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What Are Some Common Excuses Insurance Companies Use to Deny Your Claim?

Insurance companies are in the business of minimizing their risk and responsibilities to policyholders. All insurance companies aim to maximize profits by shirking coverage for injuries, accidents, and property damage whenever possible. Insurers have a long list of reasons they like to use to deny policyholders’ claims. Review some of the most common excuses, find out if they are legitimate, and learn what to do if you think you have a bad faith insurance company on your hands. An attorney can help you go up against bad faith insurance companies in the face of unfair claim denials.

The Company Isn’t Liable

An insurance company might try to deny your claim by saying that its policyholder isn’t liable for the accident. After the insurance company conducts its own investigation of the accident, it might conclude that you or a third party caused the accident and not its insured client. To combat this denial, hire an attorney for your own investigation. An attorney will be on your side, not the insurance company’s. Conducting your own investigation can help make liability clearer and hold the insurer accountable if its policyholder caused your damages.

You Have Preexisting Injuries

Preexisting injuries or health problems can get in the way of your insurance claim if they impact the injuries you’re currently claiming. Thanks to the Affordable Care Act, however, health insurance companies can no longer refuse you service or limit benefits for preexisting conditions. If your accident aggravated a preexisting injury, you still have the right to benefits. Prove your claim by signing the waiver that releases requested medical records to the insurance company. This will show the insurer that although you have a preexisting injury, your current injuries are from the accident.

The Treatments You’re Using Aren’t Medically Proven

Most insurance companies will offer only coverage for medical treatments backed by science and data – not treatments that are new, experimental, unnecessary, or investigational. You can argue your claim by providing the insurance company with signed statements from your health care provider showing that the treatment has been effective in similar cases. Your company might be able to deny your claim, however, if you can’t prove that the treatments are necessary or effective.

You Didn’t File Your Claim Correctly

Insurance companies can deny claims based on legal red tape. You must comply with all rules and requirements for filing your claim, as stated in your policy. Failure to do so could give the insurer grounds to deny your claim. Make sure you meet all deadlines for notifying the company of the incident, filing your claim, and providing documentation. Work with an attorney if you need assistance fulfilling all the requirements for your claim the very first time – saving you time, energy, and a headache.

You’ve Exceeded Your Policy Limit

It’s possible that a claim denial stems from you allegedly exceeding your policy’s coverage limits or for filing a claim under a type of insurance you don’t have. If this happens, review your policy carefully. Contact the insurer if you have reason to believe it owes you a certain type of coverage based on your policy. If you still have questions or the insurance company won’t reconsider its answer, contact an insurance bad faith attorney.