You may face a denied motorcycle accident claim because the insurer has found a reason, big or small, to protect its bottom line. An insurance company's denial isn’t the final word on your case; it's the start of a fight you can prepare for.
An motorcycle accident attorney can persuade the insurer to re-evaluate your claim on its true merits by collecting new evidence, building a strong case, and showing the company the financial risk of a potential lawsuit.
Key Takeaways for Denied Motorcycle Accident Claim
- Insurance companies often deny claims based on disputes over who was at fault for the accident.
- A common tactic involves using a rider's own statements against them to justify a denial.
- Pre-existing biases against motorcyclists frequently influence an adjuster’s decision-making process.
- A formal appeal letter is a critical step in challenging the insurance company’s determination.
- Legal counsel can manage the entire appeals process and counter the insurer's arguments.
Common Reasons Insurers Deny Motorcycle Claims
An insurance adjuster reviews cases, looking for reasons to reject them. They scrutinize every document and statement that victims provide. A formal denial letter typically includes a specific justification, which gives you a starting point for your appeal.
Allegations of Fault or Contributory Behavior
The most frequent reason for a denied motorcycle accident claim is a dispute over liability. The other driver’s insurance company may argue that you caused the crash because you were speeding down the I-35E, made an unsafe lane change near Klyde Warren Park, or were otherwise negligent.
Texas law reduces your claim value by your percentage of fault, so an insurer gains a financial advantage by shifting as much blame as possible onto you.
To support their position, adjusters will look for any evidence that shifts blame to you. This includes analyzing the police report for officer opinions, examining photos of the vehicle damage, and searching for witness statements that favor the policyholder.
When liability isn't clear, the insurer will almost always decide in its own favor.
Claims of Policy Violations
Your claim might face a denial for reasons that have nothing to do with the accident itself. Insurance policies are complex contracts filled with specific exclusions and strict procedural requirements.
The company may point to one of these technicalities to invalidate your claim, preventing any payment for your injuries or property damage.
Here are a few technical reasons for a claim denial:
- Lapsed Coverage: The policy wasn’t active at the time of the crash due to a missed payment.
- Unlisted Operator: The person driving the motorcycle wasn’t named on the policy.
- Failure To Report Promptly: You waited too long to report the accident to the insurance company.
- Non-Cooperation: You failed to provide the requested documentation or a statement in a timely manner.
Disputes Over the Severity of Injuries
In some cases, the insurer agrees that their policyholder caused the accident but contests the seriousness of your injuries. This kind of dispute focuses on reducing the value of your case rather than rejecting it altogether.
They may argue that your injuries aren’t as severe as your doctors have stated. An adjuster might hire an independent medical examiner to review your file or even require you to attend a physical examination.
This doctor, whom the insurer pays, may look for evidence to downplay your condition. They might conclude that your injuries predated the accident or that you exaggerated your symptoms, providing the insurer with a reason to deny payment for certain medical treatments.
Misrepresentation of Policy Terms
An insurance company may deny a valid claim by misinterpreting the language within its own policy. An adjuster might incorrectly inform you that certain damages, such as pain and suffering or specific types of medical treatments, aren’t covered under the applicable policy.
They interpret ambiguous phrases in the company's favor, hoping you won't read the fine print or question their authority.
This tactic can cause you to abandon a legitimate part of your claim without realizing the adjuster misled you. It relies on the complexity of insurance contracts and the trust a policyholder places in the company.
A knowledgeable attorney can review the policy and identify when an insurer isn’t honoring its contractual obligations.
Disputes Over Damages
Even if the insurer accepts liability and acknowledges your injuries, they can still dispute the total value of your claim. An adjuster can challenge the reasonableness of your medical bills or question the repair estimates for your motorcycle.
The company aims to pay out as little as possible on every single component of your losses. A denied motorcycle accident claim can occur in part because of these valuation disputes.
Adjusters use specific methods to lower your claim's value:
- Questioning Medical Bills: They argue that the costs for certain treatments are above the customary rate for the Dallas-Fort Worth area.
- Challenging Repair Estimates: An adjuster might demand you use a specific repair shop known for low-cost, lower-quality work.
- Downplaying Lost Wages: They can contest the amount of time you took off from work, claiming you could have returned sooner.
- Ignoring Non-Economic Damages: The insurer may make an offer that completely ignores your right to compensation for pain and suffering.
Bad Faith Practices
Every insurance company in Texas has a legal duty to handle claims in good faith. This means they must investigate and process your claim fairly and in a timely manner.
A motorcycle accident claim denial may be the result of bad faith, which occurs when an insurer unreasonably denies, delays, or underpays a claim without a proper justification.
Here are some signs of bad-faith insurance practices:
- Failure To Investigate: The adjuster doesn’t conduct a thorough investigation into the circumstances of the accident.
- Unreasonable Delays: The insurance company fails to make a decision on your claim within a reasonable timeframe.
- Lack of Communication: The adjuster doesn’t return your calls or respond to your inquiries about the claim's status.
- Lowball Settlement Offers: The company makes an offer that is drastically lower than the actual value of your damages.
The Damaging Effect of Rider Bias
Motorcyclists face an unfair stereotype. Many people, including insurance adjusters, wrongly assume that bikers are inherent risk-takers. This bias can infect the entire claims process and lead to an improper denial.
An adjuster might see that the accident happened in a busy area like Deep Ellum or the Fort Worth Stockyards and assume you were riding aggressively.
They may operate from a default position of skepticism, viewing your actions as the primary cause of the collision, even when evidence shows the other driver was distracted or violated traffic laws.
