11 Tricks Insurance Companies Use to Deny Claims

Get your free, no-cost case evaluation below

  • This field is for validation purposes and should be left unchanged.

* all fields required

After a personal injury accident, an insurance company is often your first outlet for securing compensation. Insurance companies should reimburse policyholders, claimants, and accident victims for their losses in the event of property damage or bodily injuries. Yet insurers are notorious for denying claims, often to save money.

The following 11 tricks are tactics an insurance company might use to unfairly deny your claim. If you see these, call an accident lawyer in Fort Lauderdale to discuss the possibility of further legal action.

Missed Filing Deadline

One of the most common attempts to deny insurance claims is to allege that the claimant missed an important filing deadline. Accident victims must report their injuries promptly to the correct parties to qualify for coverage, such as to a supervisor in a workers’ compensation insurance claim. Claimants must also obey claims filing deadlines – usually “as soon as possible” after an accident, but no later than 30 days. Make sure you know and adhere to all applicable deadlines.

Failure to Fulfill Specific Stipulations

Insurance companies often have detailed requirements for different types of claims. You may have to submit certain injury documentation or paperwork. Communicate with your insurance agent and get a full list of the information the company needs from you.

Missing Paperwork

It can be easy to miss a piece of paperwork the insurance company required for your claim. Unfortunately, this can be enough reason for an insurer to deny your claim altogether. Using a lawyer to submit your claim can ensure this mistake doesn’t happen.

Not Enough Information

Some insurance claims receive denials because the claimant didn’t include enough information or details about the incident. The insurance company may request further information or launch an investigation into your case before accepting it as a valid claim.

The Insurer Isn’t Liable for Damages

An insurance company may believe it isn’t the right party to be fulfilling the victim’s claim. It might deny the fault of its policyholder or assert that the claimant was partially responsible. Since Florida is a no-fault insurance state, this isn’t often a problem, since all accident victims seek damages through their own insurers regardless of fault.

The Policy Doesn’t Cover the Damages

It’s possible the claimant’s policy doesn’t have the correct type or amount of coverage for the recovery he or she is seeking. Ask your insurance agent for a copy of your policy if you don’t already have one. If you do in fact have the coverage in question, the denial may be wrongful or a clerical error.

False or Exaggerated Injuries

An insurance company could allege that you’re exaggerating your injuries or reporting the accident with false information. Providing adequate documentation of your accident and injuries, such as medical records, can help refute these types of denials.

Pre-Existing Injuries

If the insurance company says it denied your claim based on pre-existing injuries, you could have an appeal on your hands. While pre-existing injuries may disqualify you from insurance coverage in some situations, oftentimes the insurance company is wrong in denying the claim.

Self-Inflicted Damages

An insurance company might deny your claim if it has reason to believe you purposefully inflicted your injuries or property damage to recover money. If an insurance company is accusing you of this type of insurance fraud, contact an attorney for assistance.

Uncovered Medical Treatment

Many insurance companies won’t pay for all types of medical treatments. Instead, insurers will stipulate they will only pay for certain treatments. Holistic or “experimental” treatments may have to come out of the claimant’s own pocket.

Gap in Coverage

Finally, an insurance company might issue a denial if the claimant does not currently have coverage, or is in between coverage periods due to a missed payment. Purchasing a new plan also often comes with a waiting period in which the insurance company will not provide coverage. If you just bought your policy, it’s possible not enough time has passed.

Denied insurance coverage unfairly? Refute your denial. File a complaint with help from an injury attorney in Florida.