5 Methods Insurance Companies Use to Deny Claims

If you need to file an insurance claim in pursuit of compensation for hospital bills or other expenses after an accident, you may assume that the insurance company is on your side. Although insurance providers carefully market themselves this way, the truth is that insurers want to save as much money as possible when paying claims. They may even resort to denying valid claims using a variety of excuses.

Rushing the Process

Most accident victims do not immediately grasp the extent of their injuries or how an injury will impact their life. These issues take time to understand. Many injuries may not even show symptoms right away. Insurance companies know this and can use it to try to take advantage of claimants. The insurer will contact victims right away to intentionally catch them before they fully understand their injuries.

You may have to talk to an adjuster before you realize that you’re injured or know how much these injuries will cost. This is a tactic used to take advantage of your confusion and request a recorded statement from you. Later, the insurance company can twist your own words around to paint you as an unreliable witness and either deny or devalue your claim.

Delaying the Claim

Insurance companies will also take advantage of the fact that injured accident victims want to resolve their claims as quickly as possible. Rather than doing so, an insurer may drag out the claims process to wear the victim down. This can increase the likelihood of the victim accepting less than his or her claim is worth simply to end the process.

Misinterpreting the Policy

Insurance policies can be lengthy, confusing, and contain a great deal of legal jargon and fine print. Even if you read an insurance policy carefully, an insurance company may misinterpret its language in an attempt to deny liability for your claim. It may also have misrepresented the terms of the policy at its time of purchase. Insurers realize that policies are complex legal documents and may rely on this to deceive or confuse claimants into accepting denials.

Blaming the Claimant

The insurance company may try to place liability for the incident on anyone else – including the claimant. It may refuse to admit that its policyholder is at fault for the accident and use tactics such as an inadequate investigation as “proof.” It is important to have a third party investigate the accident to prevent this scenario, such as the police or a law firm.

Disputing Medical Facts

Another tact that an insurance company may take to deny a claim is to dispute the medical evidence. The claims adjuster may try to argue that you are exaggerating the severity of your injuries or that they should have healed by now. The insurer may also try to blame you for the extent of your injuries (failure to mitigate) or assert that it is a pre-existing condition. Do not let an insurance company convince you to cease your medical treatment early. Instead, combat the denial with assistance from an attorney.

What to Do After an Insurance Claim Denial

You have the right to file an appeal if you believe an insurer has wrongfully denied your claim. First, learn the reason for the denial. Look at the explanation given to you in the letter of denial and read the insurance policy to determine if your losses should have been covered. It may be possible to remedy the situation by submitting additional documentation to prove your losses. If not, the next step is to request an internal review of the denial, then to request an external review, if necessary.

Trust an experienced insurance bad faith lawyer to assist you with the appeals process. An attorney can take over communications with an insurance company on your behalf to ensure the protection of your rights.