If you are pursuing a personal injury claim for injuries resulting from a motor vehicle accident that occurred in North Carolina and the insurance company has informed you that they will be denying your bodily injury claim, it is important to understand reasons why the claim could be denied.
1. Contributory Negligence
In North Carolina, contributory negligence is the most likely reason that your car accident claim would be denied. In North Carolina, adjusters like to determine or find fault in the accident victim thereby effectively barring their recovery under the theory of contributory negligence. It is a very strict standard for car accident victims, as it bars recovery even if you were just 1% at fault for the accident.
In many car accident cases, the insurance company will attempt to find or determine that the accident victim shared some degree of fault in causing the accident as early in the process as possible. It is important to have a complete and thorough understanding of contributory negligence if you plan to present a claim. For more information on contributory negligence, visit our Contributory Negligence section.
2. No Insurance Coverage
Another possible reason that your personal injury claim would be denied is if the at-fault driver did not have insurance coverage for his or her vehicle at the time of the accident. Fortunately, if you own a car, you may be able to seek compensation through uninsured motorist (UM) coverage.
UM coverage provides benefits that will compensate you for your medical expenses, lost wages, and pain and suffering when the at-fault driver does not have insurance coverage. In 2009, North Carolina made it mandatory that all auto policies have UM coverage of at least $30,000 per person, or $60,000 per accident. You can find more information about UM coverage here.
Therefore, unless you also do not have insurance coverage on your vehicle or you do not own a vehicle, it is likely that UM coverage is already provided for in your auto policy.
In the unlikely event that neither you nor the at-fault driver has active insurance coverage, you would have to pursue your personal injury claim against the at-fault driver directly. This is generally less successful, as your recovery depends on the assets of the at-fault driver, and if he or she is not able to pay for auto insurance there is not a great chance that they would have the assets necessary to adequately compensate you.
3. Not Enough Insurance Coverage
You may encounter a situation in which the other driver does not have enough insurance coverage to adequately compensate you for your damages. Although this is not a denial, it can certainly act as one if you were involved in a serious car accident and the other driver only carried minimum bodily injury coverage, since a significant portion of your settlement money will likely be used to pay your medical expenses, leaving very little for your pain and suffering.
However, if you purchased underinsured motorist (UIM) coverage through your auto insurance provider, this may provide you with additional means of recovery. As with uninsured motorist (UM) coverage, minimum UIM coverage of $30,000 per person and $60,000 per accident is provided for NC auto policies since 2009. Once you have exhausted the limits of coverage available under the bodily injury policy of the at-fault driver, you can request that your own insurance company open a UIM claim. However, do not sign a settlement and release with the at-fault insurance company if you plan to submit a UIM claim. For more information on underinsured motorist coverage, you can visit this article on our website.
4. Expired Coverage and/or Excluded Drivers
If you discover the vehicle that struck you had expired auto insurance or that it was being driven by an excluded driver, your situation is the much the same as if there was no insurance coverage at all on the vehicle. You can open a UM claim through your own auto policy, assuming that you have active insurance coverage.
You might also try to establish why the driver of the vehicle was excluded from coverage. If the vehicle was stolen, for example, it provides a clearer justification for denial than if the vehicle was being driven by someone who knew the owner of the vehicle. Occasionally, insurance companies will attempt to avoid paying claims where the owner of the vehicle loans the vehicle to someone else. If the operator of the vehicle was given permission to drive the vehicle, an agency relationship exists and the owner’s insurance company should accept the claim as valid.
5. No Contact and Low-Impact Collisions
One frequent cause for denial of a claim is what the insurance companies have termed “low-impact collisions.” Often, the insurance adjuster will assert that there was no contact at all between the vehicles because of the lack of visible damage to the vehicles. Furthermore, the adjuster may determine after an investigation into the circumstances of the accident that the vehicles were traveling at such a low speed that had there been any contact between the vehicles, it would not have caused the injuries alleged.
In order to provide solid evidence for your claim, it is important to take your own photographs of the vehicles at the scene of the accident. The other driver could repair the damage to his or her vehicle without the insurance company’s knowledge and make it appear that there was no contact between the vehicles. An easy way to avoid this happening is to take a few quick photos with your cell phone of the damage to both vehicles immediately after the accident.
Next, if the insurance adjuster asserts that an investigation was conducted in which collision testing confirmed a low impact or lack of impact between the vehicles, ask the adjuster to provide the “experts” who made this determination. Unless the insurance company has sent an investigator to inspect your vehicle, these assertions of a thorough investigation are likely being falsely represented to you.
6. Sudden Emergency
The “sudden emergency” doctrine is a defense to liability in a situation where a person, through no fault of his or her own, is suddenly and unexpectedly confronted with an imminent danger or harm and is forced to take immediate action to avoid injury. The doctrine requires 1) an emergency situation requiring the person to take sudden action to avoid injury; and 2) the person must not have caused the emergency situation by his own negligence.
As an example, take the recent 2013 decision in Mary E. Fulmore, Administrator of the Estate of Priscilla Ann Maultsby v. Gregory Howell and PFS Distribution Company, Inc., N.C. App. 741 S.E.2d 494, (2013), in which North Carolina upheld the “sudden emergency” doctrine in this case where the operator of a tractor trailer observed a vehicle approaching him in the wrong lane and threatening a head-on collision. The tractor-trailer was forced to veer into the other lane to avoid the collision and caused an impact with another vehicle, fatally wounding the driver. The plaintiff was unsuccessful in suing the tractor-trailer company because the driver’s actions were said to fall within the parameters of the “sudden emergency” doctrine. The appeals court found that it was an unfortunate result but the driver was forced to take sudden action to avoid the collision with the vehicle and he did not create the situation by his own negligence. Therefore, he met the requirements of the doctrine.
If you find yourself in a similar situation, you should pursue a bodily injury claim with the insurance company of the driver that started the chain of events if that driver can be located. If the driver leaves the scene of the accident unharmed and you are unable to find any information on the driver, you could pursue an uninsured motorist claim through your own auto policy.
7. No Damages
In order to have a valid personal injury claim, you must be able to prove that you were injured as a result of the accident. If you have not been treated by a medical professional and/or there are no records of medical treatment, the insurance company will fairly assume that you were not injured in the accident and you will not be able to receive compensation.
However, there is no monetary threshold for damages that must be met in North Carolina in order to have a valid injury claim. Therefore, if you simply went to the doctor for one visit and did nothing else, you could still recover for that one date of treatment. That being said, the severity of your injuries often goes hand in hand with the amount of treatment received, so evidence of multiple treatment sessions provides a better argument for your damages than one doctor’s visit.