Top Reasons for AL Insurance Claim Denials (And What You Can Do About Them)

Posted in Uncategorized on May 22, 2017.

Being involved in an accident is stressful, to say the least. You may still be recovering from your injuries while your medical bills mount. Perhaps your injuries keep you from maintaining your livelihood, so you’re also facing lost wages. Accidents take both a physical and emotional toll, so it can be frustrating when you receive a claim denial from your insurance company.

There are a few common reasons why your insurance claim may be denied after an accident – let’s take a look at them, and your legal options moving forward.

  1. Shared Fault, or an Avoidable Accident

Insurance companies have become masters at avoiding payouts. It doesn’t matter that you faithfully pay your premiums in full and on time. Like any other business, insurance companies are intent on maximizing their profits, which means paying out as few claims as possible.

For this reason, you may get a claim denial letter that says your accident was “avoidable.” Generally, this means that your insurer believes you were doing something at the time that led to the accident. This holds especially true if you did something that would make your policy ineffective, such as driving under the influence or letting someone who didn’t have a license drive your car.

Sometimes, insurance companies may deny a claim because they believe you shared fault for an accident. In other words, the other driver may have done something to cause the accident, but so did you. For example, a distracted driver may have drifted out of their lane and hit you, but you were speeding, so you technically “share fault” for the accident.

  1. There Was No Claim of Injury After the Accident

If you’ve been injured in a car accident, it’s essential to receive treatment for your injuries right away. If you don’t, an insurance company may say your injuries weren’t connected to the accident, let alone a result of one. If you seek immediate treatment, you have a much stronger case, minimizing the chances of a claim denial.

Related: What to Do Immediately After an Accident?

Unfortunately, many people do try to game the system and get a payout. On the other hand, some injuries may not fully manifest until after the adrenaline of the accident has worn off. That’s why we recommend seeing a medical professional as soon as possible.

  1. You Have a Pre-Existing Condition

Lastly, your insurance company may issue a claim denial if you have a pre-existing condition, arguing that it’s this condition that caused your pain and injuries, not an accident. If your accident made your symptoms worse, you may be able to get compensation, but it’s hard for insurance companies to sort out what resulted from the accident and what was pre-existing.

What Are Your Legal Options?

So, what can you do if you receive one of these (or any other) claim denials? First, request an explanation of the denial in writing. Insurance companies are required to provide you with this information. Once you have a detailed explanation, ask about the appeals process.

If you feel none of their explanations apply, it may be a case of insurance bad faith. In other words, your insurer is not living up to its end of the agreement, nor is it fulfilling its obligation to fairly close your case. If you suspect you’re the victim of insurance bad faith, retaining the services of an attorney will be one of the most valuable things you can do. Sometimes, the simple act of hiring counsel is enough to persuade an insurance company that a payout is the right thing to do.

An attorney will help represent your interests during the appeals process and ensure you’re getting the insurance payout you deserve. Fighting a claim denial isn’t easy, but it’s possible with a proactive approach – especially with an experienced attorney by your side.