The main goal of purchasing any type of insurance policy is protection. Whether it be health, auto, life, or some other type of insurance, consumers buy insurance policies to help them when they need financial support. This contract seems pretty straightforward: a person pays his policy premium and, when he suffers some type of damage or loss, he files a claim to utilize the protection the insurance company has promised to provide. However, interactions with insurance companies are not always so direct. Insurance companies are businesses out to protect their bottom line. To that end, they will employ any number of tactics to avoid paying on a claim
, even denying a legitimate claim.
Why Insurance Companies Deny Claims
Insurance companies will find any reason to deny a claim, even trivial ones. Some of the most common include:
Every policy has limits on what it will pay. Consumers select the amount of insurance they desire when they purchase the policy, and these limitations do vary from individual to individual.
In addition to limitations, there may be specific exclusions in the policy, or the insurance company may try to claim that a certain type of coverage is excluded.
Failure To Report Damages/Injury
Policies may specify that an accident or injury must be reported to the insurance company within a certain amount of time to qualify for coverage. It’s important to report any incident to the insurance company as soon as possible.
Lack Of Medical Evidence
For injury claims, the insurance company may require proof that the injury exists and was caused by the accident. Injury victims will need to provide certain medical documents to prove their claim.
One common tactic of insurance companies is to refuse coverage by claiming that an injury is a pre-existing condition. They will claim the injury is not a result of the accident and simply related to another condition already experienced by the victim.
If any incorrect information is reported, even accidentally, the claim could be denied. In addition, there are cases in which the injured party did not follow the claim requirements exactly, which could prompt a denial.
Failing to fully and properly report the claim or failing to provide all the necessary information can also result in an initial denial.
A 2011 study conducted by the Government Accountability Office found that many claims are denied based on simple paperwork errors. Additionally, that same study reported that denial rates among insurance companies can reach as high as 30 percent, but when the insured parties challenge these denials, they are ultimately successful in obtaining benefits in half of those initially denied claims.
So, why do insurance companies continue to deny claims for these trivial reasons? An LA Times article suggested that these large companies may hope that claimants will simply give up trying to overturn a denial because they’re overwhelmed and unsure of their rights.
Your Rights When an Insurance Claim Is Denied
It’s understandable that people may hesitate to continue to pursue a claim after a denial, especially when they are already dealing with a serious injury and the stress that accompanies that injury. However, insurance compensation can make all the difference in an injury victim’s ability to recover as fully as possible. It also can have a significant impact on the victim and his family’s financial stability. That’s why it’s important to fight back. An initial denial does not have to be the final word on your insurance claim, and our experienced insurance attorneys can help.
An effective insurance lawyer can make sure that victims and their families are fully aware of their rights, and they can provide the guidance needed to pursue a successful claim. If your claim has been denied, our attorneys may be able to:
● Review your policy and explain your coverage
● Review paperwork to find any errors or omissions
● Submit an appeal with the insurance company for reconsideration
● Negotiate with the insurance company
Have You Been Denied An Insurance Claim? Is Insurance Delaying Your Payment?
If you've been denied an insurance claim, or the insurance company is delaying your payment, you need to speak with an experienced attorney as soon as possible. Please contact us online or call our Conway, South Carolina office directly at 843.484.0707 to schedule your free consultation. We are also able to meet clients at our Myrtle Beach, Charleston, Mt. Pleasant, Columbia, North Myrtle Beach or North Charleston office locations.