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Top 4 Reasons Insurance Companies Deny Claims

May 14, 2019 Published in Car Accidents,Personal Injury

The point of insurance is for the insurance company to provide financial support to policyholders when they have claims. Unfortunately, most insurance companies do not look forward to upholding their end of the contract. During the claims process, the insurer may try to avoid liability for the claimant’s damages through common deny-or-delay tactics. Knowing some of the most common reasons insurance companies use to deny claims can help you determine whether the denial is valid or invalid.

Pre-Existing Injuries

Insurance companies may try to deny benefits to a policyholder because of pre-existing injuries or conditions. Pre-existing injuries or surgeries, however, are not always valid reasons to deny a claim. If the pre-existing condition is not related to the injuries you sustained during your accident, the insurer may still owe you for your medical bills. The same is true if your accident exacerbated existing injuries. Even if you had the injury before, if the incident worsened your symptoms or condition, you could still be eligible for financial compensation.

It is common for an insurance company to at least allege that the extent of your accident-related injuries is less serious than you are claiming because of a pre-existing condition. It may take a look through your medical records to help you prove that this is not the case. Hiring a lawyer to help you prove your claim can strengthen the odds of an insurance company offering you full compensation for your damages.

Missed Deadline

Insurance companies are very strict with their requirements for how and when policyholders must file their claims. It is important to read the details of your policy and to uphold your end of the requirements if you wish to recover benefits. Your auto insurance company, for example, may require that you call and report the car accident within 72 hours of it happening, or as soon as possible. Missing a filing deadline could give the insurance company the right to deny your claim. Contact your insurance company as soon as you can after an accident to make sure you do not miss an important deadline.

Too Much Time Between the Accident and Medical Attention

Most insurance companies require that you seek immediate medical attention after an accident. If you wait too long, the insurance company could use this as an excuse to deny your claim. The insurer could allege that you exacerbated your own injuries by waiting too long to see a doctor. This is why it is important to go immediately to the hospital after an accident, even if you do not think you have any injuries. A medical assessment can provide proof of accident-related injuries for your insurance claim. Do not tell a police officer you do not have injuries until you have seen a doctor to make sure. Changing your story later could give the insurance company a reason to deny the claim.

Policy Limits

If your insurance claim seeks more money than the limits on your policy, the insurance company could deny the claim altogether. The same is true if you seek coverage for a type of injury or bill that your policy does not cover. If you have already exhausted your insurance coverage limits, the claim exceeds the limit, or if you are filing a claim for coverage you do not have, the insurance company may withhold benefits.

Call your insurance agent and ask about the specific limits on your policy. Read your copy of the policy to find out how much you could receive for a specific kind of damage. If you believe the insurance company wrongfully denied your claim, speak to an attorney. The insurance company could be guilty of bad faith. A bad faith insurance claim can help you secure compensation for your initial damages, on top of additional recovery to punish the insurer. Working with a personal injury lawyer can make it easy to understand whether the claim denial is valid or invalid, as well as to obtain the compensation you need to move forward after an accident.