What Are Some Common Ways Insurance Companies Try to Get Out of Paying Claims?

Is the Insurance Company Going to Try to Avoid Paying Your Claim?

If you’re ever injured and need medical aid, it’s crucial to have adequate health insurance coverage. Otherwise, you may be paying for those medical expenses yourself. So, one would assume that, provided they have a good healthcare plan, they will be appropriately looked after should they ever need it. However, that is far too often simply not the case, as insurers will seek to save money whenever and however they can, even when it comes at the expense of upsetting their supposedly valued policyholders by using common tricks insurance companies employ to minimize payouts.

Is the insurance company going to deny your claim? We cannot say. It’s certainly possible. And, if they see the opportunity to save money, they will take it. However, it is possible to stay a step ahead of the insurance companies; make sure that your coverage is in order, follow all the appropriate steps, and establish that fault rests with other parties when attempting to recover compensation for a personal injury accident. For the highest chances of success, it is advisable that you seek the professional legal guidance of a personal injury attorney to represent your case.

How Frequently Do Insurance Companies Deny Claims?

While it may seem unfair for an insurer to turn down your claim, it is by no means uncommon. However, that is not to say that you should feel that denials are the default. The AARP estimates that an average of 1.4 billion health insurance claims are filed annually.

On average, 5% to 10% of health insurance claims are denied by an insurer, with many companies denying claims based on various factors, including evidence found online. This means you have the likelihood of your claim being approved nine times out of ten. This should comfort those worried that their claims will inevitably be denied. However, it is naturally little comfort for those who have been dismissed before and understand the frustration that can cause.

Tactics Used to Deny or Devalue Claims

Delaying the Process

Insurance companies often employ delay tactics to frustrate claimants and devalue their claims. These tactics can include ignoring the claim, requesting unnecessary documentation, taking an unusually long time to respond to communications, and making it difficult to get in touch with the insurance adjuster. By dragging out the process, insurance companies aim to make claimants desperate, hoping they will accept a lower settlement just to resolve the matter quickly. To counteract these tactics, it’s essential to keep a meticulous record of all communications with the insurance company, including dates, times, and details of conversations. This documentation can be crucial if you need to escalate the issue or seek legal assistance.

Misrepresenting Information

Another common trick insurance companies use is misrepresenting information to deny or devalue claims. This can involve misrepresenting the law regarding what damages the claimant is legally entitled to seek, misrepresenting the amount of insurance coverage available for the claim, or downplaying the severity of the claimant’s injuries. Insurance companies may also use misleading language or make false promises to convince claimants to settle for less than they deserve. To protect yourself from these tactics, it’s crucial to seek the guidance of an experienced personal injury attorney. An attorney can help ensure that your rights are protected and that you receive a fair settlement for your injuries.

Blaming the Victim

Insurance companies may also try to blame the victim for the accident to deny or devalue claims. This can include arguing that the victim was partially at fault for the collision, that the victim’s injuries were pre-existing, or that the injuries occurred after the accident. By shifting the blame onto the victim, insurance companies aim to avoid paying out on the claim. To counter these tactics, it’s essential to gather strong evidence to support your claim. This evidence can include medical records, witness statements, and police reports. Having comprehensive documentation can help demonstrate that the fault lies with the at-fault party and not with you, increasing your chances of a successful claim.

What Reasons Do Insurance Companies Give for Claim Denials?

Whether you’ve been in a car accident, a slip-and-fall accident, have suffered a dog bite, were injured at your workplace, or one of any number of other instances, you deserve the chance to recover financial compensation for your injuries and lost wages. However, recovering that financial settlement is no sure thing, as the insurance companies and defending council will work overtime to prove that they are not obligated to compensate you for your injuries.

The insurance company’s adjusters commonly cite certain specific reasons why a claim could be denied.

Does Your Policy Cover the Specific Type of Accident?

It’s not fair, but you want your insurance coverage to be as universal as possible so that it covers a multitude of different kinds of accidents. Whether because of an error on the part of the policyholder or a technicality that the insurer exploits, it may be possible that a specific type of accident simply is not covered by the insurance company, leaving both the victim and the at-fault party in a difficult spot following an accident. Know your policy.

Has Your Coverage Expired?

Health insurance coverage does not always automatically renew in the US. The policyholders are held responsible for keeping their coverage up to date. If you fail to do so, your coverage could lapse. If you do not have active healthcare, an insurance company is likely to deny your claims.

Is Fault or Liability in Doubt?

If the circumstances surrounding the accident are in doubt, an insurance company may point to that as a valid reason to deny your injury claim. In such cases, the other party in the accident may be trying to shift blame onto you, or the evidence may indicate that both parties were at fault. Until fault can be determined, an insurance company may not see a good reason to approve any claims.

Is the Cause or Extent of the Injuries Being Contested?

An insurance company may be suspicious about an accident victim’s medical treatment and injuries and refuse to settle their claims. Examples include instances where the victim exaggerates their injuries. Additionally, insurance companies may be doubtful that the injuries arose from the accident in the first place. They may suggest that a claimant is hindered by preexisting injuries or injuries suffered in the time after the accident.

Did You Seek Immediate Medical Attention?

The most surefire way to avoid having an insurance company raise doubt about the timeline of the accident is to seek medical care immediately following the accident, despite the potential for mounting medical bills. Do not go home and ‘sleep it off’ and do not wait a week until it’s convenient to see a doctor.

Get checked up and evaluated as soon as it is safe after your accident. The sooner your injuries are on record following the accident, the better your chances of getting your claim approved.

Did You File Your Accident Claim On Time?

Most accidents have a statute of limitations for filing a claim after an accident. Even if you did everything else right, taking too long to file a claim could result in a strict ‘no’ from the insurer.

What Are ‘Bad-Faith’ Denials?

Sometimes the insurance companies act in bad faith, requesting recorded statements from accident victims shortly after an incident, and will deny a claim without good cause in order to save themselves some money. Insurers have a legal obligation to perform a proper investigation and ethically consider all claims. If you believe an insurance company has denied your claim in bad faith, you need to speak with a lawyer right away.