The injury hurts twice – once physically and the second time when dealing with the insurance company. Whether it’s a child’s broken leg, swelling in an ankle after a fall or the lasting effects of a serious injury, the right accident insurance should help. In practice, however, insurance companies often refuse to pay, dispute the connection or pay out ridiculous amounts. How to defend yourself? What are you really entitled to? And when is it worth contacting a lawyer?
Accident insurance is one of the most common forms of personal insurance. Its purpose is to compensate for financial loss in the event of an accident – whether it is pain, hospitalisation, loss of income or permanent damage.
In an ideal world, all you would have to do is file a report and wait for the payout. But in reality, insurance companies often cut benefits or seek exclusions. In such cases, a lawyer can help you pursue your claim, review the contract and communications with the insurance company, and, as a last resort , represent you in court.
While personal injury insurance is simple on paper, in litigation, those who are not familiar with the policy terms often come up short. That’s why it’s a good idea to handle even seemingly trivial insurance claims with a lawyer, especially if you suspect your insurance company is not acting fairly.
Accident insurance covers the costs or damages associated with an accident. This is usually a lump sum for permanent damage, pain and suffering, disability compensation or daily compensation. However, it depends on the specific contract as each insurance policy has different rules and limits. For example, if there is a serious injury, it is necessary to assess whether it is a temporary limitation or a permanent injury.
In most cases, entitlement to benefits is only triggered once medical reports, an accident report and proof of completion of treatmenthave been provided. Although the insurance company should make an objective decision, in practice they often try to downplay the consequences of the accident or find reasons not to pay. In such a situation, it pays to consult with an attorney. An independent legal perspective will help determine whether the insurance company’s decision is justified and how to seek higher benefits if necessary.
Accident insurance is designed to protect you, not let you down. If your insurance company refuses to pay or offers you a ridiculous amount, contact us. Our attorneys can help you get what you are truly entitled to.
Children’s accident insurance has its own specifics. Parents often arrange it when their child starts school, goes to camp or as part of a family package. It typically covers fractures, concussions or longer-term effects after a fall.
But the problem arises when the policy looks convenient but contains a number of exclusions or ridiculously low sums insured. For example, for a child’s broken leg, the insurance company will only pay out a few hundred crowns because the “table value” is low. Moreover, for children, the assessment of permanent consequences is more complicated because development is not yet complete.
Child accident insurance certainly makes sense, but only if it is well negotiated and you have someone who knows the rights of children and parents behind you in a dispute.
The permanent consequences of an accident are the most significant item in accident insurance. These are permanent physical or mental limitations that cannot be fully cured – for example, limited mobility, loss of sight or permanent pain.
The amount of the claim is determined by the insurance company’s valuation tables, which are based on the percentage of damage to the body. And this is where the problem often begins. The insurance company may assess the outcome as less severe than the reality, or question the causal link to the injury. In such a case, we can help you secure an independent medical assessment, compare the insurance company’s procedure with its own rules and, if necessary, take your case to a financial arbitrator or the courts.
While work-related injuries are handled by the employer (including compulsory liability insurance), the situation is more complex for non-work-related injuries. For example, if you break your leg on the mountain, it all depends on whether you have your own accident insurance.
The state does not compensate for non-work injuries, except for sick pay. Insurance companies often argue for exclusions – for example, that the injury occurred during a risky activity, under the influence of alcohol or in a territory where the policy does not apply.
If you have insurance but the insurance company refuses to pay, a legal analysis is in order. This is because in many cases the insurance companies’ reasoning is weak, and a thorough knowledge of the Insurance Act and case law can significantly improve your chances. A non-work-related injury may put you out of business, but it should not deprive you of fair compensation.
Tip: Have you had an accident, your house burnt down or your bike stolen? You are relieved because you have insurance. But alas, the insurance company denies your claim and refuses to pay the claim. What should you do in this case?
Injuries such as sprains, bruises or ankle swelling after an accident are often seen as trivial. Many people don’t even report them because “it will pass”. But sometimes it doesn’t, and even a small injury can result in long-term limitations. If you have accident insurance, it is always better to report even a seemingly minor injury.
The insurance company should take into account the extent of the difficulties and the length of treatment. However, if the benefit provided does not correspond to reality (e.g. they will only accept 2 days of treatment even though you have had your leg in plaster for three weeks), it is worth defending yourself. An injury is an injury and even if it is not an amputation, you are entitled to fair treatment.
The basic rule is: Report the injury to the insurance company as soon as possible. Ideally immediately after the first medical treatment. Include a medical report, a description of the incident, and any witness statements. The insurance company will ask you to provide additional documents, so make sure they are complete and accurate. Always keep copies of everything you send.
Watch out for deadlines – some contracts require reporting within 3 or 7 days. Even a small error can be assessed by the insurance company as grounds for denial of benefits. If you are in doubt about what to document or if communication with the insurance company stalls, reach out to a lawyer. You should always review the full details of the specific accident insurance contract and act according to the terms and conditions stated in the contract.
If the insurance company refuses to pay or pays you a ridiculous amount, you have several options. The first step is to file a claim and request a review. If that doesn’t work, you can go to a financial arbitrator. But in some cases, the dispute requires thorough argument and legal representation. Then comes the civil action.
As well as interpreting the insurance policy, it will be important to prove the causal link between the injury and the consequences, the extent of the damage and the specific amount claimed. The lawyer plays a key role in such litigation, especially in the negotiations that often lead to an out-of-court settlement. If tens or hundreds of thousands of crowns are at stake, do not try to convince the insurance company yourself. We know from experience that a lawyer will negotiate a settlement 30-50% higher than the insurance company originally offered.
Tip: “Crap insurance” is a popular term for liability insurance that we can take out for bodily injury, property damage or financial loss caused to someone else. Why is it definitely worth taking it out?
Accident insurance covers pain and suffering, daily compensation, hospitalisation and the permanent consequences of an injury – for example, after a fall, a car accident or a sports injury. For children, beware of policy exclusions and low limits that may mean you only get a few hundred for a broken leg. Even a seemingly trivial injury, such as ankle swelling, can qualify for compensation if there is evidence of treatment and a medical report. In the case of a non-work-related injury, the insurance company will often look for a reason to deny benefits – for example, because of alleged risky behavior. An attorney can help you formulate a report, review insurance policies and represent you in litigation. If the insurance company refuses to pay or offers an unreasonably low amount, you can go to a financial arbitrator or file a lawsuit. An attorney will often negotiate a 30-50% higher benefit than the original offer. Whether it’s a child’s injury, permanent damage, or the insurance company’s reluctance, legal help can be the key to a fair outcome.
Yes, as long as the injury has been treated and meets the terms of the policy, you are also entitled to benefits for “minor” injuries.
First, check that the lockout actually corresponds to the situation. In practice, insurance companies often interpret exclusions too broadly. We recommend consulting a lawyer.
This depends on the specific contract. Usually it is 3 to 15 days. Any delay can be a problem – act without delay.
Yes. If you feel that the insurance company has understated your medical condition, you have the right to a medical review and possible legal action.
Not necessarily. Many attorneys work on a commission arrangement on the basis of the fee earned. The first consultation is often free.
Our team of experienced attorneys will help you solve any legal issue. Within 24 hours we’ll evaluate your situation and suggest a step-by-step solution, including all costs. The price for this proposal is only CZK 690, and this is refunded to you when you order service from us.
Ondřej is the attorney who came up with the idea of providing legal services online. He's been earning his living through legal services for more than 10 years. He especially likes to help clients who may have given up hope in solving their legal issues at work, for example with real estate transfers or copyright licenses.
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