A personal injury claim may be denied when the evidence does not establish fault, the injury cannot be connected to the incident, the claim was reported or filed too late, or the insurance policy does not provide coverage. A denial is not necessarily the end of the matter, but it should be reviewed promptly because insurance deadlines and legal filing deadlines can operate separately.
Denver is Colorado’s capital and its most populous city. The city sits near the eastern edge of the Rocky Mountains and has a large network of roads, highways, and pedestrian areas. These conditions can make the area prone to accidents, resulting in personal injury claims.Â
If you are dealing with personal injury claims in Denver, understanding common reasons for denial can help you identify what evidence may be needed. Below are some common causes for denial of a personal injury claim.
The Evidence Does Not Establish Fault
Most personal injury claims require evidence showing that another party owed a duty of reasonable care, breached that duty, caused the incident, and caused compensable harm.
An insurer may dispute a claim when:
- Witnesses give conflicting accounts.
- Photographs or video are unavailable.
- The police report does not support the claimant’s version.
- The insured person did not cause the accident.
- Another person or condition may have caused the injury.
A citation can support a claim but does not automatically establish civil liability.Â
You Are Found Partly Responsible
Colorado uses modified comparative negligence. Under Colo. Rev. Stat. § 13-21-111, damages can be reduced according to the claimant’s percentage of fault, and recovery is generally barred when the claimant’s negligence is equal to or greater than the opposing party’s.
An insurer may argue that the claimant was speeding, distracted, intoxicated, failed to use a crosswalk or seat belt, ignored a warning, or made the injury worse by delaying treatment. Those allegations still need to be connected to the claimed loss.
The Injury Cannot Be Connected to the Incident
Medical causation can become a major issue when treatment begins long after an accident, records show a preexisting condition, symptoms existed beforehand, or there are significant gaps in treatment.
A preexisting condition does not automatically defeat a claim. An incident may aggravate an existing problem, but medical evidence should explain what changed and how the event contributed.
The Claim Was Reported Too Late
Insurance policies may require prompt notice. Delays can make it harder to investigate an incident, inspect damage, or locate witnesses.
An insurer may consider late notice when the policy requires prompt reporting, an inspection was prevented, the insured failed to cooperate, or the incident was reported only after a payment demand.
The Policy Does Not Cover the Loss
Coverage may be disputed because there is no applicable liability policy, the policy was canceled, an exclusion applies, another insurer is primary, or available coverage has been exhausted.
Ask for the denial in writing and request the specific policy language supporting it. Understanding the insurer’s stated coverage position is important before deciding what to do next.
The Legal Deadline Has Passed
Colorado’s statute of limitations can prevent a lawsuit even when the underlying claim might otherwise have merit. Colo. Rev. Stat. § 13-80-102 generally provides a two-year period for tort actions, although different deadlines can apply to certain motor-vehicle claims, government defendants, and other situations.
An insurance demand or settlement discussion does not necessarily stop the clock. Public entities may also have special notice requirements.
Key Takeaways
- Weak evidence can lead to denial.
- Comparative fault can reduce recovery.
- Medical records help establish causation.
- Late reporting can create coverage disputes.
- Policy exclusions may prevent payment.
- Legal deadlines should be checked promptly.