This prejudice can be difficult to overcome on your own because it influences how an adjuster interprets every piece of information.
Strengthening Your Motorcycle Accident Case After a Denial
When the insurance company denies your claim, you need to respond strategically. You must shift from simply reporting information to building a strong argument supported by compelling evidence. Your goal is to dismantle the insurer's reasons for the denial.
Document Everything Meticulously
From the moment you receive the denial letter, you need to keep detailed records of every interaction with the insurance company. Save all correspondence, including emails and physical letters.
Your meticulous documentation creates a paper trail that demonstrates the insurer's actions and arguments throughout the process.
Here is the essential evidence your case requires:
- The Official Police Report: Obtain a complete copy of the accident report.
- Comprehensive Medical Records: Gather all records from every doctor, hospital, and therapist who treated your accident-related injuries.
- Proof of Lost Income: Collect pay stubs and a letter from your employer detailing the hours you missed from work.
- Photos and Videos: Compile all visual evidence from the accident scene, including pictures of your bike, the other vehicle, and any visible injuries.
Issue a Formal Appeal
A formal appeal is your official response to the denial. This isn't just a simple disagreement; it’s a structured counterargument that directly addresses the insurer's stated reasons for denying the motorcycle accident claim. You present your evidence and explain why their conclusion is wrong.
The appeal letter must be professional, clear, and based on facts. Reference specific evidence, such as witness testimony or Texas traffic laws, to support your position.
A well-crafted appeal letter forces a supervisor or a different department to conduct a new review of your file, which offers a fresh chance at a fair evaluation.
Common Insurance Company Strategies
Insurance adjusters use specific strategies to protect their company's financial interests. Their objective is to close claims for the lowest possible amount or to uphold a denial. Recognizing these tactics helps you protect your rights and avoid common pitfalls.
Adjusters use these tactics to weaken your claim:
- Recorded Statement: An adjuster may press you for a recorded statement, hoping you say something they can use against you. You’re not obligated to provide one.
- Blanket Medical Authorization: They may ask you to sign a form that gives them access to your entire medical history, which they can use to argue that a pre-existing condition caused your injuries.
- Misrepresenting Policy Terms: An adjuster might tell you something isn’t covered under the policy when, in fact, it is.
- Unreasonable Demands: They may repeatedly ask for documents you have already sent or request irrelevant information to create delays and frustrate you.
How a Lawyer Protects Your Rights and Challenges a Denied Motorcycle Accident Claim
An attorney advocates directly on your behalf against the insurance company. Their involvement signals to the insurer that you won’t accept an unfair outcome. A lawyer takes over the complex and time-consuming work of fighting the denial, allowing you to focus on your recovery.
A motorcycle accident attorney provides these critical services:
- Communication Management: Your lawyer handles all calls, emails, and letters with the insurance adjuster, preventing you from making statements that could harm your case.
- Independent Investigation: An attorney gathers new evidence that the adjuster may have ignored, such as interviewing witnesses and obtaining traffic camera footage from along I-30 or the President George Bush Turnpike.
- Valuing Your Claim: They calculate the full value of your damages, including future medical needs and lost earning capacity, to counter a lowball offer.
- Negotiation and Litigation: A lawyer will negotiate forcefully for a fair settlement and can file a lawsuit if the insurance company refuses to act reasonably.
FAQ for Denied Motorcycle Accident Claim
What Is the First Thing I Should Do After a Claim Denial?
First, carefully read the denial letter to identify the exact reason the insurer gave for the rejection. Next, gather all your existing documentation, including the police report, photos, and medical records, and call a lawyer.
How Do I Appeal a Denied Motorcycle Accident Claim?
Your lawyer can appeal a denied motorcycle accident claim by sending a formal appeal letter to the insurance company. The letter must clearly state that you’re disputing their decision. Your motorcycle accident attorney will directly counter their reasoning with your own evidence and explain why their conclusion needs to be reevaluated.
Can the Insurance Company Deny a Claim Without a Reason?
In Texas, an insurance company can deny a third-party motorcycle accident claim, and it may not give you a detailed written explanation because you’re not its policyholder.
If the insurer denies the claim or gives shifting or vague reasons, document every communication and request a clear explanation of what information they say is missing or disputed.
If the insurer still refuses to pay, you can pursue compensation by filing a lawsuit against the at-fault driver.
What if I Was Partially at Fault for the Accident?
You can still recover damages as long as you’re not found to be 51% or more responsible for the accident. However, your recovery amount is reduced by your percentage of fault. Insurance companies often use this rule to deny claims by exaggerating your share of the blame.
How Do I Handle Medical Bills After a Denial?
You remain responsible for your medical bills while you fight the claim denial. You can use your own health insurance to pay for treatment, though your health insurer may seek reimbursement if you later receive a settlement.
A lawyer can often send a Letter of Protection to your medical providers, which pauses collection efforts until your case resolves.
Get a Strong Advocate in Your Corner
You don’t have to accept an insurance company’s decision. Fighting a denied claim requires a strategic and aggressive approach. The attorneys at DFW Injury Lawyers stand up to insurance companies and fight for the rights of injured motorcyclists across the Dallas-Fort Worth Metroplex.Let us review your case and explain your options. Complete our online contact form today to get started.
Kevin L. Edwards
Founder
Attorney Kevin Edwards is a co-founder of DFW Injury lawyers. Over the last 15 years, Mr. Edwards has dedicated his practice to helping those who have been injured or harmed by the negligence, malfeasance, and/or recklessness of others.
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