Reasons Why Insurance Companies Deny Claims

If you suffer injuries from an accident caused by negligence, the person responsible should pay for the losses suffered, including medical expenses, pain and suffering, punitive damages, loss of income, and many more. To obtain the compensation, you have two options: an out-of-court settlement or a personal injury claim.

Ideally, the compensation process should be straightforward, but since insurance companies are in business, they can deny your personal injury claims or limit your payouts. Denial reasons can be policy problems, disputes over fault, or bad faith practices.

Below are some reasons why an insurance company can deny your personal injury claims.

The Person or Entity at Fault Lacks Valid Coverage

The person at fault should have a valid insurance policy for an insurance company to compensate you for damages after an accident. If the person or entity has no active policy to cover accidents, the insurance company has the right to deny the claim. For example, if you slip and fall at a local retail store and break your leg, the store's insurer can deny your claim if the store does not have a general liability policy.

The Defendant's Insurance Policy Has Exclusion Clauses

Insurance policies have exclusions in the things they cover. Exclusions mean that the insurer cannot pay for any damage resulting from the stated factors. In most cases, these are damages caused by acts of God and intentional acts of vandalism. For example, an insurer can deny your claim if an item falls and injures you at a supermarket during an earthquake.

Exclusion clauses are also common in motor vehicle insurance. While all vehicles must have a valid insurance cover to be on the road in the US, some insurance companies contain driver exclusion clauses. Therefore, even if you sustain injuries from an accident caused by a driver's negligence, the insurer of the vehicle at fault may deny your claims if the driver did not have permissions to drive the car.

The Insurer Disputes the Extent of Your Injuries 

Sometimes, an insurance company can doubt the extent of your injuries. In such a case, the insurance company will argue that your type of injury cannot result from a particular accident. For example, if you suffer low back injuries from a motor vehicle accident, the insurer can argue that the extent of the injury cannot result from such an accident.

Therefore, you should have enough evidence to prove that all your injuries result from the accident. Essential details that can help prove your claim include medical evaluations and reports, photos of the injuries, and photos of the accident scene.

You Failed to File Your Claim in Time

States have a limit on the time you should take to file your personal injury claim. These limitations protect the integrity of the evidence provided to prove your claim. For example, the    New Jersey statutes of limitation    state that you must file your personal injury claim within two years of the date of the accident. Therefore, your insurer can deny your claim if file your claim after the period has elapsed. 

You Lack Evidence to Support Your Claim

An insurer will only accept compensating you if there is clear evidence showing that its policyholder is responsible for the accident.

If you sustain serious injuries from an accident caused by another's wrongdoing or negligence, the other party's insurer should compensate you for medical expenses, loss of income, and pain and suffering. However, the insurance company may also deny the claims in "bad faith". If the insurer denies your claim in "bad faith", then you may be entitled to additional legal remedies. Therefore, you should hire an experienced attorney to protect you and ensure that you have received full compensation.



At Jarve Kaplan Granato Starr LLC, we have the experience and resources needed to help you receive the compensation you deserve. Contact us now to begin your fight for justice!