Being in an accident can be scary. Your world may flash before you in the blink of an eye. What happens when the insurance company does not accept your claim or attempts to deny you the compensation you deserve? 

You likely have many unanswered questions. A dedicated personal injury attorney at The Pendergrass Law Firm is here to inform you of your options and protect you from profit-driven insurance adjusters. 

Why Do Insurance Companies Deny Claims?

When you are involved in a severe car accident or incident in Georgia, someone else may be partially to blame for your injuries. You are looking at personal property damages and out of pocket costs. 

In addition, there are a bunch of medical bills and a loss of income due to the severity of injuries you encountered. Getting compensation from the at-fault party’s insurance company should not feel like you are jumping through hoops. However, sometimes you are met with an army of questions.

Insurance companies would prefer if they did not end up being on the hook for paying your money. So they will pull out all the tricks and gimmicks to keep their money or limit the amount they must pay. Many companies will even outright deny your seemingly legitimate claim.

Understanding why insurance companies deny insurance claims is important in combating their tactics. This understanding can be helpful for you in getting your deserved payout. If more assistance is needed, contact a personal injury lawyer at our firm for help. 

Problems With Coverage on an Insurance Policy

Insurance companies will comb through the insurance policy person who caused your incident with a fine tooth comb. An insurance company will often deny a claim if there is any evidence of an issue within the policy in discussion. Here are some examples of problems the insurer will look for:

Certain Driver Exclusions

An insurance policy must cover all vehicles registered in Georgia. However, just because you have a valid policy for your car does not mean that everyone in the vehicle will be covered.

Driver exclusion clauses are often included in policies. These clauses mean a legitimate policy exists, but only some drivers are covered. For example, an insurer might not accept any claim for injuries caused by a driver not associated with that policy.

The Coverage Has Lapsed

Lapsed coverage is a common reason for insurance companies to deny a claim. However, insurance coverage may lapse for different reasons: the insurer canceling the policy, the company no longer existing, or failure to pay premiums on time. Regardless of the reasoning, only valid and up-to-date insurance policy claims will be approved.

There Is Insufficient Coverage

Insurance companies will only pay if a valid insurance policy exists. For instance, you are involved in a slip-and-fall in a local family-owned store, and you end up breaking a few bones. You contact the insurer of the store, which gives you the insurance for the store. 

However, when you call the insurance company, they need a record of a policy for the store. The owner recently changed locations and failed to change his insurance policy properly. Since the policy was never changed over, there is no valid coverage. With a good policy, the insurance company can accept the claim.

Alternatively, the liable party might have only purchased the minimum amount of auto insurance coverage under Georgia law. This means if your damages are greater than this limit, you will have excess damages. 

The coverage excludes the damage sustained

The cause of your injuries is critical to the insurer when looking into a claim. All insurance policies list things that do not fall under coverage. The insurer will look for any policy exclusion that your claim falls under to gain reasoning to deny the claim. Damage caused by storms and acts of vandalism is the perfect example of policy exclusions.

What Are Bad Faith Insurance Practices?

Insurance coverage ensures injured victims have resources available following an accident. However, this will only be effective if insurers and policyholders follow the rules. 

A company has a legal obligation to honestly consider any claim submitted if a policyholder makes timely payments. Insurers do not play by the rules and deny claims without cause. This is called a bad faith claim. Bad faith practices are unfair verdicts that usually go against the facts presented.

Photo of Hand Injured Person Using Laptop

Claims Denied Without Proper Investigation

When considering an insurance claim for benefits, insurance adjusters must properly research the case. This due diligence will entail a dive into relevant circumstances related to the lawsuit. 

So how do you detect if you have been denied without proper investigations into your case? First, stay in the loop concerning your case. If you are refused, ensure the insurer gives you the reasoning for being denied. It is a major red flag to be denied a claim by an insurer without clear justification and reason for the denied request.

Failure to File a Claim on Time

It would help if you were quick to act when you contact an insurance company immediately after your personal injury accident. You will only have a little time. A strict limit on the total time you have to file a personal injury claim is set by the insurance company. In most situations, you must submit your claim within a “reasonable” time after your accident.

The definition of what is reasonable will differ. Some companies have a meaning for it, but not all do. If you are late in filling out your claim, then you run the risk of having that claim rejected. That is another example of a bad-faith tactic used to stop your claim from being accepted.

You Do Not Have a Personal Injury Lawyer to Represent You

Be prepared to be taken advantage of by insurance companies. Any attorney that does not represent you will try to gain the upper hand. They will take advantage of your lack of knowledge of your legal rights while using that as a weapon. 

Tactics like the ones described above are scare tactics designed to bury you with financial pressure in an attempt to make you buckle. This is their attempt to pressure you into accepting the first lowball offer you are given. However, there are ways to make sure your claim is handled with the attention it deserves by hiring a dedicated personal injury attorney to handle your claim.

Liability and Fault Disputes

Insurance companies will search for any reason to deny a personal injury claim. However, there are times when the denial has nothing to do with coverage but rather with the accident’s circumstances.

Cause of the Injury Contested

It’s essential to provide the insurance company with substantial proof that your injuries result from your incident. You will be refused your request for compensation if you do not have enough evidence to back the claims.

You may have the insurer try denying the claim because they find your injuries were from a prior accident or that negligence in your conduct worsened the injuries. So, be sure the evidence that emerged from  your accident is provided as proof.

The Extent of Your Injuries Is Disputed

The claim can potentially be called into question. the company may say that you are exaggerating the claim. In the insurer’s opinion, this is not the type of injury typically resulting from the type of accident you sustained.

Providing detailed information, including medical reports and evaluations, are vital to support your demand for compensation. In addition, it’s essential to provide clear and direct evidence to establish that all your injuries resulted from the accident.

Lack of Evidence to Establish Fault

The finger tends to get pointed in situations such as these. An insurer will question the amount of blame that you are responsible for. Clear evidence that their policyholder is to blame for your injuries is necessary for the insurer to agree to pay. With any indication that you are at fault, the insurer will deny your claim.

Claims may also be denied if evidence shows the policyholder isn’t entirely to blame for an accident. In Georgia, anyone who contributes to an accident can be held responsible for resulting injuries. Therefore, insurance companies will carefully investigate your accident to determine if you or anyone else contributed. If there’s evidence to show that more than one person is to blame, an insurer will likely reject your claim for benefits. A personal injury lawyer may be able to get you what you are entitled to.

Photo of Man with Broken Arm

How to Appeal an Insurance Company Decision

The insurance company must provide you with a reason for the denial of your claim. They also need to give you information on how to appeal the decision. 

You have the right to appeal any refusal of payment by your health insurer if they deny your claim. You also can have a third party review the decision in your appeal. Finally, you may request that the insurance company reverse its decision.  

Meet With a Personal Injury Lawyer at The Pendergrass Law Firm for Help Today

Getting the run-around can be frustrating when you are looking for answers. Do not be intimidated by being denied for your claim. Contact us, and let us see what we can do for you.

We will work with you to combat the decision made by the insurance company. Contact a reputable personal injury attorney at The Pendergrass Law Firm today. Schedule your free, no-obligation consultation when you call our office or fill out our quick contact form

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