer is made, the adjuster typically adds that:
- It’s the most the company can pay for this type of claim
- It’s a fair deal
- A greater offer is not in the adjuster’s authority
This information is typically just not true since insurers have a reason to make a low offer. They’re hoping you’ll become discouraged and accept the offer without asking for more.
Your acceptance means the insurance company saves money because it’s resolving your claim at a discounted price.
Alternately, if you get angry or upset by the low offer, you might say things that help the adjuster know just how to make you settle for less. Never admit that you’re behind on rent, need the money for an upcoming vacation or holiday, or anything else that reveals you’re in a hurry or desperate to settle.
You should never take a lowball offer personally. Rather, stay calm, reject the offer, and move on with your negotiations.
Stalling Tactics Require Patience
Insurance companies sometimes intentionally delay in resolving a slip and fall claim. If you’ve tipped your hand and shared with the adjuster that you need the money right away, they will not rush to settlement.
They can afford to wait so long as they know you can’t.
Some common stall tactics include:
- Ignoring your phone calls
- Failing to answer questions
- Rejecting counter-offers
Adjusters want you to lose confidence in your claim and stalling helps accomplish this. Delays may also frustrate you and force you to accept a low settlement.
Sometimes you may end up working with a lazy or overworked adjuster. In these cases, any delays are probably without intent, and you need to pursue negotiations with patience. Frustrations will only reduce your compensation.
Denying a Claim Can Be Strategic
Believe it or not, denial is a powerful strategy to help deter injury victims from pursuing compensation.
Once adjusters deny a claim, they’re hoping a slip and fall victim will walk away without taking any further action. Most people don’t have the knowledge or confidence to keep going after an insurance claim denial.
The tactic is even more beneficial than a lowball offer because the insurance company doesn’t have to pay out a single penny on the claim.
In the event of a denial, don’t get discouraged. You can still try to receive money for your injuries and losses.
Common Reasons for a Claim Denial
Insurance companies can deny an injury claim for any reason consistent with federal and state insurance laws.
But, when it comes to slip and fall accidents, there are some common reasons for the denial.
Lack of Evidence Regarding Causation
You bear the burden of proof when you file a claim for your fall injury to establish proof of your injuries and how they happened.
In a slip and fall case, you’ll have to show that the business or property owner is responsible for the conditions that led to your slip and fall injuries.
It’s your job to prove that this owner:
- Had a duty of care to avoid causing injuries to you and others
- Violated that duty by creating an unsafe condition or failing to take reasonable precautions to avoid one
- Directly caused your injuries through this violation.
You must provide strong evidence to each of these. If you come up short, then you give the adjuster a reason to deny your claim. The adjuster can say there is no or little evidence that shows their client was at fault for your injuries.
Evidence that helps establish causation in slip and fall cases includes:
Lack of Evidence Regarding Your Injuries and Losses
Even if you show that a property owner caused your accident, your claim may get denied if you fail to show that you were actually injured in the accident.
Without evidence of a physical injury, the insurance company has no reason to believe that you’ve suffered harm worthy of compensation. Most insurance companies won’t pay much, if anything, simply for the embarrassment of falling in a public place.
Evidence that helps show you were injured in a fall includes:
- Medical records
- Pictures and video of your injuries
- Bloody or ripped clothing
- Broken footwear
After establishing your injuries, you’ll need to go one step further to avoid claim denial. That step is to provide the adjuster with evidence of your slip and fall damages. Damages refer to the losses you’ve suffered because of your slip and fall injuries.
Some examples of damages include:
The above are examples of economic damages. Most slip and fall cases also involve non-economic damages. Non-economic damages are sometimes difficult to prove because a bill or a receipt doesn’t determine their value.
Examples of common non-economic damages are:
- Pain and suffering
- Loss of consortium
- Loss of enjoyment of life
- Physical Impairment
You can use an injury journal to help prove your pain and suffering. In the journal, make sure you document how you’re feeling (both physically and emotionally), any limitations you experience, and any activities or events you’ve had to miss because of your injuries.
Denials Based on Pre-Existing Conditions
Sometimes an insurer will deny your claim by saying that you already had an injury or medical condition before your fall. These injuries are referred to as pre-existing conditions.
