Why Auto Insurance Claims Get Denied

While the methodology used by insurance companies to determine who gets paid and how much may seem completely random, there is usually some form of rhyme or reason behind many of their decisions.

If you have had a friend or family member come to you after a denied claim, you have likely heard how unfair the process was, or how the insurance adjuster was just a money-grubbing criminal. It is completely understandable to feel frustrated after a claim denial—especially when medical bills are piling up—but in fact, the claim may have been denied for a number of reasons, most of which are common mistakes made by thousands each year.

Any Time You Are Seeking Compensation for an Auto Accident Injury, You Need to Follow Very Careful Protocol to Ensure That Your Case Will Be Successful

There are strict rules to follow, and many people make these mistakes, which ultimately ends in their claim being denied:

Missing medical appointments
Failing to follow your treatment plan
Telling first responders or the insurance adjuster that you are not injured before you have been medically evaluated
Divulging too much information on your social media account
Talking to the insurance company before speaking with an attorney

If You Have Been Involved in an Accident That Resulted in Serious Property Damage or Injury, Speaking With an Attorney Is Critical to Protecting Your Case

In the moments, days, and weeks following the crash, you will need to ensure that you are not acting in a manner that could wreck your claim. To help strengthen your case to get the compensation that you deserve, speak with an experienced auto accident injury lawyer as soon as possible.

