What are the Top Reasons for Insurance Denials?

If you or somebody you care about has been injured due to the actions of another party and are expecting compensation through an insurance settlement, receiving a denial letter for your claim can be shocking. You should be fairly compensated for your losses, but there are various reasons why an insurance carrier may refuse to pay out money for your claim. Here, we want to discuss the top reasons that insurance carriers deny claims as well as what you can do to help ensure you receive the compensation you deserve.

There are various reasons why an insurance company may deny a claim

Insurance carriers are going to do anything they can to limit the amount of money they payout to a personal injury victim. They will even look for reasons to deny a claim altogether. Some reasons that insurance carriers used to deny claims are legitimate, while others are made to seem legitimate, but are not. Some of the reasons an insurance carrier may validly use to deny a claim include the following:

  • Claim is not covered. Some insurance policies do not cover all possible types of losses in the aftermath of an injury claim. This is often the case with insurance policies that only cover the minimum is required by law.
  • Premiums not paid. If a person fails to pay their premiums, then they will likely be in violation of the terms of their policy.
  • Waited too long to file a claim. Insurance carriers have strict reporting deadlines for claims, and failing to abide by these deadlines could result in a denial of the claim.
  • Insufficient evidence to prove liability. If there is insufficient evidence to prove liability, even after extensive investigations into the incident, the claim will likely be denied.

Some of the most common examples of “bad faith” insurance claim denials include the following:

  • Misrepresenting terms of coverage. You are responsible for understanding the terms of your insurance policy, but that does not mean that insurance carriers can intentionally misrepresent what is and is not covered.
  • Failing to conduct an adequate investigation. Insurance carriers are required to conduct an investigation into the incident in order to reach a conclusion that a claim should be denied or accepted. Failing to conduct an adequate investigation in a timely manner could be an example of bad faith insurance practices.
  • Failing to consider all relevant evidence. When evaluating insurance claims, insurance carriers cannot overlook evidence that shows liability. If an insurance carrier selectively reviews the evidence and then denies the claim, this could be an example of bad faith insurance practices.
  • Making unreasonably low offers. Insurance carriers will often offer unreasonably low settlement offers that are not supported by the evidence of loss. This is an example of bad faith insurance practices.
  • False accusations of insurance fraud. Insurance companies cannot falsely accuse a person of filing a fraudulent claim. If an insurance carrier makes such a claim, they most certainly will be required to have evidence to prove the allegation. Falsely stating that a person has committed insurance fraud is often a tactic used by insurance carriers to get a person to drop their claim.

Speak to a personal injury attorney as soon as possible

If you or somebody you care about has been injured due to the actions of another party, one of your first phone calls needs to be to a skilled Portland personal injury attorney. From the very beginning of your case, an attorney will help ensure that you have an advocate on your side. An attorney will be able to anticipate the reasons that the insurance carrier may deny your claim and work to counter their efforts. When you have sustained significant losses in an accident, most personal injury lawyers will handle your case on a contingency fee basis. This means that you will not pay any legal fees until after your attorney secures the compensation you are entitled to.