Tactics Insurance Companies Often Use to Deny Claims

Have you ever filed an insurance claim only to have it denied? You’re not alone. Insurance companies are collecting premiums, not paying out claims, so they’ve developed clever tactics to avoid approving expensive claims whenever possible. Before you file your next claim, look for these common tricks insurance companies use to deny claims. 

They’ll scrutinize your policy language, claim the incident isn’t covered, say you didn’t provide enough documentation, argue the costs are too high, claim a pre-existing condition excludes the claim or stall and hope you give up. Don’t fall for it. Know your rights and fight back against their denial tactics. Your claim is legitimate, and you deserve to have it paid.

Policy Exclusions

Insurance companies are pros at finding ways to deny your claim. One of their favorite tactics is to say that whatever happened to you or your property is excluded under your policy.

They’ll dig through that long, tedious policy document to find some vague clause that lets them off the hook. They cite common exclusions like “acts of God” (natural disasters), pre-existing conditions, or normal wear and tear.

Some policies also don’t cover secondary damage. Say a pipe bursts and water ruins your flooring – they may cover the pipe repair but not the water damage. Shady, right? They bank on the fact that most people don’t read the fine print.

Delayed Response and Investigations

Insurance companies are pros at delaying claims in hopes you’ll give up. Their favorite tactic? Dragging out the investigation process.

They’ll ask for additional paperwork, statements, photos, or reports to “review” your claim. But don’t be fooled. They’re just buying time and hoping you’ll drop it. Stay on them. Call regularly to check the status and resend any requested info quickly.

If they schedule an in-person inspection, be there. Ask questions and get details on the next steps before the inspector leaves. Follow up with a call or email to confirm what was discussed.

Misrepresentation or Non-disclosure

When applying for insurance, companies will ask you questions about your health, lifestyle, and medical history. It’s important to answer all questions honestly and disclose any pre-existing health conditions you may have. Insurance companies can deny claims if they find you withheld information or were untruthful in your application.

Some worry that disclosing health issues may lead to higher rates or even denial of coverage. However, lying on an insurance application is considered fraud and can have serious consequences. It’s illegal, and the insurance company may drop your coverage altogether if discovered. 

Pre-existing Condition Denial

Insurance companies often deny claims by stating that your condition was “pre-existing”, meaning it existed before you bought the policy.

Insurers may scour your medical records for any mention of symptoms related to your condition before starting the policy. Even if you were never officially diagnosed or treated, they may claim you should have known about the issue. They’ll argue that had you disclosed this, they either would not have covered you or would have charged higher premiums.

To fight a pre-existing condition denial, provide records showing a clear diagnosis date after your coverage began. Get statements from doctors attesting that your symptoms before that date did not warrant a diagnosis or treatment. You may also request an independent medical examination to counter the insurance company’s decision.

Lack of Documentation

Insurance companies often deny claims due to a supposed lack of proper documentation. They may say you failed to provide receipts, invoices, photos, or other records to support your claim.

  • Make copies of everything and keep records of all communication with your insurance company. Send documents via certified mail so you have proof of delivery.
  • If they continue to insist on more documentation, request specifics in writing. Often, they are on a “fishing expedition”, hoping you won’t be able to provide what they’re asking for. Don’t fall for this tactic.
  • You may need legal counsel to force them to process your claim properly. Your policy details exactly what is required for different types of claims, so review it carefully and don’t provide more than is necessary.

Staying on top of documentation needs and not giving in to unreasonable demands is key. While insurance companies may try to take advantage of people’s lack of knowledge about the claims process, you have rights as a policyholder.

Policy Lapses

Insurance companies will scrutinize your policy details to find any reason to deny a claim. Double-check that all information in your policy documents is correct and up to date. Things like an incorrect address or vehicle details could be used against you.

Make sure you understand your policy’s lapse conditions. If you miss a payment by even a day, your coverage could be void – leaving you on the hook for costs. Set up automatic payments, if possible, to avoid issues. Review your policy’s grace period details and know the exact date payments are due to prevent unintended lapses.

Stay on top of any policy changes as well. If certain coverage limits or deductibles have changed and you’re unaware, the insurance company may try to apply updated details to a claim that should be covered under the previous policy terms. Review any policy renewal paperwork carefully to ensure you understand all changes before signing.

Lowball Offers

Insurance companies will often make an initial settlement offer far below what they know the claim is worth. They’re hoping you’ll accept the offer just to be done with the hassle. Don’t fall for it.

These “lowball” offers are a common tactic to save the insurance company money. They rely on the fact that many people don’t have the time, energy or resources to dispute the offer and will take whatever they can get. But you deserve to be fully compensated for your loss.

Do some research on your own to determine a fair settlement amount for your claim. Check recent payouts for similar claims, get estimates to repair or replace damaged property, or talk to others in your industry or neighborhood. Come armed with facts and evidence to support why their initial offer is too low. You can then counter with a reasonable counteroffer backed by your research.

Comparative Negligence

Insurance companies often claim that you were partially at fault for an accident to reduce the amount they pay. This is known as “comparative negligence.” They may argue that:

  • You weren’t paying full attention while driving.
  • You were speeding or violating other traffic laws.
  • You didn’t take proper precautions as a pedestrian or cyclist.

Don’t let them get away with this. You have rights, and unless it’s clear you were mostly or entirely at fault, they still owe you compensation.

Staying calm and knowing your rights will help prevent insurance companies from taking advantage of comparative negligence to deny you fair compensation. Don’t let their tactics intimidate you into backing down from a legitimate claim.

If an Insurance Company is Trying to Get Out of Setting Your Claim, Contact a Fort Lauderdale Car Accident Lawyer

Insurance companies are in the business of making money, not paying out claims. They have teams of lawyers and adjusters whose sole purpose is to deny or limit the amount of claims paid out. Don’t be naive in thinking they have your best interests at heart.

The best way to stand up to manipulative insurance companies is to hire an experienced Fort Lauderdale car accident lawyer. A Fort Lauderdale, Florida, lawyer specializing in auto accidents and personal injury claims will know all the tactics used to deny claims and how to counter them. They can handle the negotiations and pursue legal action to get you the maximum compensation you deserve.

Don’t let an insurance company take advantage of you after an accident. Contact Frankl Kominsky, a car accident lawyer serving Fort Lauderdale, today at (561) 800-8000. We are here for you.

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