Consider, for example, a woman who has a bad ankle because of prior sports injuries. If she injures the same ankle in a fall, the insurer will likely deny the claim and say that any fall “injury” is due to the prior sports events.
Having an underlying injury should not prevent you from settling a claim if you’ve re-injured the same body part. Likewise, being frail and elderly or otherwise predisposed to easy injury is not a legal reason to deny your slip and fall claim.
Failing to Mitigate Your Injuries
An adjuster can rightfully deny a slip and fall claim if a claimant fails to mitigate their injuries.
Mitigating your injuries means that you take the effort to make your injuries less severe. This is accomplished by seeking medical treatment, following your doctor’s advice, and trying not to worsen the injury.
Consider, for instance, a man that injured his knee by slipping and falling down a theatre’s stairs. If his doctor advises him to take it easy and avoid exercise for two weeks, the victim fails to mitigate his injuries by jogging every other day.
It’s important to seek medical care after a slip and fall, as soon as possible after the accident. This is true even if you feel like nothing is wrong. Many types of injuries may not manifest symptoms for hours or days after the fall.
If you haven’t had a medical evaluation right away, the insurance company will argue that your injuries are not related to the slip and fall.
Failing to File a Complete Claim
Almost all slip and fall claims will have submission requirements. The adjuster often (but not always) informs you of these requirements at the early stages of filing a claim. You should take note of these and make certain that you’ve complied with all of them.
Claims for injuries that occur on government property, whether state, local, or federal, have unique filing requirements and very short deadlines.
Insurance adjusters can deny your claim if it doesn’t adhere to any submission requirements or contains a lack of information.
Asking for an Unreasonable Settlement Amount
Adjusters are responsible for working on multiple claims at one time. They are busy people that want to save time and also wish to save their employers’ money.
If you start your settlement negotiations by asking for an unreasonable settlement amount, the adjuster will likely deny your claim in its entirety. Denial means the adjuster can move on to working on another claim while avoiding any type of payout.
You’ll also lose credibility with the adjuster if you start negotiations with an excessive compensation demand. Make sure you’re being reasonable in your negotiations.
This doesn’t mean you have to bow down to an adjuster and accept whatever offer is presented to you. Rather, make sure you know the full value of your slip and fall injury and have the documentation to back it up.
Lapse of Policy Coverage
A lapse in coverage is when a person or business doesn’t have insurance for a period of time. It can happen because the policyholder fails to renew a policy or the insurer fails to extend a policy.
If a business owner does not have insurance because of a lapse, your insurance claim will be denied because no insurance was in effect at the time of your slip and fall.
Bad Faith Insurance Tactics
It’s possible that an insurance company denied your claim because it acted in bad faith. If this happens, you might have the option to sue them, or you could file a complaint with your state’s insurance commissioner.
All states have laws in place that require insurers to use good faith and fair dealing with all claims, no matter the type of claim.
This often means that insurers should:
- Clearly communicate with claimants
- Process claims within a reasonable amount of time
- Handle settlements fairly and reasonably
- Provide clear reasons in cases of a claim denial
If an insurance company deviates from these principles, then it’s possible the insurer is acting in bad faith and you may have the basis for a lawsuit.
Specific examples of bad faith dealings are:
- Failing to promptly detail the reasons for denying your claim
- Failing to make a fair settlement when fault is easily assigned to the insurer’s client
- Denying your claim without performing a reasonable investigation
- Failing to use realistic standards to investigate your claim
If you believe your slip and fall claim was denied because of bad faith practice, you should consult with a personal injury attorney to learn your options.
Options After Slip and Fall Claim Denial
A claim denial doesn’t necessarily mean that you can’t receive compensation. There are positive steps you can take to try and recover money for your losses.
Continuing Negotiations With the Adjuster
If an adjuster informs you that there is no coverage for your accident, you should continue with your negotiations. In this scenario, the issue of whether or not a policy covers your injuries becomes just another question within the negotiation process.
You should ask the adjuster to provide a written explanation of the insurer’s reasons for the denial. Once you know the reasons, you can reply with a statement about why the reasons don’t apply to your case or why the policy should still cover your injuries.
If an adjuster states that you didn’t prove that the property owner was responsible for your injury, or provide enough information about damages, go ahead and provide more evidence to support your claim.
