Reasons Insurance Companies Deny Claims

By Jason Ferguson of Ferguson Law Group

We’ve all been there: You think you’ve done everything right. You thought an insurance company would cover an accident or health condition and made monthly payments, but they denied your claim. Sometimes, this means they won’t pay at all, and other times it means you will have to pay back some of the money you’ve already received. How can something like that happen?  Having a denied claim is just as bad as being in an accident, get in contact with Phoenix Car Accident Lawyers here and see how they can help you with your denied claims.

Insurance companies decline fair and reasonable claims for a variety of reasons. Your claim may be disapproved if your actions contributed to the accident. If you engage in behavior that renders your coverage ineffective, an insurance company may deny your claim. Your claim may be dismissed if someone who was not covered by the respondent’s insurance policy or who did not have a valid driver’s license was driving the respondent’s car at the time of the accident, your claim may be dismissed.

In addition to the reasons listed above, insurance companies may reject claims for a variety of reasons that are not valid and could suggest that the company is behaving in bad faith.

Past Injuries or Surgeries

Medical authorization papers are frequently requested by insurance companies from wounded claimants. It is critical that you do not sign the medical authorization papers without first consulting with a qualified personal injury attorney. These authorizations are used by insurance companies to look up past injuries or procedures in your medical history. If you’ve had a previous injury or surgery, the insurance company may try to blame your accident injuries on that injury or procedure. Similarly, the insurance company may argue that the severity of your accident injuries was less severe because of past injuries or procedures.

Pre-existing Ailment

If you have a prior ailment, insurance companies may try to deny your claim. The insurance company may aim to prove that your condition, rather than the event, caused your injury. For instance, if you have a pre-existing back problem but were injured in an accident and sustained additional or new injuries, the insurance company may refuse your claim, declaring that your new injuries or exacerbation of your pre-existing condition were not caused by the accident.

Failed to Sought immediate Treatment

If you’ve been involved in a car accident, it’s critical that you get medical help right away. If you wait too long, the insurance company can refuse your claim, claiming that your injuries were caused by anything other than the accident. If you forget to report the accident immediately, your claim may be denied by the insurance company. Many companies have time limits within which you must report an accident to them. However, there are situations when it is fair to wait or when circumstances warrant the delay. This is a very important matter that you should talk with an experienced lawyer.

If you claim that you were not harmed at the time of the accident, insurance companies may deny your claim. When you’ve been in an accident, it’s advisable not to deny any injuries until you’ve been thoroughly examined by a medical professional. You should get medical help as soon as possible. Some injuries don’t show symptoms for days after an event, which means you could be hurt even if you don’t think you are.

Actions to be taken If You Receive a Denial of Your Car Accident Injury Claim

If an insurance company delays or denies your claim, you will almost certainly require the assistance of an experienced personal injury lawyer. Insurance firms make money by charging more premiums than they have to pay out in claims, therefore they have a vested interest in refusing or disputing claims. If you hire a lawyer, insurance companies may take you more seriously.

On your side, an experienced, trustworthy personal injury lawyer will perform a thorough investigation of all the facts. Your attorney may then create and send a settlement demand letter to the insurance company on your behalf. If done correctly, this letter will describe your arguments regarding what transpired in the accident, how and why you were harmed, and include a formal demand for damages compensation. Sending a demand letter to the insurance company may prompt it to make you an offer through your attorney or provide a detailed reason for its denial. Your attorney may launch a formal lawsuit and go through the litigation process if the insurance company refuses to settle for a reasonable amount.

Insurance companies decline claims for a variety of reasons, but some organizations, sadly, utilize unscrupulous practices to conserve money. If you have been wounded in an accident and are having trouble negotiating with the insurance company, you should speak with an experienced personal injury attorney that would ensure that your claims will be acted on properly. In finding an attorney, try to listen for good feedback from other clients who have the same experience as you.

About the Author

Jason FergusonJason M. Ferguson, the founder of Ferguson Law Group, started his career working for an automobile insurance company as a trial attorney before owning his injury law firm for over 20 years. Attorney Ferguson has a unique experience, having tried cases on both sides of the court system in personal injury trials, unlike many other lawyers. Mr. Ferguson also served over 14 years as an Army Reserve officer and the Georgia Air National Guard. The Albany Herald recognized him as one of southwest Georgia’s “40 under 40” in 2010.


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