Denied Claim Legal Definition

What is a Denied Claim?” 

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  • Denied Claim
Denied Claims Legal Definition

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Denied Claim legal definition: In workers’ compensation cases, a denied claim is one in which the insurance company refuses to comply with requests to provide benefits or services associated with a policy.

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Denied Claims and Car Accident Cases

If you were injured in a car accident and your car sustained damage, you probably filed an insurance claim. Unfortunately, many car accident injury victims have their claims denied.

Your car accident claim may be denied if:

  • The incident was deemed to be avoidable
  • There was no complaint or claim made at the time of the accident
  • There was no medical treatment sought following the incident in question.
  • Medical records don’t indicate that an injury exists
  • You have a pre-existing condition 

If you were injured in a motor vehicle accident and your claim has been denied, calling an experienced car accident injury lawyer may mean the difference between getting the legal compensation you deserve and being left on the hook to pay for medical and other expenses related to your crash.


Denied Claims and Medical Malpractice Cases

In medical malpractice cases, claims are often denied based on an investigation conducted by the professional liability insurance provider who covers your medical provider. 

Medical malpractice cases are complex and best navigated with the help of an experienced attorney who can help you build the best possible case. Presenting all available information will help ensure that your medical malpractice claim is not denied.

Your claim should include as much supporting evidence as possible to support your allegations. The evidence presented in your medical malpractice claim should include:

  • Photographs of your injury
  • Your medical history
  • Depositions from people who witnessed the malpractice, as well as your condition afterward
  • Depositions from your current medical provider

Victims of medical errors have a limited time to file claims. If you’ve received a denied claim, it’s imperative to contact an experienced medical malpractice attorney to help get your case on the right track.


Denied Claims and Personal Injury Cases

Insurance companies are in business to make money, and they keep their budgets fat by denying personal injury claims. If you were injured as a result of a car accident, slip and fall, defective product, or medical malpractice, it’s important to understand the reasons why your personal injury claim can be denied.

There are many reasons why insurance companies may deny your claim. Your denied claim could have been because of:

  • A policy exclusion
  • A lapse of coverage
  • The expiration of your coverage
  • It was incorrect or incomplete
  • Your medical records were omitted 
  • A pre-existing condition
  • Your perceived failure to avoid or mitigate the circumstances surrounding your accident

Injury victims have strict deadlines by which to respond to a denied claim. If you received notice that your claim has been denied, it’s imperative to seek the advice of a skilled personal injury attorney.


Denied Claims and Workers’ Compensation Cases

Pennsylvania workers’ compensation claims are denied when the insurance company does not believe that your injury or illness was the result of work duties. Injured employees who are denied claims must fill out what’s known as a claim petition to begin the formal appeals process.

If your initial workers’ compensation claim was denied and you decide to appeal, hiring an attorney will be highly recommended. The appeals process requires many complex and costly steps that are best handled by a lawyers. Not only will you be required to obtain copies of your medical records, but you will also be required to depose doctors and even expert witnesses.

Be aware that appeals must be filed in a timely manner. If you were hurt on the job and you initial workers’ compensation claim was denied, contact an experienced lawyer as soon as possible to protect your legal rights moving forward.




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“If someone has a serious case, they will get a great effort and a great outcome working with us,” award-winning attorney Victor Pribanic of Pribanic & Pribanic told Best Lawyers Magazine.

If you’ve been injured call or contact us online for immediate assistance: 800-392-4529

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