Why Do Valid Insurance Claims Get Denied?

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There’s nothing more frustrating than having a valid insurance claim denied. Whether you’re dealing with car insurance, homeowners’ insurance, life insurance, or health insurance, getting denied means paying bills you shouldn’t have to pay – if you can pay them at all.

Why do insurance claims get denied? Is there any way to fight a denial?

There are several reasons insurance companies deny insurance claims:

  • Incomplete paperwork

  • Incomplete submitted evidence

  • Your claim exceeds your coverage limits

  • You don’t have the coverage you’re filing a claim for

  • You didn’t seek medical treatment fast enough

  • You have a pre-existing condition or existing injury the insurance company believes caused your injury

  • There’s a stipulation you’re unaware of that makes your claim invalid

  • You aren’t represented by a lawyer and the insurance company hopes you won’t appeal

Although insurance claims get denied for a variety of valid and invalid reasons, the good news is you can fight a denial with the help of a good lawyer.

While you can appeal your denial directly through your insurance company, call a lawyer first – appealing through your insurance company might not be your best option.

Hiring a lawyer is ideal for several reasons:

  • Attorneys are expert negotiators. Negotiating with an insurance claims adjuster isn’t easy. Their goal is to pay out as little as possible. You’ll have to negotiate hard to win tiny payouts.

  • Lawyers know exactly how to get insurance companies to pay out. Persuasive skills aren’t enough to get an insurance company to pay your valid claim – you need to know the law or the adjuster might take advantage of you. When speaking with a lawyer, claims adjusters know they can’t get away with lying, cheating, or misrepresenting state law.

  • You can get a higher settlement amount with a lawyer. All insurance claims have a payout limit regardless of whether that amount is enough to cover your expenses. Hiring a lawyer is the only way to get enough compensation to ensure you can pay your bills.

  • Attorneys can discern when a claim is valid. While many valid claims are denied, it’s possible that your claim was denied for a good reason. An experienced attorney can look at your claim to discern its validity. If it’s valid, your attorney will make sure you get compensated.

  • Lawyers help their clients get paid faster. Insurance companies drag their feet with payouts. Lawyers speed up the payout process.

If your insurance claim has been denied, you need a lawyer

Your insurance company will likely give you the opportunity to appeal your denial. Appealing sounds like an opportunity to get your insurance company to take your claim seriously. Maybe there was a misunderstanding or they rushed their decision. Maybe if you present better evidence and state your case more clearly, the adjuster will change their mind.

The truth is, insurance companies are for-profit corporations and don’t have your best interests in mind. Denials are often carefully calculated based on what the insurance company thinks they can get away with. If you were denied a valid claim, your appeal is likely to be denied as well. The only way to make sure you get compensated is by hiring an attorney.

Report valid claim denials to the appropriate organization

Regardless of whether you pursue a claim denial through a lawyer, make sure to report your denial to the appropriate Consumer Affairs organization. For example, the Consumer Affairs Division of Nebraska gives Omaha, NE claimants the opportunity to hold insurance companies accountable for unfairly denying claims.

Filing a complaint won’t help you get paid and it won’t influence the outcome of finding fault. However, Consumer Affairs will help you understand why your claim was denied and/or if your claim was unfairly denied. Another reason to file a complaint is that accumulated complaints against an unethical company will raise a red flag to investigate whether an insurance company is complying with state law.

Don’t appeal through your insurance company – hire a lawyer for a higher payout

Working with an attorney will get you a higher payout for your denied insurance claim.

No matter how good your negotiation skills are, you don’t stand a chance against an insurance company determined to prevent you from receiving compensation. Even if you do manage to negotiate a payout with a claims adjuster, the amount of compensation you’ll receive will be limited.

Insurance claims adjusters are given a top dollar value for each claim and are not allowed to offer a settlement amount beyond that limit. You can bet that their first offer will be much lower than the maximum value of your claim.

Insurance adjusters rarely pay out top dollar; you have to be an exceptionally skilled negotiator to even get close to that amount. It’s a losing situation from the start. You’ll have to fight tooth and nail to get a portion of the payout you should have initially received and the stress will hinder your healing process if you’ve been injured.

How can a lawyer near me help me get compensated?

To get compensated for your denied insurance claim, contact a lawyer in your area to request a free consultation to discuss your claim. You only have a certain period of time to appeal a denied claim, so make sure you pursue a consultation as quickly as possible. The sooner you contact a lawyer, the sooner you’ll get compensated and can move forward with your life.