What Could Cause My Insurance Claim to be Denied?

What Could Cause My Insurance Claim to be Denied?

There’s nothing more disheartening when it comes to insurance than having your car accident claim denied. Finding out that your expenses will not be covered can be both expensive and demoralizing, so if you’ve been involved in an accident and are considering filing a claim, knowing what could cause a denial can help you take necessary steps to avoid it. Some of these causes include the following:

Policy Exclusions and Limitations

If you plan on filing an insurance claim, it’s important to make sure you understand your plan’s coverage limits before moving forward. Making sure you read through every detail spelled out in the policy contract is key here so that down the line, you don’t run into any unwelcome surprises. Some of these policies use confusing legal jargon, so if you need help analyzing your coverage, reach out to a personal injury lawyer about your claim.

Lack of Documentation

Your insurer needs proof that you’ve experienced an accident in order to cover your losses. This means providing detailed documentation such as receipts, photos, medical records, and police reports. If all necessary information isn’t provided, the insurance company will deny your claim and you will be stuck dealing with expenses out of your own pocket.

Missed Deadlines

Most policies come with specific deadlines for filing claims and responding to any requests made by insurers during the process. It’s important that you keep track of these dates so there won’t be any impediments in getting compensated. Failing to meet these deadlines could lead directly to denied claims even if you would have had a strong claim to compensation had you submitted everything on time.

Pre-existing Conditions

One of the most common reasons that insurance companies deny claims is because of what they perceive as a pre-existing condition. This is a medical issue or injury that existed before the policyholder began coverage under their current insurance policy.

Many times, insurance providers will argue that the condition in question existed before the policy was in place, and therefore should not be covered.

Unfortunately, some insurance companies may use this excuse even if the pre-existing condition is unrelated to the claim at hand. If you suspect that your claim is being denied because of an unfounded pre-existing condition argument, be sure to gather any relevant medical records and enlist the help of a lawyer to help you fight the denial.

Bad Faith Insurance Practices

Another reason for insurance claim denials is bad faith insurance practices. This involves an insurance company acting in a manner that is unfair, disingenuous, or dishonest when handling a policyholder’s claim.

Recognizing Bad Faith Practices

Some of the most common examples of bad faith insurance practices include:

  • Unreasonably delaying the processing of a claim
  • Failing to conduct a thorough investigation
  • Misrepresenting the policy terms, conditions, or exclusions
  • Offering an unfairly low settlement
  • Denying a claim without providing a reasonable explanation

Insurance Policy Not Active

If a policyholder falls behind on payments, this could lead to the policy lapsing and cause you to be without coverage. There’s usually a grace period, but if enough payments are missed, the policy will be canceled. This can happen by mistake – for example, you use autopay and your credit card expired – so always make sure you know for sure that your payments are getting made on time.

Understanding the reasons behind insurance claim denials is critical for policyholders. By recognizing these factors and taking steps to address them, you can ensure you get the compensation you’re entitled to.

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