There’s a wide range of reasons that insurance companies utilize to deny a claim. While the majority of denied claims are the result of an insurance company trying to save money, a limited few are due to other factors.
Dispute About Liability
If there’s even a shadow of a doubt that you may have been responsible, or even partially at fault, in a car accident or damage to your home the insurance company will use it to deny coverage. The insurers will look at actions you could have or should have, taken to avoid the situation.
If your medical claims from an accident have been regularly paid, but you suddenly receive statements that are being denied, it may be a coding error. The first step is to contact the insurance company. If they’re approved the treatment, contact the doctor or hospital.
An insurance company will deny a treatment if it doesn’t think it’s medically necessary. Insurers also try to avoid responsibility by claiming your injuries were pre-existing, your actions made an injury worse, or the type of injury couldn’t have been sustained in a particular type of crash.
If you fail to pay your premiums on time, the insurance company can cancel your policy. Insurers can terminate coverage if it thinks you’re a high risk or if you’ve filed multiple claims. In some instances, you may discover that the insurance company has gone out of business. They’re obligated by law to inform you 30 days prior to their closing so you can obtain coverage elsewhere.
Every insurance policy contains exclusions. It may be that a certain type of driver wasn’t included in a vehicle policy or a specific type of home damage was excluded. There may be limitations on how much the insurance company will pay.
Some insurance companies will automatically deny a claim without ever investigating. Denial may also be the result of bad faith practices by the insurance company. Always ask for a specific reason a claim was denied.
There are typically time limits within which a claim must be filed. Failure to do so will result in a denied claim.
Public Adjusters can help with denied insurance claims in some instances, but not all. Find the right public adjuster based on the type of claim that was denied.