If you recovered from minor injuries and don’t have much evidence, with persistence you might still be able to get a nuisance value payout, rather than walk away with nothing.
If for some reason an adjuster doesn’t provide a written explanation, send a certified letter to the adjuster that includes the fact that you made such a request. Keep a copy of your letter in your injury claim file. This letter may cause the adjuster to act. If no action is taken, it may help show bad faith if you later file a lawsuit.
File a Claim with Another Party
There are situations when an adjuster is justified in denying a claim. If this is your situation, look at the facts of the case and see if you can file a claim with the insurance company of another party involved.
Let’s say that a person tripped and fell on a rake that was on a park’s grounds, and the city denies the claim because it was not responsible for the rake. The injured claimant could file a claim with the business or person responsible for leaving the rake in the park. Perhaps a landscaping service or another third party is to blame.
Filing a Lawsuit Against the Property Owner
You can turn to the court system if the adjuster in your case doesn’t budge in denying your claim.
Even though it was the property or business owner’s insurance company that denied your slip and fall claim, you won’t sue the insurance company. Your injury claim lawsuit will name the business or property owner.
You’ll want to file a lawsuit in the correct venue, meaning district or superior court for the county you reside in or where your slip and fall accident occurred.
Depending on the amount of compensation you’re seeking, a small claims court lawsuit might be a good option for you. Most states set a limit of $5,000 to $10,000 for small claims cases and the rules are designed to be easier for those who choose not to hire an attorney.
Outside of small claims courts, the litigation process can be costly and complicated, with several stages and deadlines.
Litigation stages include:
- Court filings: This includes the filing of a plaintiff’s complaint and the defendant’s answer.
- Discovery process: Both parties use the process to investigate the case and gather evidence via depositions, witness interviews, document requests, and accident reconstruction.
- Filing of motions: Parties can file motions to ask the judge to do certain things in the case, like exclude certain evidence.
- Trial phase: This phase can last a few days or up to a few weeks, depending on the facts of a given case.
- Appeals process: A party that loses a trial can file an appeal, which is a request by a higher court to review the trial proceedings.
Most lawsuits settle out of court, before the actual trial starts. If your case goes all the way to trial, your lawsuit will be decided by a judge or a jury.
How an Attorney Can Help
There are many ways an attorney can help you pursue compensation, even if the insurance company has denied your slip and fall claim.
Establishing the Strength and Value of Your Claim
Most injury attorneys offer a free consultation, so you’ll know upfront what your claim is generally worth, and what options make sense for your situation. If you hire an attorney, they can contact the adjuster and work on continuing with negotiations on your behalf.
Lawyers are used to adjusters’ tactics and might have more success in persuading them to settle your claim for a reasonable amount.
If your claim was denied because of a lack of evidence, an attorney can get to key evidence you would have a hard time getting on your own. For example, your attorney can file a subpoena to force the property owner to hand over surveillance film footage and incident reports.
A personal injury lawyer is also better situated to look at the facts of your case to determine if there are other parties that might be liable for your injuries. For example, if you slipped and fell in a convenience store, and the puddle you slipped on was caused by a defective ice machine, both the store and the machine manufacturer could be liable.
Representation in the Courtroom
If you chose to file a lawsuit, you or your attorney has to file suit within your state’s statute of limitations for injury claims. If you fail to settle your claim or file a lawsuit before the statute runs out, you forfeit your right to any compensation.
When you file a lawsuit against a business or homeowner, you can be sure they will be represented by experienced defense attorneys. The same insurance company that denied your slip and fall injury claim has a duty to defend their insured in a lawsuit by hiring the best lawyers. Let your attorney face them for you.
Help in Proving Bad Faith
An attorney can also assist you in filing a bad faith claim against the insurer – either in court or with your state’s insurance commissioner.
To show bad faith, you usually have to prove that you didn’t receive the benefits you were entitled to under the owner’s policy. Or, you might also show that the insurance company unreasonably withheld your benefits.
A lawyer can help gather the evidence to make these claims.
Most injury attorneys work on a contingency fee basis. This fee basis means you don’t have to pay them a dime unless your claim settles or you receive a favorable award in court.
Don’t lose hope because an adjuster denied your slip and fall claim. Get the reasons for the denial and talk to a personal injury attorney about your options for getting the compensation you deserve.
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