What Are the Top Reasons for Insurance Denials?

An insurance claim may be your ticket to financial compensation after a bad accident, but it is not the easiest process for victims to navigate. Rather than being on your side and wanting you to recover the full costs of your injuries, the insurance company will want to minimize your payout for better profitability. If an insurance company has denied benefits, it may not mean the end of your claim. Speak to a Houston personal injury lawyer for advice about how to contest a denial.

Lawful Reasons for an Insurance Company to Deny Benefits

Having a successful insurance claim in Texas is not easy. You will need to provide enough information and documentation with your insurance claim to show the company that its policyholder caused your injury and that your losses are coverable according to the policy. You may have to negotiate back and forth with an insurance claims adjuster for a fair outcome. If you receive a letter stating that the insurance company has denied your claim, it must also give you the reason.

• Late filing/missed filing deadline
• Missing information on the claim
• Arguments regarding liability
• Questions about the circumstances of the accident
• Allegedly broken laws by the claimant
• Claimant’s comparative negligence
• Pre-existing medical conditions
• Cause of injury or death not covered under the policy
• Claimant not covered under the policy
• Lapsed or expired insurance policy
• Exceeded policy limits

These are examples of some of the most common reasons insurance companies give for denying benefits to claimants. If your denial letter did not state the reason, call the insurance company to ask for one. You can plan your next move based on the reason the insurance company gives you for withholding benefits.

What to Do About an Insurance Claim Denial

Even if the insurance company has a valid or lawful reason to deny coverage, you may have options for continuing with your claim. First, you can ask for an internal review of your case within the insurance company. Reply to the insurance company’s denial letter with a written request asking the company to take another look at your claim. You can improve your chances of an internal review succeeding by supplying further evidence to support your claim, such as additional medical records, if the company needs them. Look at the reason listed for the denial and do your best to remedy the situation.

If an internal review does not change the insurance company’s mind, your next option is to request an external review. Contact the Texas Department of Insurance to submit a formal complaint against the insurance company. The department will work with you to contact the insurance company, learn more about the denial and reverse the decision if it finds the insurance company does not have grounds to deny benefits.

Do You Have an Insurance Bad Faith Claim?

It is against the law for an insurance company to treat you unfairly or in bad faith. Unfortunately, this does not stop many insurance companies from intentionally mishandling claims and mistreating claimants. An insurance company may have unfairly or illegally denied your claim to save itself money. If you suspect an insurer of failing to resolve your claim promptly, fairly and reasonably, you may have grounds for a bad-faith insurance claim.

An insurance bad-faith claim alleges that the insurance company did not handle your case as an honest and reasonable insurer would have. It claims that the company wrongfully denied your claim and that you deserve additional compensation for insurance bad faith. If your lawyer succeeds in proving insurance bad faith, the company may owe you more money in penalties on top of paying out your original claim. Speak to an attorney right away if you believe you are the victim of insurance bad faith in Texas.