Why Do Insurance Companies Delay or Deny Valid Claims?

You’ve suffered a preventable injury with significant financial consequences, like medical expenses and income loss, and the injury was the direct result of someone else’s actions or carelessness. The insurance company of the at-fault party should cover your financial damages and provide compensation for your pain and suffering, and you’ve filed the claim appropriately. But what happens when the insurance company continually delays, asks for repeated redundant paperwork, or outright denies your valid claim?

Despite their sympathetic tones and heartfelt ads, insurance companies are private businesses with profits as their motives. The job of the insurance adjuster assigned to your case is to protect company profits at your expense and they have effective means of doing so. Some of the most common reasons insurance companies delay or deny claims are listed below.

You Waited Too Long to Get Medical Care

This is one of the most common reasons that insurers deny valid claims. Even if you did suffer a debilitating back injury due to another party’s actions, if you went home after the fall or car accident and hoped your stiffness would improve, but instead it worsened and you sought medical treatment three days later, the insurance company can deny your claim due to lack of evidence that your injury was caused by the car accident or fall.

After any significant trauma, it’s always best to seek immediate medical treatment straight from the scene of the accident, have a thorough evaluation to detect injuries with delayed symptom onset, and ask for a comprehensive medical report. This not only ensures you receive treatment but also provides evidence that your injury occurred due to the act of negligence or wrongdoing as you state in the insurance claim.

The Insurance Policy Was Not In Effect At the Time of Your Accident

Once you make a claim against an at-fault party’s insurance policy, the insurance adjuster carefully scrutinizes the terms of the policy. They may discover the client’s insurance has lapsed, or the coverage wasn’t in place when the accident occurred. For instance, if a store owner opened a second store and failed to update their policy, or if the policy excludes coverage for the type of damages you experienced.

The Insurance Company Assigns You a High Percentage of Fault for the Accident

In fault-based insurance states with comparative negligence systems, an insurance company could significantly reduce or deny a claim completely by claiming you were to blame for the injury. For instance, if you fell in a convenience store because the entryway was very wet, but you were wearing flip-flops, the insurance company could claim that your inadequate footwear on a rainy day caused the accident. If they find you 75% at fault for the accident, it reduces a $100,000 payout for serious injuries to only $25,000.

The Insurance Company Asserts That Your Symptoms Are From a Pre-Existing Condition

Insurance companies commonly ask injury victims to sign a medical authorization so they can review the medical report of the injury. Unfortunately, many people do not realize that they are signing a blanket authorization allowing the insurance adjuster access to their entire medical history. If they find a previous injury or pre-existing condition, they could dispute the claim on the grounds that the pre-existing condition is the true cause of your symptoms.

Delaying Your Claim Works in The Insurance Company’s Favor

When an insurance adjuster cannot find valid reasons to dispute or deny your claim, they may resort to common delaying tactics, such as failing to return phone calls, making excuses for postponing action on your claim or asking for repeated paperwork. This works in their favor in several ways. By repeatedly delaying action they hope you’ll accept a low-ball settlement offer when they finally make one. The offer may be far less than the full value of your claim, but by wearing you down, you’re more likely to accept any settlement they offer. Also, each month they delay making a payout on the claim, they continue to earn interest on the funds while they are still in the company’s account.

You Don’t Have Skilled Legal Representation

When an injury victim hires an experienced St. Louis injury lawyer, the attorney protects the client’s rights and best interests. They understand the common tactics insurers use and safeguard clients against them. When an insurance adjuster knows you have an attorney, they are far less likely to deny, delay, or undervalue your claim.