An injury is a pretty big inconvenience in itself. But when an insurance company refuses to pay you the money you’re entitled to after an accident, the situation can quickly turn into a protracted fight for justice. Reasons for denial can range from formal errors in the accident record to disputed injury scores. What should I do if an insurance company denies benefits after an accident?
An accident is an unpleasant experience in itself, and when an insurance company refuses to pay compensation on top of that, it can be literally frustrating. People often believe that by taking out accident insurance they are assured of financial compensation in the event of an accident. But practice is often different. Insurance companies often look for reasons to reduce or deny benefits altogether – often because of minor formal errors.
What kind of injuries do insurance companies compensate? A very common case is compensation for a fall on the pavement, for example a fall on ice or a pothole. In such situations, the municipality or road manager may be liable. It is important to document the scene immediately, take photographs and contact witnesses.
Then there are workplace injuries. The employer has a duty to make a record of the injury and report the accident to the insurance company. If they refuse, you can contact the labor inspectorate or a lawyer directly.
If you have been injured in a car accident, a claim for compensation is usually handled by the at-fault party’s liability insurance. Even here, however, insurance companies often examine every circumstance to reduce the claim.
One of the most common reasons an insurance company will refuse to pay is a poorly completed injury report. This document is essential to prove that the injury actually occurred, where, when and how. If witnesses’ signatures are missing, an accurate description of the accident is missing, or the record is filed late, the insurance company may claim that the accident did not occur under the circumstances claimed.
Each insurance company has a time limit by which an accident must be reported. If the injured party reports the incident late, the claim is usually reduced or denied. Many people are not aware of this obligation until it is too late.
The insurance company may also claim that there is no direct link between the injury and the consequences. Typically, for example, back pain after a fall after several weeks, or when there are pre-existing medical conditions.
Each injury has a point value according to the law and the insurance companies’ methodologies. These points are multiplied by the financial value of one point to arrive at a compensation amount. If an injury’s score is incorrectly tabulated (e.g., fewer points than the severity corresponds), the result is less or no compensation.
Our Indemnity service is ideal for anyone who has been refused compensation by their insurer or offered an unreasonably low amount. You can resolve everything online, without complicated paperwork and with the certainty of legal protection.
Once the insurer has told you that it will not pay the claim, you have the right to ask for a written explanation of the decision. This should include the exact reasons why the claim was refused – for example, failure to prove a causal link between the injury and the consequences, late reporting of the claim or failure to comply with the terms of the contract. Without this justification, you can’t practically defend yourself because you don’t know the insurer’s reasoning. Therefore, if the insurer has not done so, ask for the justification to be sent to you by registered letter or e-mail with acknowledgement of receipt. If the insurance company refuses to provide the justification or has formulated it vaguely, this is a breach of the obligation to act transparently and you have the right to lodge a complaint with the Czech National Bank, which supervises insurance companies.
Every insurance company is obliged to follow current methodologies when assessing an injury. These set out how many points correspond to specific types of injury – for example, fractures, permanent consequences or limitations of movement.
If your compensation seems suspiciously low, it may be because the insurer has used outdated or internally adapted methodologies that do not comply with generally accepted standards. Insurance companies must use the Supreme Court’s methodology that is consistent with the current state of the law and medicine.
Therefore, you can request that the insurance company make the injury scoring table used available to you, and if there are any discrepancies, you can request a review of the calculation.
If you disagree with the way the insurer has rated your condition following your accident, it is advisable to get an independent medical opinion. This should be prepared by a specialist in the relevant field who is not in an employment relationship with the insurer.
This report may confirm that the effects of the accident are more serious than the insurance company’s report states, or that the accident actually occurred as you describe. An independent opinion is often a key piece of evidence in an appeal or potential lawsuit. If the court finds that the insurance company’s report was incomplete or misleading, it may order the insurance company to pay the claim or re-evaluate the entire case.
If, even after all steps, there is no remedy, it is time to engage an attorney who specializes in compensation and insurance claims. An experienced attorney can help you prepare an appeal of the insurance company’s decision, request all necessary documentation, including medical records and the insurance company’s internal guidelines, and, if necessary , draft an insurance claim that can force the insurance company to pay the amount owed.
Another advantage of legal representation is that the attorney will explain to the insurance company exactly what legal provisions it has violated, and often the legal reasoning alone will lead the insurance company to settle out of court. In addition, if the court decides in your favour, the insurance company will usually also pay the legal costs.
The amount of compensation is based on the so-called injury score. Each type of injury has a certain amount of points (e.g. 100 points for a fracture, 400 points for permanent damage, etc.). The value of one was set at 451.07 CZK in 2025. So if your doctor awards you 300 points, your compensation will be 135,321 CZK.
If the insurance company incorrectly determines the number of points, you have reason to defend yourself – the difference can mean tens of thousands of crowns.
Tip: Did your insurance company refuse to pay you compensation? Read how to proceed in such a case.
If an insurance company refuses to pay you compensation after an injury, it’s not the end, it’s often just the beginning of the journey to fair compensation. Contact us and we can help you review the insurance company’s decision, assess medical reports and scores, secure an independent review, and negotiate an out-of-court settlement or file a lawsuit.
If an insurance company has refused to pay you compensation after an injury, it’s not over – you have several options to defend yourself. First, always ask for a written justification of why the insurance company denied benefits and make sure they followed the applicable tables and methodologies in evaluating your injury. If in doubt, get an independent medical opinion, which may show more serious consequences or wrongdoing by the insurance company. If even this does not help, contact a specialist personal injury solicitor who will handle all communications for you, prepare an appeal or claim and ensure that the insurance company pays you what you are rightfully owed. The amount of compensation depends on the injury score, which can be worth up to CZK 451.07 per point in 2025 – so even a small difference in the calculation can mean tens of thousands of crowns. An accessible solicitor can help you check that the insurance company’s procedure was correct and make sure you get fair compensation without unnecessary stress and complicated paperwork.
You can ask the insurer to review the decision. If new reports confirm more serious consequences, the insurer must reconsider the claim.
It depends on the complexity of the case. Out-of-court settlements can take a few weeks, while court proceedings usually take several months to a year.
In many cases, legal costs can be claimed from the insurance company if the court rules in your favour.
Yes. If it is proven that the sidewalk was in poor condition or was not adequately maintained, the municipality or road manager may be able to recover damages for a fall on the sidewalk.
Get compensation for harm or damage – quickly and without stress. We will assess your chances, propose a strategy and prepare a challenge. All within 48 hours of placing your order. If necessary, we will then file a lawsuit and arrange legal representation. We will stand up for you fully.
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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