Common Reasons Claims are Denied
Let's face it. Speaking with an insurance adjuster regarding your car accident should only be done with an experienced lawyer by your side. Why? An insurance company is a business designed to make profits, and in most cases, speaking with an insurance adjuster may not align with processing your claim in a fair manner. That is, not until you've spoken with an attorney first. Regardless, if you must speak with your insurance, understanding the way insurance companies work will help you better gauge what insurance adjusters consider in response to car accident claims. Reasons for insurance claim denials may include:1. A car accident could have been avoided.
After review, an adjuster may determine the car accident could have been avoided, or perhaps your actions led to or caused the accident. In these instances, it’s nearly certain your claim will be denied.
This could also be the case if an insurer believes you render the policy coverage ineffective (e.g. driving under the influence at the time of the car accident or allowing an unlicensed driver to use your car).
When the insurance company suggests you could have avoided the car accident, it may be in your best interest to speak with an attorney in Austin since it becomes evident the insurance company’s interests are in opposition to those of your own.
2. No complaint or treatment was made at the time of injury.
Following a car accident, it’s important to seek treatment immediately. Otherwise, an insurer will argue the injury wasn't sustained or not related to the accident.
Obtain proof of your injury at the time of your hospital or doctor visit to provide with your claim. Doing so will strengthen your case, and by avoiding delay, there’s less likelihood an insurer can assess the injuries reported are made up or exaggerated in order to receive a payout.
Seek medical attention immediately; unfortunately individuals without the financial means to pay for medical treatment may be turned down simply for not receiving treatment when they needed it. This is often a point of contention between the injured individual and the insurance adjuster, and a much more common reason for a claim to be denied.
3. Medical records don’t report an injury or pain.
Without medical records to support your claim, it’s highly likely you will be denied. A lack of documentation ensures that you are unable to prove any damages you’ve sustained from your car accident.
4. Pre-existing conditions may nullify your claim.
In cases of a pre-existing condition, an insurance claims adjuster may claim that your condition is causing the injury or pain, rather than the accident. In cases where your condition is worsened by the accident, a claimant may be able to receive compensation, but it may pose more difficulty to prove what injury or pain was caused by the accident, and to what extent the injury was pre-existing.
5. Instances where a denial may be a sign of “Bad Faith”.
The previous examples are a few of the more common reasons claims are denied, and if you receive a notice of denial, it’s important to speak with your insurance company right away to determine what went wrong with your claim and what you may need to provide to fix it.
If you consider these issues are not applicable to your case, it’s possible the insurance company may have denied your claim in bad faith. What this means is that the insurer is not living up to the terms of the agreement to resolve your case.