Insurance claim denied – Reasons

In the past two posts, we have discussed what to do when insurance companies deny your claim and what tips and tricks insurance companies use in order to deny your claim.

This week we will be focusing on the potential reasons WHY insurance companies deny your insurance claim. So let’s get started.

Being in an accident is stressful enough. But learning that the insurance company has denied your insurance claim is very disconcerting.

There are several reasons why they refuse your insurance claim. Some of them can be valid, while others not so much but hey still use them in order to pay you as less as possible. So if you’re dealing with an insurance claim and it gets denied, it’s good do consult with a personal injury lawyer because they know the system and are more aware what tactics insurance providers use in order to either minimize your claim or just deny it.

Cause of the accident

Many insurance companies have denied insurance claims to their policyholders simply because the accident you were in could have been avoided OR because your behavior caused the accident. Furthermore, claims have also been denied if your conduct was in conflict with your insurance policy. This practically renders your policy ineffective. And if the vehicle was operated by someone who is NOT included on the insurance policy or didn’t have a driver license when operating the vehicle…well that’s another potential reasons insurance claims get denied.

These are the most common reasons and mostly logical and valid. But what about if the insurance provider is using not valid reasons and starts acting in bad faith?

Insurance claim denied over previous injuries / surgeries

It’s a common practice that insurance companies ask their prospective policyholders to sign so called ‘medical authorization forms’. The important thing to point out about these forms is that you shouldn’t (under ANY circumstance) sign them until you’ve spoken to a personal injury lawyer. You must ask yourself ‘What’s the big deal about those forms?’. Well, when you sign those forms, you’re basically giving the insurance company permission to dig through your medical history and to look for previous injuries or surgeries.

If by any chance, you had injuries and surgeries for those injuries before, the insurance company could use that as a possible (but not really valid) reason for the accident and thus deny your insurance claim. Another example is that insurance providers may use previous injuries as an argument to diminish your injuries from the accident i.e. to present as less severe than they really are.

Pre-existing conditions

Another reasons why insurance companies require you to sign the medical authorization forms is so that they could see if you have any pre-existing conditions. Let’s say that you have pre-existing back injury and that you suffered new injuries in the accident. Since your back injury is a pre-existing condition, the insurance company can argue that the accident was cause because of your back problems and deny your claim.

Time of accident and time of seeking treatment

When you’re in a car accident it’s important that you seek medical treatment immediately. Waiting to seek treatment, may be another reason why your insurance provider refuses your claim. The lapse of time between the accident and treatment, can give ‘ground’ to the insurance provider to argue that your injuries are actually caused another even, not the accident.

Insurance companies go so far that they even state in their insurance contracts a specific time frame in which you need to seek treatment for your accident-related injuries. Of course, there are cases when it’s good to wait before seeking treatment and you can learn more about that from your personal injury lawyer.

Right after the accident, while on the scene, make sure that you don’t deny any injuries until you have been thoroughly checked out by a medical professional. Denying injuries at the scene of the accident may also be another reason why they deny your claim. So if you get into an accident seek medical evaluation at once.

What do to if your insurance claim is denied?

We must be clear on one thing. Insurance companies make profit from taking higher premiums from their policyholders than what they pay in claims. So their interest in denying insurance claims is quite significant.

In the event that your claim gets denied, you will need help from an experienced personal injury lawyer. Furthermore, policyholders that have a lawyer are taken more seriously.