Common Tactics Used to Deny Insurance Claims
Dealing with an insurance claim denial in Connecticut can be frustrating and overwhelming. You thought your policy would have your back after an accident, but now the insurer is pushing back. Why does this happen? The reality is that insurance companies are businesses focused on protecting their bottom line. They sometimes rely on familiar tactics to delay, deny, or minimize claims, hoping you’ll give up or settle for less than the fair compensation you deserve. Understanding these tactics can help you stay prepared and advocate for your rightful compensation.
Insurance adjusters are trained to protect the company’s interests. They might seem friendly or helpful, but remember that their goal is often to save money for the insurer. This can lead to strategies that unfairly deny or devalue valid claims, leaving accident victims financially vulnerable. The good news is that if you recognize how these tactics work, you can take steps to counter them and protect your rights with the guidance of a professional.
Below are some common tactics insurance companies use to deny claims – and tips on how legal counsel can fight back. Keep in mind that Connecticut law provides certain protections for claimants, and you don’t have to accept an unfair insurance claim denial at face value.
Minimal Property Damage (“MIST” Cases)
One tactic you might encounter is the argument that if the car isn’t hurt then the person isn’t hurt. Back in the day, they referred to these cases as M.I.S.T. cases, or Minor Impact Soft Tissue cases. If your car only has a small dent or scratch, an insurance adjuster may claim that you couldn’t possibly have been hurt. They often use the lack of significant vehicle damage as an excuse to deny or downplay injury claims. This is based on the myth that a minor fender-bender can’t cause significant injuries – a myth that is often challenged in legal proceedings.
In reality, even low-speed collisions can jolt the human body in ways that cause serious harm. Medical studies confirm that whiplash injuries, for instance, frequently occur at speeds as low as 5 to 10 miles per hour. Soft tissue injuries, such as sprains or strains to the muscles and ligaments of the spine, are common consequences of car accidents. Because these injuries are often “harder to diagnose,” they are “frequently questioned by insurance companies,” requiring strong legal advocacy to prove their legitimacy and recover compensation.
How Legal Counsel Fights Back:
The appropriate response when facing the MIST argument is to rely on medical and accident reconstruction evidence. An attorney focuses on gathering detailed medical documentation, which may include opinions from treating doctors, to establish a clear connection between the crash and your symptoms.
Furthermore, an attorney may secure expert testimony to explain to the insurer or a jury how the forces of even a minor accident can cause significant soft-tissue or spinal injuries, thus dispelling the myth that vehicle damage must correlate directly with the severity of personal injury. This process aims to secure maximum damages for your injuries.
Comparative Negligence and Shifting Blame
Another common strategy is for the insurance company to shift the blame onto you. This is known as comparative negligence – essentially claiming that you were partly (or mostly) at fault for the accident, so they shouldn’t have to pay full value on your claim. An adjuster might suggest things like “You were going a bit too fast” or “You weren’t paying enough attention”, even if the other party was clearly at fault. Why do they do this?
Connecticut follows a modified comparative negligence law, outlined in Connecticut General Statutes § 52-572h. This law specifies that a claimant can still recover damages as long as their share of fault is 50 percent or less. If the claimant is found to be more than 50 percent responsible, they are completely barred from recovering any compensation.4 Insurers routinely use this system strategically by attempting to maximize the claimant’s percentage of negligence to reduce or extinguish liability entirely.
How Legal Counsel Fights Back:
A personal injury attorney’s role is to ensure that fault is allocated fairly and based on objective evidence, not on the insurance company’s unsupported assertions of negligence. This involves a thorough review of police reports, witness statements, accident reconstruction data, and any available video footage.
Retained counsel works to prevent the insurance company from mischaracterizing evidence or using slight operational errors to unfairly push your fault past the 50 percent threshold, ensuring that the compensation owed reflects the true dynamics of the crash and that you recover the maximum possible damages.
Pre-Existing Conditions
Insurance companies also frequently investigate your medical history, looking for pre-existing conditions or old injuries. This tactic works by the adjuster arguing that your current injury is not new or is not the result of this accident, but rather something you had all along, justifying an insurance claim denial.
The law recognizes that someone who had a prior issue can still suffer new harm. Connecticut law follows the “Eggshell Plaintiff” doctrine, meaning defendants are liable for the full extent of a plaintiff’s injuries, even if those injuries are more serious due to a pre-existing medical condition or fragility. However, recovery is limited to the aggravation of the pre-existing condition, not the original condition itself. But that makes common sense.
How Legal Counsel Fights Back:
The key to countering this tactic is strong, differentiated medical documentation. Retained counsel works closely with your treating physicians to secure clear medical opinions that demonstrate how the recent accident specifically caused a worsening of the pre-existing condition or created entirely new injuries. This evidence is essential to obtaining compensation.
