Why Insurance Companies Challenge Slip-and-Fall Claims

Key Takeaways:

• Insurance companies are for-profit entities, and denying or challenging a slip-and-fall claim is often a tactic to protect their bottom line, not a reflection of the claim’s validity.
• Common denial reasons include disputed liability, pre-existing injury arguments, and missed deadlines or documentation gaps.
• If you received a denial letter, you can request a written explanation for the denial, gather supporting evidence, and work with an attorney to challenge it.

Denials or challenges to a slip-and-fall insurance claim are common. Insurance companies are for-profit entities with a fiduciary responsibility to maximize profits for stakeholders. To protect their bottom line, they may institute tactics like blanket denials, liability challenges, or low-ball settlement offers.

Unfortunately, many claimants drop their claims at this initial stage. They mistakenly assume the insurer is an unbiased party that knows the policy and law better than they do. But an insurance company is never neutral. They profit directly whenever an injured person gives up or accepts a fraction of what they deserve.

If your slip-and-fall claim is denied or challenged, don’t take it at face value. Demand a written explanation, preserve your evidence, and seek experienced legal counsel. Segal, Berk, Gaines & Liss is here to fight for the fair compensation you deserve.

No Win, No Fee

Many people find it difficult to understand slip-and-fall insurance coverage. Policy language is often verbose and filled with jargon. Segal, Berk, Gaines & Liss can help you learn about different policies and how they affect your slip-and-fall insurance claim. The firm can also help you organize and collect evidence to support it.

Building a credible case, one that proves negligence, requires familiarity with premises liability laws and standard insurance practices. Even when a slip-and-fall claim is denied, this foundational knowledge helps challenge the denial and establish an argument for fair compensation.

Segal, Berk, Gaines & Liss has the personal injury law experience and track record to fight for your claim. The best part for you is the firm doesn’t make a cent unless you win; that’s its “No Win, No Fee” promise.

Why Do Insurance Companies Deny Slip-and-Fall Claims?

Claim denials and challenges must have an explanation for cause. An insurer can’t just deny a claim. Most reasons stem from three challenges.

1. Disputed Liability

Most denials argue liability. The insurer may claim the property owner had no way of knowing the hazard existed, and therefore had no actual or constructive notice. For example, if a spill occurred only moments before a fall, or if ice formed too quickly to act in a reasonable amount of time with salt or signage.

If the insurer can’t claim a lack of knowledge, they may assert the slip-and-fall claim was denied because the hazard was obvious, such as a large pothole or obstruction — they argue that any reasonable person would have seen and avoided it.

Insurers may also argue that the slip-and-fall insurance coverage is only partly responsible for damages. Since Pennsylvania is a modified comparative negligence state, many insurance companies try to shift blame to victims, helping to reduce the value of a slip-and-fall insurance claim.

2. Pre-Existing Injury Arguments

A claim denial or challenge letter may also cite past medical history to diminish a claim’s value. Insurers are legally allowed to request and review claimant medical histories. They may use past neck, back, knee, or joint complaints to show an injury pre-dated the accident.

In some cases, a slip-and-fall claim was denied because insurers argued that a pre-existing condition, such as arthritis or degenerative disc disease, was the actual cause of injury and not the slip and fall.

An insurer may also attempt to exploit gaps in medical treatment. For example, if you delay going to a doctor after a slip and fall, even for a few days, they may argue that delay is evidence the injury wasn’t that serious.

3. Missed Deadlines or Documentation Gaps

Personal injury attorneys know how to build a case against denials and challenges to your slip-and-fall insurance claim in most instances. But missing filing deadlines, a lack of immediate incident reports, or an absence of witness details is more problematic.

You have two years from the date of the accident to file your claim, separate from any internal reporting deadlines that slip-and-fall insurance coverage may require. If the accident occurred on government or public property, you must also file a letter of your intention to sue within six months. Missing either deadline means forfeiting your right to sue for compensation, and a slip-and-fall claim can be denied. While there are caveats to this rule for minors and others facing extenuating circumstances, Pennsylvania law, for the most part, is unforgiving.

Beyond missed deadlines, insurers will also capitalize on claimants who don’t have an incident report or witness contact information. While many people leave the scene after a slip-and-fall, the failure to file an incident report immediately following the accident leaves room for an insurer to question the validity of your claim, especially if you don’t have witnesses.

What Should You Do If Your Slip-and-Fall Claim Is Denied?

The initial denial or challenge notice may not have the complete details for the decision. You need the full explanation, a statement citing policy exclusions, specific legal statutes, and all factual arguments the insurer has for denying your slip-and-fall insurance claim. Send a certified letter requesting this information immediately.

This does two things: it locks your insurer into a narrative and lays the foundation of your response. Once you have the insurer’s response, you can go about proving liability and dismantling their challenges systematically.

An attorney will help you defend your claim using specific language from the slip-and-fall insurance coverage, the same policy the insurer used for the denial. They will also use subpoenas and legal demands to preserve surveillance and maintenance logs.

Just because your slip-and-fall claim was denied doesn’t mean the fight is over. Your attorney will work with you to gather all of the evidence along with medical timelines and witness accounts to defend the validity of your claim.

Who Can Help You Appeal a Denied Claim?

Building a case to challenge a denial takes more than persistence; it takes a legal team that knows how insurers think and how to counter their tactics. Segal, Berk, Gaines & Liss reviews the insurer’s reasoning for the denial, gathers the evidence to support your claim, and challenges the denial with policy language and legal statutes. Reach out today if your slip-and-fall claim was denied, and remember, you don’t pay unless you win.

About Derek Liss, Esq.