What to do if I fell and was injured in a store parking lot but my claim with the store’s insurer was denied?
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What to do if I fell and was injured in a store parking lot but my claim with the store’s insurer was denied?
I tripped and fell over a curb in a parking lot and bruised my palms, knees and chest. I went to the doctor, got X-rays and received physical therapy. The insurance company for the owner of the store contacted me. I was informed that the accident was not the store’s responsibility. I thought that I would have to wait until my physical therapy was done. I have 9 more treatments left but don’t have the money. Anyway, the agent even came out to my house to talk but I was at therapy. Yet, without talking to me, the agent determined his client was at not at fault. I didn’t get to tell him the lights were out at the time. Can he legally say his client was at not at fault?
Asked on July 7, 2015 under Personal Injury, California
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 9 years ago | Contributor
The insurer's determination is NOT a legally binding determination: it's just the insurer's opinion. On the one hand, it is an informed opinion--the insurer has a lot of experience evaluating cases, and if they feel a case is strong, will often choose to pay (settle) rather than go through the cost of trial only to lose in the end. On the other hand, the insurer has a built-in bias: it does not want to pay money. It is not a neutral third party: it is someone you are asking to pay you money, so it's not surprising when it says "no."
Again, though, this is not a court adjudication or legally binding decision. It's just the insurer choosing to not voluntarily pay you. If you feel that the store was at fault, you can sue the store: if a judge or jury believes you and feels you proved your case, you will get a judgment, or court order that the store has to pay. At that point, if the store's insurance covers this situation, the insurer will step in to pay. The *only* way to force the store and/or its insurer to pay if the choose to not do so volutarily is to sue them and win.
You should speak with a personal injury attorney (many provide free initial consultations; you can inquire into this before making an appointment) to evaluate your case and advise you its strength, what it might be worth, and what it would cost to pursue it.
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