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$10,043,952.13 Personal Injury
Schmidt Kramer, P.C.partner Gerard C. Kramer won a personal injury action for $10,043,952.13 in Northumberland County on behalf of a volunteer firefighter who was the victim of Intentional Tort. The 50-year-old volunteer firefighter was seriously injured when a barn collapsed, causing a spinal injury which left him a paraplegic. The claim was brought against the arsonist who intentionally started the fire. It is believed that the verdict is the highest ever in Northumberland County.
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$4,034,000.00 Personal Injury
Yesterday a Judge in Union County (Lewisburg, PA) awarded a couple from New Berlin, Pennsylvania, over $4,000,000 because the husband was shot while turkey hunting.You might ask yourself, how does a turkey hunting accident end up with that type of verdict? In order to understand the verdict you would have to know our clients. They are good people who had their life wrecked. Plus, you would have to know the defendant, who should not have been hunting with a gun because he was prohibited after a previous criminal conviction.It is a good verdict, because the Judge was able to do two things with his decision. First, he communicated to two very good people that their losses were something that those of us on the outside could appreciate and value. Mike Hobbins (our client) is a 51 year old guy who lost his sight because a convicted felon --who should not have even possessed a gun-- went hunting illegally, and broke with impunity the most fundamental rule in hunting: identify your target before you pull the trigger. The Judge accepted the financial loss Mr. Hobbins' suffered, but listened closely to the evidence of less tangible losses. When Mike broke down on the stand, because his daughter would end up walking him down the aisle at her wedding, as opposed to how it was supposed to go, the Judge was listening. When Mike could not keep it together, because of how emasculating it was for him not to be able to provide financially for his family, the Judge was listening. It was facts like these that the Judge cited to support the $2,000,000 award for non-economic damages. Second, the Judge wanted to send a message. Union County is a hunting county. Many of the residents hunt there, and people from outside the area come to Union County to hunt. It was my impression, from the Judge's statements as he rendered his decision, that he wanted to send a message to the people in Union County to protect them in their sport. The rules in place to restrict people convicted of crimes not to have a gun are not to be broken. Hunting is serious and you have to identify your target before you shoot. When you turn your back on the rules that are set to provide safety in a sport, you risk being an example. Here, the $1,000,000 punitive damage award sends that message loud and clear.When it really comes down to brass tacks, the right action was taken against a Defendant who may never truly appreciate what kind of impact his reckless choices caused.At Schmidt Kramer, we are injury lawyers. That means we work with people who were hurt in car accidents, who were hurt by the neglect of nursing homes, or those that were seriously injured because of the reckless, thoughtless acts of others. If you or a loved one have been injured in Pennsylvania, we may be able to help. While the verdict yesterday is not one that is representative of every case we do, it does show that serious and dedicated representation can bring good results.Joe ChapmanJanuary 18, 2013
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$2,200,000.00 Auto Accidents
On Monday, January 6, 2014, Schmidt Kramer accident lawyer Scott Cooper obtained a verdict on behalf of his client who is the widow of a man who died in a fiery crash on Interstate 78 in Lebanon County. The awarded verdict of $2.2 million was in a nonjury proceeding before a federal judge in the Middle District of Pennsylvania. That verdict includes $100,000 in punitive damages assessed against the owner of the trucking company.Kamilah Claxton won summary judgment in November after the defendants, Sukhwinder Singh and the trucking company for which he worked, failed to file a brief in opposition to Claxton's motion, which was made in September. The verdict in Claxton v. Singh was issued after the court held a non-jury assessment of damages earlier this month."Mr. Sukhchan Singh, the employer, is liable on the basis of respondent superior, but was also grossly negligent in failing to maintain his vehicle in compliance with state and federal law, particularly with regard to having required safety inspections and correcting defects in its braking equipment," said U.S. District Judge William W. Caldwell of the Middle District of Pennsylvania in his opinion accompanying the verdict."He was also grossly negligent in entrusting his vehicle to Sukhwinder Singh, an inexperienced truck driver who had failed the written test and driving test multiple times before finally earning his commercial driving license," Caldwell said.
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$1,200,000.00 Personal Injury
A Dauphin County jury has awarded a $1.2 million verdict to the parents of a 5-year-old who had an anoxic brain injury and stopped breathing after he had a tonsillectomy.2012-06-26 10:00:00 AMDate of Verdict: June 19. 2012Court and Case No.: C.P. Dauphin County No. 2009-CV-14003-MMJudge: Scott EvansType of Action: Medical malpracticeInjuries: Anoxic brain injuryPlaintiffs Counsel: Terry S. Hyman, Schmidt Kramer, HarrisburgPlaintiffs Experts: Dr. Anna H. Messner, liability; Lucille Packer, Pediatric Otolaryngology, Palo Alto, Calif.; Terry P. Leslie, vocations and earning capacity, Lancaster; Dr. Hilary B. Berlin, pediatric psychiatry, Great Neck, N.Y.Defense Counsel: Andrew H. Foulkrod, Darlene K. King, Foulkrod Ellis, Camp Hill, PADefense Experts: James C. Reilly, Pediatric Otolaryngology, Wilmington, DEComment: A Dauphin County jury has awarded a $1.2 million verdict to the parents of a 5-year-old who had an anoxic brain injury and stopped breathing after he had a tonsillectomy.The entire verdict came against Dr. Andrew M. Shapiro, the doctor who plaintiffs Reginald Graham and Tykeisha Metz alleged chose to have the boy monitored at a pediatric ward. The plaintiffs argued Shapiro failed to tell nurses caring for the baby about, and how to care for, the boy's enhanced risk for respiratory failure.The jury came back on June 19 and awarded Reginald Graham and Tykeisha Mets $500,000 in non-economic damages and $686,170 in loss of future earning capacity, according to the plaintiffs counsel.According to the statement, the baby's mother brought him to Shapiro because she was "'afraid that he might stop breathing during his sleep,'" the plaintiffs' pretrial statement said. Shapiro performed a sleep study and observed the baby's Apnea Hypopnea Index to be 43 — four times higher than what's considered severe. A tonsillectomy and adenoidectomy were performed.According to the plaintiffs, the baby's sleep study results put him at an increased risk for post-operative respiratory complications. Despite this, they argued in the statement, Shapiro ordered the pediatric nurses at the Harrisburg Hospital general pediatric ward to observe the boy as they would any other patients — about once every four hours.The pretrial statement said that one in four children who have an AHI in the 40s and oxygen desaturation below 80 have some type of respiratory problem. The younger the child, the greater the risk of a respiratory problem, the statement said.According to the statement, Shapiro took off the child's pulse oximeter, the finger-mounted device used to measure blood oxygen, and ordered a heart and respiratory rate monitor. The child was 11 months old at the time.The plaintiffs pled that the baby was last seen at 4 a.m. There was no record of his oxygen saturation for the next hour and 45 minutes. He stopped breathing a 6:40 a.m., and his brain was without oxygen long enough to cause demonstrable injury on an MRI."Immediately prior to his surgery, [the child] was a normal child, who could say mama, eat finger foods, and was just on the verge of walking," the statement said. "After his code, [he] was like a newborn. He could not lift his head or sit up. He could not talk. He could not move."In his pretrial statement, Shapiro argued that he recognized the child's pre-operative sleep study showed he was driven to breath by decreased blood oxygen saturation, which he said was typical in patients with obstructive sleep apnea.He argued the American Academy of Otolaryngology dictates that admission to the intensive care unit is not the standard of care. In the statement, he said nurses did not observe signs of respiratory distress. No alarms sounded until the child arrested, the statement said.He said the baby likely arrested as a result of hypoglycemia and/or an acute aspiration, which he argued would not have been identified by blood oxygen saturation.— Ben Present, of the Law Weekly
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Why Was Your Auto Insurance Claim Denied? These Common Missteps Lead to Failed Claims

Any Time You Are Seeking Compensation for an Auto Accident Injury, You Need to Follow Very Careful Protocol to Ensure That Your Case Will Be Successful