Reasons Why Insurance Companies Deny Claims

Most of us have one or more insurance policies that cover various situations that may arise in our lives. We have health insurance coverage, car insurance, home insurance, and life insurance. When we travel, we purchase travel insurance in case something goes wrong before or during our trip.

If you pay your premiums, you should be able to rely on the insurance to pay if something goes wrong. Unfortunately, many insurance companies search for ways to deny claims.

Why Do Insurance Companies Deny Claims?

Insurance companies are for-profit corporations. These companies are in business to make money. Paying insurance claims is contrary to the objective of earning a profit. Therefore, companies train adjusters to search for ways to deny claims, even claims that are valid and legal. The reasons why companies deny claims are varied, but there are a few reasons some insurance companies use on a regular basis.

Reasons Why an Insurance Company Denies a Claim

One of the most common reasons why a claim is denied is for noncoverage. Insurance companies argue that the policy does not cover the nature of the claim. For example, a health insurance company may deny a certain procedure, such as infertility treatments or cosmetic surgery, as a noncovered charge. Likewise, a travel accident insurance claim may be denied because you changed the form of transportation at the last minute and failed to notify the company.

Another common reason given for denying a claim is providing false information. The insurance adjuster analyzes each line of your insurance application and your claim form to find a small mistake the company can use to deny the claim. Most policies contain clauses that invalidate the coverage if you falsify information or you fail to disclose information.

Automobile insurance companies may be some of the worst offenders when it comes to denying valid accident claims. The most common reason for denying a car accident claim is failure to prove fault. The company denies the claim stating its insured is not at fault; therefore, the company is not liable for any damages resulting from the collision.

An experienced Ontario car accident lawyer can help obtain evidence to prove fault so that you can receive compensation for an accident. Denying claims for fault is also used in other personal injury cases, including premises liability cases (slip and fall claims), wrongful death cases, animal or dog bite claims, and work-related injuries.

What Can You Do If Your Insurance Company Denies Your Claim?

First, you should always read your insurance policies thoroughly. It may be tedious to read the fine print; however, your first defense when an insurance company denies your claim is to know your coverage. Also, be very careful when completing forms, including application forms and claim forms. One small mistake can provide the company with a reason to deny your claim.

Instead of calling your insurance company, put everything in writing. It is much more difficult for the insurance company to dispute something that is in writing. Keep written records of all bills, correspondence, claims, and other documentation related to your insurance policy and any claims you file.

Do not give up! An insurance company may try to delay your claim until the time to file a lawsuit expires. If an insurance company is delaying your claim, contact an Ontario insurance claims lawyer for help. An experienced lawyer understands how insurance companies operate and how to fight for your right to receive a fair and full settlement for your insurance claim.

Call Diamond and Diamond for A Free Consultation

If you have questions about an insurance claim, our experienced Toronto insurance claims lawyer can help. The team of lawyers at Diamond and Diamond have experience handling insurance claims. Call our 24/7 injury hotline at 1-800-567-HURT or visit our website to speak to someone now.

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