Avoid Settlement Mills by Working with a Real Personal Injury Lawyer
Posted in: Car Accidents
KNR Legal Blog
Whether dealing with your health insurer or the at-fault party’s insurance, you may face delays, coverage disputes, or denied medical treatment. Here’s what you need to know to protect your health and rights.
After an injury-causing accident in Ohio, insurance companies—whether it’s your provider or the at-fault party’s insurer—have specific legal obligations regarding covering your medical treatment. These obligations exist to ensure injured victims are not unfairly denied care or financial support.
However, insurers are businesses and may not always act in your best interest. That’s why knowing how to spot insurance red flags can protect your right to recover.
If you’ve been injured in an accident in Ohio and an insurance company is trying not to pay for certain treatments or procedures, call the Ohio personal injury lawyers of KNR at 1-800-HURT-NOW for a free, no-risk evaluation.
Under Ohio law, insurance companies must handle claims in good faith, requiring them to investigate promptly, communicate clearly, and avoid unnecessary delays or unfair denials.
If an insurer denies medically necessary treatment without justification or misrepresents coverage, it could be engaging in bad faith practices, which may entitle you to additional legal remedies.
Insurers must cover reasonable and necessary medical treatment directly resulting from an accident. This includes ER visits, diagnostic tests, specialist care, rehabilitation, and appropriate future care.
While they may challenge specific procedures, they must rely on accepted medical standards when determining what’s covered under the policy.
Your health insurance may cover immediate care but could require pre-authorization or deny some procedures. If another party caused your injuries, their liability insurance is responsible for compensating you, including medical bills. However, they may dispute treatment costs or push early settlements to avoid full payouts—making it critical to understand which insurer is responsible for what.
Every insurance policy has coverage limits, which cap how much the insurer is required to pay. Until those limits are reached, insurers must honor their contractual duties, including covering approved treatments and following claim procedures. If they try to reduce or deny payments prematurely, it may indicate bad faith or improper handling, and legal action may be necessary to recover full compensation.
Insurance companies are for-profit businesses—and one of the easiest ways they protect their bottom line is by minimizing how much they pay on injury claims.
Even when you’re clearly hurt and your doctor recommends treatment, the insurer may push back to reduce its financial liability. This often means challenging the extent of your injuries, questioning the necessity of your care, or attempting to settle your claim before the full cost of treatment is known.
Common reasons for denial include arguing that a procedure isn’t “medically necessary,” claiming your injuries weren’t caused by the accident, or saying you waited too long to seek care—suggesting your condition isn’t serious. They may also blame pre-existing conditions or point to gaps or missing details in your medical records. While these tactics are frustrating, they’re not uncommon—and with the proper legal support, they can often be challenged successfully.
If your medical treatment is denied—whether by your health insurer or the at-fault party’s insurance—it’s important not to panic and don’t give up.
An experienced attorney can consult with medical experts, ensure your treatment is valued correctly, and present a strong case for why your care is necessary and related to the accident. They can also handle negotiations with insurers, push back against unfair tactics, and—if needed—take legal action to recover the full cost of your medical treatment.
Read Why Insurance Companies Don’t Want You to Get a Lawyer
You can and should continue receiving care, even if your insurance claim is delayed or denied.
Delaying treatment can worsen your condition and potentially harm your personal injury case. In the meantime, you may have several options to cover medical costs, including using your health insurance, tapping into MedPay coverage through your auto policy, or working with your attorney to arrange a Letter of Protection (LOP). This allows you to receive treatment now and pay from your settlement later.
In most cases, you have the right to choose your doctor. However, if you’re using certain types of health insurance, your network or plan may have restrictions. Regardless, the at-fault party’s insurance cannot dictate who treats you—they can only dispute whether they’ll reimburse the cost. Always follow your physician’s recommendations and keep detailed records of your treatment.
If an insurer claims your treatment was not medically necessary, they may attempt to reduce or deny your compensation. This is common, especially for higher-cost procedures. You can fight back by providing supporting medical documentation, seeking a second opinion, and—if needed—working with an attorney who can present expert evidence to validate your care.
Using your own health insurance after an accident typically helps ensure you get the care you need without delay, as your provider can seek reimbursement through subrogation. Waiting on a third-party claim to settle could leave you without care for weeks or months.
While insurance companies are legally obligated to handle claims in good faith, some still use unfair tactics to minimize payouts. Here are common red flags that may indicate your insurance provider—or the at-fault party’s insurer—is acting in bad faith:
If you’re experiencing any of these, speak with an attorney right away. Ohio law protects victims from insurance bad faith, and you may be entitled to additional compensation. At Kisling, Nestico & Redick, we can evaluate your case, hold the insurer accountable, and fight for the full benefits you’re owed.
If you were injured in an accident and are having difficulty trying to gain compensation through an insurance company, call KNR at 1-800-HURT-NOW or submit your details here. Our legal team is well-versed in insurance company regulations and underhanded tactics. We will protect your rights and fight for you to receive all the compensation you deserve.