Insurance is a good thing to have since it can provide a significant amount of peace of mind. After all, one never knows when they’ll be involved in a vehicle accident or some other accident where financial help is required in order to cover the costs of damages or health care.
However, there are times when an insurance company will deny coverage for an injury. There are many reasons for this. Sometimes it’s a case of where the insurance company is trying to reduce their financial losses by refusing to pay out a claim, even if a person has paid premiums for years.
When this happens, it can be a frustrating, scary and confusing situation. The good news is that an insurance company can be held legally accountable for unreasonable denials and denials can be contested.
Reasons For Claim Denial
An insurance company may justify denying a claim for the following reasons.
Expiration or Lapse of Coverage: Coverage may not be automatically extended if a police holder does not renew various types of insurance.
Policy Exclusion: Insurance policies often intentionally exclude coverage for certain types of injuries or damages. It’s common for these exclusions to be hidden in fine print. Sometimes these exclusions may be illegal. There are many cases where an insurance company will deny coverage loosely based on a vague exclusion described in the policy.
Delay in Treatment: If the allegedly injured person does not seek medical attention right away, an insurance company may deny a claim.
Incorrect or Incomplete Claim: If claim submission guidelines or incorrect information is provided, an insurance company may deny a claim.
Pre-existing condition: The insurance company will use a pre-existing condition to claim that an injury was not caused by the incident.
Limited or No Medical Records. Medial records are crucial to a claim since they provide proof of the injuries. Without medical records, an insurance company can claim there was no injury.
Failure to Avoid/Mitigate Injury: An insurance company expects a person to do everything they can to avoid the injury and to act reasonable to avoid making it worse. If they determine the person did not do this, they may reject a claim.
Options after Injury Coverage Denial
Some instances a person may not be able to do anything if a claim is denied. However, the insurance company is required to act in good faith. Some are more concerned with their profits and reducing payouts than they are in helping a person who has paid into a policy for years. So, they may stretch the limits of the legal reasons they can reject a claim.
If you have a claim that has been rejected, let your injury lawyer in Grand Prairie study the policy and contact the insurance company again. If a valid explanation is not provided, or if one seems suspicious, it may be appropriate to contact a personal injury lawyer.