An attorney can also advise you regarding the scope of medical records authorization, ensuring the insurance company’s investigation is appropriately limited to relevant records. By clearly separating the damages caused by the accident from prior conditions, an attorney helps meet the burden of proof required in Connecticut courts to secure compensation for your injury aggravation.
Injuries or treatment rendered more than 10 years before an incident is considered too remote in Connecticut and kept out of a case. A good trial lawyer knows this and will make sure such information is excluded.
Lack of Proper Investigation
Insurers have a legal duty to investigate claims fairly. However, some issue denials without reviewing all available information, such as ignoring witness statements or misinterpreting facts.
It is important to understand that a routine claim denial does not automatically constitute actionable statutory bad faith. Connecticut General Statutes § 38a-816 defines “unfair practices” that must be met to establish bad faith, such as failing to attempt a prompt, fair, and equitable settlement when liability has become reasonably clear. Denials based on legitimate disputes over comparative negligence or medical necessity typically do not meet this high legal standard.
How Legal Counsel Fights Back:
If a claim is denied without a fair review, an attorney can hold the insurance company accountable by documenting the missing or ignored evidence, such as witness statements, police reports, or vehicle damage assessments. By communicating in writing and formally presenting clear evidence, a lawyer can prompt a more serious review of the claim.
If the insurance claim denial is unwarranted, an attorney can help the claimant understand if the insurer’s conduct meets the standard for bad faith negligence and subsequently advise on the potential legal action required to resolve the dispute.
Biased “Expert” Testimony
Insurance companies don’t just rely on adjusters – they often bring in “experts” to bolster their reasons for denying your claim. These may include doctors performing an “independent medical examination” (IME), accident reconstruction specialists and biomechanical experts hired and paid by the insurer. These experts often downplay injuries or suggest treatment is unnecessary, providing the insurer with an opinion they can use to dispute liability or damages.
Claimants have rights when facing an IME in Connecticut, including the right to have a friend or family member present for support and the right to request that the examination be recorded. However, the rules governing IMEs are technical and complex, governed by procedural rules laid out in the Connecticut Practice Book.
How Legal Counsel Fights Back:
An attorney serves as your strategic partner in challenging biased reports. If an IME report is unfavorable, an attorney can review the findings, present contradictory evidence from your treating physician, and, if necessary, seek a second opinion from a qualified, objective specialist. This is critical for securing fair compensation.
In cases of serious dispute, an experienced personal injury attorney will know how to find credible experts to counter the insurer’s narrative. Furthermore, during any legal proceedings, counsel can cross-examine the insurance company’s experts, exposing biases or inconsistencies in their testimony to ensure the client’s story is heard and proper compensation is awarded.
Don’t Give Up – You Have Options
Facing these insurance company tactics can be exhausting, but knowledge is power. By understanding strategies like minimal property damages arguments, comparative negligence claims, pre-existing condition excuses, poor investigations, and hired-gun experts, you can respond more confidently. Always remember that an insurance claim denial is not the end of the road.
Navigating Your Next Steps:
When a claim is denied, you have several avenues for recourse, including internal appeals or filing a lawsuit. However, decisions regarding claim appeals and the timing of filing a lawsuit must be made in consultation with an attorney, as statutory deadlines for filing a lawsuit are extremely strict and non-negotiable. The law governing negligence claims in Connecticut, General Statutes § 52-584, is complex, involving both a discovery rule and an absolute deadline. Attempting to manage the appeal process without legal counsel could result in missing the critical filing deadline, thereby voiding your entire claim.11
Most importantly, you don’t have to navigate this battle alone. In Connecticut, help is available for those dealing with unfair insurance claim denial or lowball offers. An experienced personal injury attorney can guide you through the process, handle communications with the insurer, and advocate for the fair damages and compensation you deserve.
Let’s discuss your case
If your valid claim has been denied or undervalued by an insurance company, the attorneys at Anderson Trial Lawyers are here to assist. We understand these insurance tactics inside and out and have experience fighting them.
Contact us for a free consultation, and let us review the details of your situation. We’ll help you explore your options – whether it’s negotiating a better settlement or pursuing legal action. You don’t need to accept an unfair insurance claim denial. Let’s talk about how we can help you push back and seek the compensation you need to move forward.
DISCLAIMER: This content is for informational purposes only. It does not constitute legal advice and does not create an attorney-client relationship. Connecticut law imposes strict statutory deadlines for filing claims. If you have been injured, you must consult an attorney immediately to discuss your specific deadline, as failure to file within the required timeframe may result in the loss of your claim. Past results do not guarantee or predict a similar outcome in any future matter.