What Could a Denied Claim Mean?

While insurance companies claim to exist to serve their customers, they are ultimately businesses—not charities. Like any business, their existence depends on receiving more money than they disburse, so adjusters are instructed to be very particular about which insurance claims they honor.

To balance out this tension between profitability and policy fulfillment, insurance companies are legally bound to “act in good faith” with you. That means any claim must be acknowledged and start the investigation process within 15 days of filing. On the 15th day, you must receive notice of rejection or acceptance.

Finally, rejected claims are legally required to come with an explanation. If you’ve had your claim rejected, you should have received your notice of the reason why. While it may feel unfair (and many times often is), there are plenty of legal reasons why your insurance company may have denied your claim.

If your claim was rejected on the following grounds, your options may be limited, though you may be able to file an appeal. However, if you feel that your claim was still rejected unjustly, give our attorneys a call. We’re more than happy to help you figure out your injuries and get the support you need.

If Your Claim Was Filed Late

One of those reasons may be that you did not file your claim on time. Time limits will differ for different claim types. An auto insurance claim will differ from a workers' compensation claim, and so on. It is always best to file your claim as soon as possible after an accident or other damages.

If you are unsure how long you have to file, then contact your insurance company in order to find out. A denied claim may simply mean that you did not file within the time limits. There may be exceptions that grant you some flexibility, but it’s better not to take a chance when you’ve been injured.

If Your Claim Was Not Valid

Note, this is not the same as lacking a valid reason for seeking recovery. Your accident injuries are valid and are still perhaps entitled to compensation and financial support.

However, insurance adjusters will find myriad reasons for why they aren’t obligated to fulfill a policy. For example, if you are attempting to file a workers' compensation claim because of an accident that took place at work, your claim may be denied on the basis that your injuries did not take place in relation to performing your job duties—no matter how severe your damages.

In some cases, people are denied support because the insurance company believes your injuries were caused in an earlier incident or are not related to the accident you’re claiming. For instance, if you file a claim for the damage a car accident caused to your knee, the adjuster may claim that knee surgery years earlier is the cause.

One related denial justification is that you lack the necessary documents to justify a claim—a perfect illustration of why filing with an injury lawyer could help speed up your process.

If Your Monthly Premiums Are Unpaid

Insurance companies are only obligated to honor the contracts that are not lapsed. Adjusters may deny your claim if they do not have record of payments from you. This is why it is incredibly important to keep all receipts and transactions on file, so that you can easily prove that you made a payment if it is called into question.

If you do not fall into any of the above categories, then you may have cause for an appeal—or a case against your insurance for bad faith.

How an Injury Lawyer Can Help

Injury lawyers spend almost their entire careers fighting against insurance companies. We know their tactics, their loopholes, and what makes them nervous. If you’ve been hurt by another’s negligence, an injury lawyer can do more than prepare your case for court—they can represent you while dealing with your insurance adjuster.

For instance, we can ensure that your insurance company only has access to your relevant medical records, not your entire medical history. We can make sure there no loopholes on your end regarding your claim, and most importantly, we can fight for the settlement you deserve.

Strategy Tip: Having a trial lawyer on your side provides a little leverage—the insurance company knows that if they walk away from your lawyer’s settlement offer, they’re facing costly litigation. It makes them that much more willing to pay the settlement amount you are actually entitled to.

With severe injuries, facing a denied claim can be both terrifying and frustrating. No one wants to feel like they’re freefalling without a safety net. However, if your claim was denied, you can still have a lawyer determine if legal action would benefit you. If your injuries are affecting your quality of life, talk to an attorney.

If that’s you, give Arnold & Itkin a call. We’ve been protecting the injured for a while, and we’ve secured over $1 billion in the last 5 years alone for our clients. Let’s see if we can help you figure this out.

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