Many people have shared this experience: Spending what feels like an eternity on the phone with your insurance company trying to understand why they’ve either decided to deny your claim or introduce a whole host of paperwork and hoops you have to jump through before they can even consider covering your claim.
All the while, all you can think to yourself is: Isn’t this precisely what I’m paying you to cover with my premiums every month?
In the midst of this harrowing, frustrating ordeal, it can be helpful to talk to professionals about some of the patterns that stand out when insurance companies decide to deny benefits that you thought were a part of your policy, especially those that might lend themselves to being challenged through negotiations and/or a legal response. Of course, every reason will be case specific, and these justifications depend upon whether you are dealing with an injury claim, an auto insurance claim, homeowners’ insurance, etc.
To that end, we would like to discuss some of the most common reasons insurance companies use to deny claims:
Auto Insurance Claims
Some of the justifications we see when auto insurance claims are denied include:
- The individual involved is over the age of 14 but not listed on your policy (everyone in your household who potentially has access to your cars—even if they have their own insurance policy)
- You used your personal vehicle for business use without a “business use” endorsement or a commercial auto insurance policy
- There must be a different policy for each separate address—your car is not covered if it was garaged at a different address than what is listed on the auto policy
Some of the claim denials for disability benefits can include:
- You are not technically disabled (in terms of the official requirements established for your job)
- Your condition was preexisting
- You are lacking the objective evidence necessary to substantiate your claim/disability
- You were not under the regular care of a particular physician
- You were not disabled during the entire “elimination period” and thus are not eligible for particular benefits
- Your condition is not covered and/or requires a larger co-pay because it is a mental versus physical illness
Homeowners Insurance Claims
Homeowners insurance claim denials can be especially devastating, particularly given the cost associated with some types of home-related damage (such as having to replace an entire roof or severe damage to your home’s foundation). It’s important to know that just because you’ve spoken with one person at the insurance company who’s told you your claim isn’t covered, it doesn’t necessarily mean that you won’t be able to change or challenge that decision. In some circumstances, it makes sense to work with an experienced attorney on the issue, particularly if you are looking at covering major expenses out of pocket if your insurance company continues to deny the claim.
Some of the common reasons companies use in denying home claims include:
- Your policy does not cover this particular loss and/or item (note: how the insurance company decides the damage is caused is crucial and you may need to get a second opinion)
- The loss is linked to a period of time when you did not have the policy in place
- You have not yet completed a prerequisite to obtaining coverage for this particular issue
Advice for All Claims
Regardless of whether you are in the process of filing a claim or appealing a denial, there are important steps to take in order to maximize your chance of success, including:
- Reading your policy very carefully before signing anything or calling anyone at the insurance company
- Keeping meticulous records, including of your verbal conversations with the company
- Making sure there hasn’t been a miscommunication about exactly what happened, what the damage looks like, etc. If it’s possible that the picture painted for the company is incorrect or incomplete, it is important to work on fixing that and getting that change on the record
Note that filing a complaint with the Department of Insurance is always an option if you feel that you have been the victim of serious neglect at the hands of your insurance company
Contact Us Today
An insurer’s failure to honor a policy and deal honestly with policyholders is unfair and unlawful. If you feel that your insurance company isn’t properly analyzing your claim or has made you the victim of bad faith, it is important that you contact an experienced bad faith insurance attorney right away so that they can defend your interests.
You can reach a member of our legal team at the Bennett Law Firm by calling 405-272-0303, and receive your free consultation.