There are many reasons personal injury claims may be denied in Florida, including:
- Failing to get medical treatment within 14 days
- Failing to prove your case
- An inactive policy
- Too much assigned fault
- Pre-existing conditions
- Failing to act quickly enough
Our Florida personal injury lawyers explain how each of these can happen.
Failing To Get Medical Treatment Within 14 Days
Your first claim after an injury in Florida will almost always be with your Personal Injury Protection (PIP) coverage. You must get medical treatment within 14 days of your injury, per Florida Statute § 627.736. If you fail to do so, your claim may be denied.
Failing To Prove Your Case
To have a successful claim against the other party, you must be able to prove that they caused or primarily contributed to the accident or your injuries. This requires establishing the following:
- Duty of care: The other party must have owed you a duty to keep you safe in some way. Drivers owe other people on the road a duty to follow traffic laws and drive safely. Doctors owe patients a duty to uphold their industry’s standard of care. Property owners owe visitors a duty to maintain safe premises.
- Breach of duty: The other party breached that duty. The breach will depend on the type of accident, but could include speeding, driving while intoxicated, failing to clean up a spill, failing to fix crumbling stairs, operating on the wrong person, or failing to diagnose a condition.
- Causation: The breach of duty must have caused your accident and injury. For example, a driver is intoxicated and veers into oncoming traffic, hitting you head-on and causing internal bleeding. A property owner fails to clean up a spill, causing you to slip and break your hip. A doctor misdiagnoses your heart attack as anxiety.
- Damages: You suffered damages, such as medical bills, lost wages, and pain and suffering.
If you do not prove all of the above, your claim will likely be denied.
An Inactive Policy
If your policy or the other driver’s policy is inactive, your claim will be denied. Your lawyer can help you explore other options.
Too Much Assigned Fault
Florida follows a modified comparative negligence rule, which allows injured parties to recover compensation even if they contributed to their accident or injuries. However, if they are over 50% at fault, they can recover nothing.
For example, you were walking through a grocery store when you slipped in a puddle and fell. It is determined that the spill had been there long enough for an employee to be aware of, but they did not clean it up or place warning signage. The owner of the property is deemed at fault. However, it is also discovered that you were wearing footwear with little traction. If you had been wearing different shoes, you could have possibly avoided falling. You are assigned 30% of the fault. This would still allow you to recover compensation.
Let us change the example a bit. You slipped and fell in a puddle at the grocery store. The spill had been there long enough that someone should have cleaned it up or placed signage. However, it is also determined that you were texting while walking through the store and would have seen the spill if you were paying better attention. You are assigned 60% of the fault. You would be unable to recover compensation.
Pre-Existing Conditions
Insurance companies are always on the lookout for pre-existing conditions to blame your symptoms on. If they find a pre-existing condition they can link your symptoms to, your claim might be denied.
Failing To Act Quickly Enough
If you fail to file a lawsuit within a specific time period, your lawsuit will be denied. In Florida, the statute of limitations for most personal injury lawsuits is two years. We recommend that you get in touch with us as soon as possible so we can protect your right to compensation.
How Can I Avoid A Claim Denial?
While no personal injury claim is ever guaranteed, there are several steps you can take to significantly reduce the risk of a denial and strengthen your case from the beginning.
Seek Medical Treatment Immediately
Getting medical care as soon as possible after an accident is one of the most important things you can do. Prompt treatment not only protects your health but also creates medical records that clearly link your injuries to the accident. As we mentioned above, failing to seek treatment within 14 days can automatically jeopardize your PIP benefits, so acting quickly is critical.
Document Everything
Strong evidence can make or break a personal injury claim. If possible, take photos or videos of the accident scene, your injuries, property damage, and any hazardous conditions. Collect contact information from witnesses and keep copies of police reports, incident reports, medical bills, prescriptions, and repair estimates. The more documentation you have, the harder it is for an insurance company to dispute your claim.
Be Careful What You Say to Insurance Companies
Insurance adjusters may sound helpful, but their goal is to minimize or deny your claim. Avoid giving recorded statements, speculating about fault, or downplaying your injuries. Even innocent comments can be taken out of context and used against you later. It is best to let an experienced attorney handle communications with insurers.
Follow Your Doctor’s Recommendations
Failing to attend follow-up appointments, skipping treatment, or ignoring medical advice can hurt your claim. Insurance companies may argue that your injuries are not serious or that you made them worse by not following medical guidance. Consistent treatment shows that your injuries are real and ongoing.
Avoid Social Media Posts About Your Accident or Injuries
Insurance companies often monitor social media accounts for anything they can use to challenge your claim. Photos, check-ins, or comments suggesting you are active or feeling fine could be used to dispute the severity of your injuries. It is safest to stay off social media or keep your activity very limited while your claim is pending.
Act Quickly and Know Your Deadlines
Florida’s statute of limitations for most personal injury cases is two years, and waiting too long can permanently bar you from recovering compensation. Evidence can also disappear over time, and witnesses’ memories can fade.
Work With an Experienced Personal Injury Attorney
An attorney can level the playing field by investigating your case, gathering evidence, handling negotiations, and ensuring all deadlines and legal requirements are met. If you have been injured, taking the right steps early can make all the difference. Reaching out for legal guidance as soon as possible helps protect your rights and puts you in the strongest position moving forward.
Call Us Now If Your Claim Has Been Denied
If the insurer denied your claim, give us a call. Anidjar & Levine can help determine the reason for the denial and the best course of action. You can also call us at any point in the process to ensure that your claim is accurate and well-supported.
Contact us today.
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