What are the Top Reasons for Insurance Denials?

If you or somebody you care about sustains an injury or property damage due to the careless or negligent actions of another individual, then you rightfully expect to recover compensation. However, what happens if the insurance carrier for the at-fault party denies your claim? There are various reasons why insurance carriers deny claims in California, and we want to discuss those here with you today. However, do not take an insurance claim denial to mean that you will not recover compensation at all. We strongly encourage you to contact a skilled personal injury lawyer who can help you throughout the entirety of your case.

• Failure to Receive Medical Treatment

If an individual is seeking compensation for an injury through an insurance settlement, they will have to have proper documentation showing that the injury has occurred. If an individual has failed to seek medical treatment for the injury, the insurance carrier will very likely deny reclaim. Insurance carriers have to see proof that you have sustained an injury and that the injuries arose in the way that you say they did.

It is imperative for any person who sustains an injury caused by the negligence of someone else to seek medical care immediately. Injury victims should request copies of all relevant medical records and submit them to the insurance carrier. Never sign a blanket medical authorization form presented by the insurance carrier because this will allow them to dig into all of your medical histories.

• Injuries From Pre-Existing Condition

Insurance carriers commonly use pre-existing injuries as a reason to deny current injury claims. One of the reasons that insurance carriers ask for medical authorization is so they can look at your medical history to find a pre-existing injury that could explain your current symptoms. We do want you to be aware that the existence of a pre-existing injury does not absolve the at-fault party and their insurance carrier of liability for the situation. However, the existence of pre-existing conditions can make a claim more challenging.

• Failing to File a Claim Before the Deadline

It is crucial that you file an insurance claim as soon as possible after an accident occurs in California. In fact, you agree to file a claim promptly after an injury occurs when you sign any type of insurance contract. Most insurance carriers have very tight deadlines, typically within a day or two after the accident occurs. If you fail to meet this deadline, the insurance carrier may very well deny the claim.

• Fault is in Dispute

If an insurance carrier disputes fault for the incident, this could certainly be a reason for them to deny the claim. However, an insurance carrier will likely conduct an extensive investigation into the incident to determine liability. It could be the case that multiple parties share liability, but even in this circumstance, there should not be an outright denial. California operates under a “pure comparative negligence” system for most injury claims, which means injury victims can recover compensation even if they are up to 99% at fault for the incident. However, the total amount of compensation they receive will be reduced based on their percentage of fault. 

• Bad Faith Insurance Denials

Insurance carriers have a duty to uphold their end of the insurance contract. Even though there are certainly legitimate reasons that insurance carriers deny claims, there are also times when insurance carriers wrongfully deny a claim. This could be a case of insurance bad faith practices. If an insurance carrier acts in bad faith, it may be possible to hold them accountable for their actions.