Counter-arguments for common insurance claim denials and lowball offers
Insurance adjusters are trained to minimize payouts. They may use various tactics to deny, delay, or devalue your claim. Knowing these tactics helps you respond effectively.
Insurance claims you share blame for the accident to reduce your settlement under California's comparative fault rules.
"Please provide the specific evidence you're relying on to claim I was at fault. My evidence, including [police report/witnesses/photos], establishes your insured was fully responsible. Even under comparative fault, your insured's negligence entitles me to substantial damages."
Insurance claims your injuries existed before the accident or were caused by something else.
"Under California's eggshell plaintiff doctrine, your insured is liable for aggravating any pre-existing condition. My doctor has documented that this accident significantly worsened my condition. I was [working/active/symptom-free] before this incident."
Insurance questions your medical treatment, claiming you went to too many appointments or got unnecessary procedures.
"My medical treatment was prescribed by licensed physicians based on my injuries. Attached is my doctor's letter explaining the medical necessity of each treatment. Your adjuster is not qualified to second-guess my treating physicians' medical judgment."
Insurance says they'll only pay "reasonable and customary" rates, which are lower than your actual bills.
Insurance claims the gap between the accident and seeking treatment proves you weren't really hurt.
"I sought medical attention when symptoms became apparent. My doctor confirms that [injury type] commonly has delayed onset of symptoms. The gap in treatment does not negate my injuries, which are well-documented in my medical records."
In car accidents, insurance claims minimal vehicle damage means you couldn't have been injured.
"Medical research shows that vehicle damage does not correlate with occupant injury. Modern vehicles absorb impact, meaning the energy transfers to occupants. My documented injuries are real regardless of cosmetic vehicle damage."
Insurance makes a quick, low offer hoping you'll accept before understanding the full value of your claim.
"Your offer of $[X] is inadequate and does not reflect the full value of my claim. I am still treating / have only recently completed treatment. My documented damages, including [itemize], far exceed your offer. My demand is $[amount]."
Insurance wants you to give a recorded statement, hoping you'll say something they can use against you.
"I decline to provide a recorded statement at this time. I will provide all relevant information in writing through my demand letter and supporting documentation. Nothing in California law requires me to give your company a recorded statement."
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