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What are the Top Reasons for Insurance Denials?

By Butler Prather LLP on October 26, 2020

If you or somebody you care about has been injured due to the careless or negligent actions of another person or entity, you may be entitled to various types of compensation for your losses. In most situations, personal injury cases are settled out of court through insurance carriers. However, it is not uncommon for insurance claims to be delayed or denied by insurance carriers. Here, we want to discuss the top reasons that an insurance carrier uses to deny a claim.

Top reasons for an insurance claim denial

Understanding why your claim was denied by an insurance carrier is the first step in standing up to the insurance provider when securing the compensation you need. Some of the top reasons for a denial include:

  • The insurance policy does not cover the type of claim you have filed. For example, if you are in a car accident and your claim is for collision coverage, but the policy only provides liability coverage, the collision claim will be denied.
  • Lapsed coverage due to late premium payments. If you pay your insurance late, your insurance carrier will use this as a reason to deny your claim.
  • Errors made by the insurance company. This can include a claim sent to the wrong insurer, an incorrectly entered code, etc.
  • The full damages exceed policy limits. If the amount of compensation sought for your claim exceeds the limitations on the insurance policy, the carrier will only pay up to the limits.
  • Lack of coverage under the specified policy. This could include things such as a teenage driver being excluded from their parents’ insurance policy.
  • The claim was not reported promptly. Most insurance carriers have specific deadlines for reporting insurance claims. Often, these deadlines are very soon after an incident occurs. Failing to abide by these reporting deadlines could result in the claim being denied.
  • The claim application was not truthful. All information given to insurance carriers needs to be truthful, or the insurance carrier will likely deny the claim.
  • The insurance carrier does not agree with the facts of the case. Insurance carriers will conduct investigations into any injury incidents. If their claims adjusters think that their policyholder was not at fault for the incident, they may deny the claim.
  • Treatment rendered was not medically necessary. If the doctors or other medical professionals treating an injury perform a procedure that is not determined to be medically necessary, the insurance carrier may deny the claim.

Will you need an attorney to help with an insurance denial?

If you or somebody you care about have been injured due to the actions of another person, you should be entitled various types of compensation. If your insurance carrier has denied your claim, you should speak to an attorney as soon as possible. A skilled and experienced Atlanta personal injury lawyer will understand the tactics used by insurance carriers in these cases. Your attorney will be able to conduct a full investigation into your case in order to counter any reasons your insurance carrier has given for a denial of your claim.

Posted in: Personal Injury

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