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What Are the Top Reasons for Insurance Denials?

Posted in Car Accidents on March 29, 2021

If you were injured in an accident in Dallas, Texas, you may not expect to encounter any problems during the insurance claims process. Unfortunately, most insurance companies wish to undervalue your claim or deny benefits altogether. This can lead to an insurance company denying your claim for a variety of different reasons – some valid, others not.

Top Reasons for Insurance Denials

Broken Rules or Requirements

Insurance companies have strict rules when it comes to filing claims. For a valid claim in Texas, you must obey the insurance company’s filing requirements. A common mistake is missing the deadline to file. Most insurance companies require claimants to report their accidents as soon as possible. Some place specific deadlines on filing, such as 72 hours after an accident. If you wait too long to file or skip another required step, this may provide a reason for the insurance company to deny coverage.

Liability Dispute

If the insurance company that receives your claim does not believe its policyholder is responsible for your accident, it may give this as the reason for the insurance denial. In your initial settlement demand letter, you must explain why you believe the insurance company is liable for your damages, including any relevant personal injury statutes. If you fail to do this, the insurance company may initially deny your claim by refuting liability. It is up to you or your attorney to respond with an explanation of why you believe the insurer is liable.

Comparative Fault

Part of a liability dispute may be the insurance company arguing that you caused or contributed to your own injuries. This is the defense of comparative negligence. In Texas, comparative negligence does not fully bar you from financial recovery. Even if the insurance company has proof you contributed to the accident, you could still recover partial compensation. The insurance company may have the right, however, to reduce your recovery by your percentage of fault.

Failure to Receive Medical Care

It is very important to receive medical care immediately after an accident in Dallas. If you wait to go to the hospital, an insurance company may state that you failed to mitigate your losses and base a denial of benefits on this fact. Failing to see a doctor will also result in no officially diagnosed injury. Be sure to fully list all of your symptoms to your doctor, including any pain and suffering you are experiencing. Your medical records must indicate your losses clearly to be eligible for insurance coverage.

Pre-Existing Injuries

Insurance companies often use pre-existing injuries to try to avoid paying clients. However, a pre-existing injury alone should not bar you from insurance coverage in Texas. Insurance companies must take plaintiffs as they are at the time of their accidents – even if this means with pre-existing injuries or health conditions. If an insurance company gains access to your full medical records in tries to deny your claim based on a pre-existing injury alone, a lawyer can help you argue your eligibility for benefits.

Insurance Bad Faith

Some insurance denials do not come with a reason. These are wrongful denials, as insurance companies have a legal obligation to explain why they reject claims. Your lawyer can help you contact an insurance company to request a reason for the denial.

If the insurance company gives a reason that does not apply to your case, this could be evidence of insurance bad faith. Bad faith is an insurer intentionally mishandling your claim. If you are the victim of insurance bad faith, a lawyer can represent you during a lawsuit against the insurance company itself.

If an insurance company recently denied your personal injury claim, consult with an attorney in Dallas for legal advice. An attorney can review your case and let you know if you are the victim of wrongful insurance denial. If so, your attorney can help you take action to appeal the denial.