How To Appeal A Denied Claim For Catastrophic Injuries

Catastrophic injuries require extensive medical care. Victims need every penny they can get from insurance coverage to make it through tough times ahead. Unfortunately, denied catastrophic injury claims are more common than they should be. 

Under Colorado law, victims have the right to appeal when their catastrophic injury claim has been denied. Here’s what you need to know about this process.

What Is A Catastrophic Injury?

Catastrophic injuries are injuries so severe that they forever affect a victim or at least affect them for many years. Common types of catastrophic injuries include:

• Head and brain injuries
• Neck, back, and spinal cord injuries
• Burns
• Crushed and fractured bones

Essentially, any injury that can have long-lasting or debilitating effects is a catastrophic injury. 

Filing Catastrophic Injury Claims In Colorado

Catastrophic injury claims typically involve claims to insurance companies for coverage of severe injuries and damages. Although these injuries can happen in numerous contexts, they frequently occur in:

• Traffic accidents
• Work-related incidents
• Slip-and-fall accidents
• Other premises liability incidents
• Intentional violence

Depending on the incident, a victim will make a claim to one or more different types of insurance policies.

These policies may include:

• Auto insurance policies
• Employer liability policies
• Workers’ compensation policies
• Business liability insurance
• Homeowners insurance

Insurance companies generally fight against having to pay out claims, perhaps especially so when it comes to catastrophic injuries. This is because the financial impact on insurance companies for paying catastrophic injury claims can significantly affect their bottom line and growth projections. 

However, just because your catastrophic injury claim has been denied does not mean that this denial was justified. This is where the help of an experienced claim appeal attorney comes in. 

Why Your Catastrophic Injury Claim May Have Been Denied

There are many reasons why your catastrophic injury claim may have been denied. An experienced attorney can evaluate the details of the denial and determine whether it was unreasonable. If so, the attorney can then work to overturn that denial.

Common reasons for the denial of a catastrophic injury claim in Colorado include:

• No medical records: If you did not seek treatment for your injuries or otherwise have no medical record proof, your claim will likely be denied. 
• Took too long to seek medical care: If you wait too long to seek care, the insurance company may deny your claim and argue that you exacerbated your injuries.
• Insufficient coverage: There may be too little coverage in your policy to pay for your catastrophic injury claim.
• Wrong insurance: You must file a claim against the appropriate insurance company for your claim, such as auto or malpractice.
• Pre-existing injury: The insurance company might argue that your injury is owed to a pre-existing injury it is not bound to cover.
• Policy lapsed: The insurance company might claim that the policy was not in effect at the time of the injury.

No matter the reason for your denial, your first step after receiving one should be to meet with a personal injury attorney. You deserve a review of your case by a professional who cares about your future.  

Comparative Fault And Catastrophic Injury Claims

If an insurance company cannot deny a reasonable catastrophic injury claim altogether, such as when doing so can invite a bad-faith lawsuit against the insurance company, then the company may do what it can to reduce its liability. 

One way an insurance company can accomplish this is by blaming the victim for some or all of the incident. In Colorado, if a victim is responsible for their own injuries, they can still seek compensation but will see their damages reduced according to the degree of fault they have. 

For example, if you are deemed to be 40% responsible for your catastrophic injury and have incurred $100,000 in damages, your damages will be reduced by 40%, which would leave you with $60,000. Keep in mind that victims who are 50% or more at fault are barred altogether from seeking compensation for their injuries. 

As you might imagine, insurance companies devote significant resources to lower their bills and employ all manner of tactics to pay less, including using victims’ words against them. This makes it essential for victims to have qualified counsel to protect their compensation interests throughout their claims and appeals. 

The Claims Appeals Process For Denied Catastrophic Injury Claims

The process for appealing the denial of catastrophic injury claims in Colorado begins with an internal review of the decision by an insurance company employee not involved in the first round of decisions. The employee will review the claim with fresh eyes and make a decision. 

This internal review process may involve two rounds of evaluation. Once the decision is made, the claimant will be contacted with the decision. If the decision is not satisfactory to the claimant, the claimant may begin an external appeals process. 

In all cases, claimants are encouraged to seek experienced representation throughout their initial claim and any subsequent appeals. Improper or incomplete appeals actions can harm a case.

Colorado Division Of Insurance Consumer Complaint Portal

If the internal review results are not satisfactory, you can file a complaint on the Colorado Division of Insurance Consumer Complaint portal. Once filed, the Department of Regulatory Affairs will review the issue and make a decision. 

Lawsuit

Insurance companies generally avoid lawsuits because they can spell double liability for bad-faith insurance judgments. Bad faith in insurance dealings exists when an insurance company engages in unlawful tactics to pay less money than they are obligated to pay.

Victims of bad faith insurance have statutory and common law grounds to sue. Both can result in significant damages, as well as the payment of attorney’s fees and court costs by the insurance company if it’s found to have acted in bad faith. 

However, victims must act within two years of a bad-faith action to preserve their claims, which is also the statute of limitations for catastrophic injuries. 

Get the Appellate Representation You Deserve Today

A denial of a catastrophic injury claim is not the end of your story. The claims appeal process can get you the catastrophic injury coverage you deserve. At Bachus & Schanker, we devote every resource to victims of serious and catastrophic injuries because we understand exactly what these victims are going through.

Our founder, attorney Kyle Bachus, survives his mother, who was tragically killed by negligence. In his book Unthinkable, he details his family’s struggles to cope with loss and explains how they pursued justice through compensation using the civil system. 

If you are in need of insurance coverage for a catastrophic injury, our team can fight to help you get the justice and compensation you deserve. Reach out by phone or contact us online to get started on your appeal today.

Contact Our Catastrophic Injury Lawyers Today To Schedule A Free Consultation.

Citations:

Burns. (2023).
C.R.S. 10-3-1115; 10-301116.
Traumatic Brain Injury: Symptoms and Causes. (2021).