Common Reasons for Insurance Injury Claim Denials


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When you are making a claim through your insurance after an accident, you may be counting on the money coming in from that claim in order to pay your medical bills and other costs. Unfortunately, things don't always happen that way, and sometimes your insurance claim is denied. When this occurs, it is important to understand exactly why it was denied. Every situation is different, of course, but below are some common reasons that insurers give for denying claims. 

Reasons for Claim Denials

Some common reasons for insurance claim denials include:

  • The accident was avoidable: If you could have avoided the accident, or if you did something that led to or caused it, then you may have your insurance claim denied. This is especially true if the insurer believes that you did something that would render the policy coverage ineffective, like driving drunk at the time of the accident or letting an unlicensed driver use your vehicle. If you find yourself in a situation in which the insurance company claims you could have avoided the accident, it is best to get a lawyer since the insurance company's attorney may have interests that are directly opposite to those of your own. 
  • There was no complaint or treatment at the time of the injury: If you wish to claim that you got injured as a direct result of an accident, it is imperative that you actually go and get treatment right away. Otherwise, the insurer may argue that the injuries didn't really happen as a result of the accident or that those injuries are not related or connected to the accident. If you have proof that you went to the hospital immediately after the accident and your injuries were diagnosed then, you will have a lot stronger of a case than if you wait. Furthermore, if you delay, this may make the insurer believe that the injuries are made up or exaggerated to try to get a payout, since most people who are genuinely hurt do get medical care immediately. 
  • Medical records don't indicate an injury/pain: If you don't have medical records that indicate that you actually suffered an injury, then your claim is very likely to be denied since you cannot prove you will be entitled to any damages.
  • Pre-existing condition: If you have a pre-existing condition, the insurer may argue that it was this condition that is causing your injury and pain, and not the accident. If your condition was worsened by the accident, you may still be able to get some compensation, but it can be hard to sort out and prove just what was caused by the accident and what extent of the injury was pre-existing. 

These are just a few of the most common reasons why claims are denied. If you receive a notice of denial, you need to talk to your insurance company as soon as possible to find out what went wrong with your specific claim and what you need to do to fix it. 

Getting Help

When an insurance claim is denied, you should strongly consider speaking with a lawyer. Your attorney can help you to talk to your insurance company, find out what the problem with your claim was, and fix that problem so you can get the benefits you deserve. 

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