5 Reasons Your Insurance Claim Could Be Denied

Insurance is, in theory, there to provide people with peace of mind. Damage to a home, a car, or worse yet, sustaining a personal injury can be a very costly experience for many people. But there are some instances where, despite faithfully paying the premium every month, a claim for insurance coverage is submitted, and the insurance company denies the claim, refusing to release funds.

Why does this happen? Here are some of the more common reasons why an insurance company might look at your claim and deny it.

Your claim Wasn’t Submitted In Time

This is just common sense, but if an injury is serious and requires comprehensive medical treatment, most people would notify relevant parties as soon as possible, including the insurance company. An injury victim is unlikely to want to pay for medical treatment when the insurance company could do it.

However, in some cases, people will make a claim for medical treatment well after an accident—and subsequent treatment and even recovery—have occurred. With such a long lapse in time between an accident and the claim submission, this makes it much harder for an insurance company to verify everything it needs to form their own documentation. Even things like the state of a vehicle on the day of the accident can be difficult to ascertain if there are no photos and the vehicle itself is fully repaired. Most insurance companies will not honor an injury claim if too much time has passed since the accident.

You Can’t Provide All The Required Information

In the same way, that a more recent event makes verification easier, so does your ability to provide requested information. Insurance companies are very detail-oriented; if their paperwork can’t be filled out to satisfaction, then a claim has a higher likelihood of being denied.

For example, if you submit a claim but can’t specify what the injuries were, where the accident took place, or even furnish medical documents from a doctor or hospital emergency room certifying that you have visited a medical facility and been diagnosed, it will be tough for any insurance company to provide compensation. When even necessary information such as where an injury took place and what kind of damage it had no proof of ever taking place, the case can’t be processed.

You Caused The Accident

An insurance company is there to provide financial support when the unexpected and unpreventable happens. However, when a situation doesn’t fall into those circumstances, there’s no obligation to provide support. If an accident occurs where you are at fault, that would be one instance where an insurance company would have the legal right to deny a claim, even if everything else is in order.

For example, if you decide to go bungee jumping but then, once you arrive on the site, insist that you don’t need a bungee cord after all, because “it’s not that high,” and then jump down and injure yourself, you’d be out of luck. Voluntarily throwing yourself off an elevated position after refusing all safety gear is a prime example of a preventable injury where you, not anyone else, are at fault.

You Have A History Of Claims

Accidents are something that happens on freak occasions. However, if you have a history of making frequent accident claims, this is statistically significant. For example, few people will get into more than a few significant accidents throughout their entire life, if ever.

However, if you have a recurring history, such as making ten accident claims across a period of two years, this looks extremely suspicious, even if the injuries are legitimate. If an insurance company has reason to believe an accident is deliberate, in an attempt to get insurance money, they may deny the claim on the grounds of possible fraud.

They Don’t Believe You

Finally, a claim may be denied because the insurance feels that the injury is either fake or deliberate. Unfortunately, the insurance world is full of scams that attempt to defraud insurance companies. One thing that may disqualify you from your coverage is if they doubt your claim’s actual legitimacy.

For example, people have claimed whiplash injuries in car accidents. As a muscular injury, this doesn’t show up on x-rays and can be difficult to detect. If an insurer suspects your claim isn’t legitimate, it will be denied.

If your insurer is denying your claim despite its legitimacy, you can contest that. Contact a personal injury lawyer to explain your case and get what you deserve.