Why Would an Insurance Claim Be Denied?
According to CMS Transparency, insurers denied 18% percent of health claims. Unfortunately, it leaves victims to endure pain, suffering, loss of income, medical expenses, or death. These statistics don’t revoke the rights of the victim to receive fair compensation.
An insurance company can apply the policy terms and conditions to deny a claim. Remember, insurers are profit-making organizations, a justification for their tendency to deny injury claims. The knowledge of denied claims can inspire victims to prepare well while seeking compensation.
Moreover, an insurance company may present an offer that isn’t equivalent to your loss.
If an insurance company has denied you a claim, a personal injury lawyer can take up your case to pursue a deserved compensation.
Here are the common reasons insurers deny claims.
The Insurer Believes You’re Partially or Wholly Liable For the Accident
All insurance contracts operate under specific terms and conditions. For instance, the owner of an insured vehicle must conduct frequent vehicle maintenance, observe traffic rules, and avoid drunk driving.
If the insured party fails to observe the laid terms and conditions, an insurer is within their rights to deny a claim. Besides evaluating intentional acts, insurers investigate whether a victim could have avoided the accident.
Insufficient Documentation to Support the Claim
The available evidence validates all insurance claims. In a car accident injury, the insurer will demand medical documentation to ascertain and value your damages. Remember, some injuries disappear a few days or weeks following the accident. It’s, therefore, prudent to seek urgent medical attention to improve the validity of a claim.
Here are a few medical documents that can enhance your claim:
- Doctor’s diagnosis
- Out-patient medical bills
- In-patient costs
- Lab examinations
- X-ray records
- MRI scans
- Detailed notes of physical therapists
Shoddy Investigations By the Insurer
Insurance companies conduct due diligence before approving payment of an insurance claim. Therefore, the quality of the investigation can affect the outcome of the claim. Moreover, consider studying the investigation report to understand the reasons behind the claim denial.
Here are the possible details that an investigation could unravel:
- A pre-existing medical condition could be the cause, not the accident.
- An eyewitness was present when the victim disregarded safety measures
- Investigations indicate other parties were to blame, for instance, a poor maintenance job by the mechanic
Incomplete, Incorrect, or Missing Details
Insurers may also deny claims due to administrative reasons. For instance, errors like patient data oversights, incorrect biographical details, missing identification documents, missing dates, and signatures.
Although it’s possible to rectify missing records, the lack of these details can void crucial documents. It’s, therefore, recommendable to work with an attorney to verify every detail and documentation of your insurance claim.
What’s more, missing or incomplete documentation may contribute to a delay— frustrating the injury victim.
Get Help From an Experienced Personal Accident Attorney
When an insurance company denies a legitimate claim, it compounds the woes of a victim.
It’s, therefore, crucial to a reputable lawyer like Holladay Law Firm. We’re passionate about representing the best interest of our clients. Contact us online or call us at 281-984-3948 for a free case review.