Sponsored Love: Common Tactics Insurance Companies Use To Deny Claims

May 29, 2024

When you file an insurance claim, you expect your insurance company to provide the financial support promised in your policy.

Unfortunately, insurance companies often prioritize their profits over their policyholders, employing various tactics to delay, reduce, or outright deny claims. Understanding these tactics can help you better navigate the claims process and advocate for your rightful compensation. Here are some common strategies insurance companies use to deny claims:

Delaying the Claims Process

One of the most frustrating tactics is intentionally delaying the claims process. Insurance companies might request excessive documentation, repeatedly ask for the same information, or take an unreasonably long time to respond. By dragging out the process, they hope you’ll give up or settle for a lower amount than you deserve.

Asking You to Give a Recorded Statement

Insurance adjusters often request that you provide a recorded statement about the incident. While this may seem like a routine part of the process, it can be a tactic to find inconsistencies in your account or to use your own words against you. They might ask leading questions or try to get you to downplay your injuries.

Remember, you are not legally required to give a recorded statement without consulting with an attorney first. It’s crucial to be cautious and ensure you fully understand your rights before agreeing to any recorded statements.

Asking You Not to Seek Legal Advice

According to the Dallas personal injury attorneys at Mathias Raphael PLLC Accident & Injury Lawyers, insurance companies often aim to settle for the lowest amount possible. Insurance companies might suggest that hiring an attorney will complicate the claims process or reduce your payout.  They may imply that legal representation is unnecessary or that they can settle the claim quickly without the involvement of lawyers.

Disputing Liability

Insurance companies often deny claims by disputing who is at fault. They might argue that their policyholder was not responsible for the accident or that you share a significant portion of the blame. This tactic is particularly common in car accident claims, where fault can significantly impact the settlement amount.

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Downplaying the Severity of Injuries

Another common tactic is to downplay the severity of your injuries. Insurance adjusters may argue that your injuries are pre-existing, not as severe as claimed, or that you did not require the medical treatment you received. They might also question the credibility of your medical providers to undermine your claim.

Misinterpreting Policy Language

Insurance policies are often complex and filled with jargon. Companies might use this to their advantage by misinterpreting or selectively quoting policy language to justify a denial. They might claim that your policy doesn’t cover certain damages or that exclusions apply to your situation, even when that’s not the case.

Offering Lowball Settlements

Insurance companies might offer a quick, lowball settlement soon after you file your claim. While it can be tempting to accept fast cash, these offers are typically much lower than what you’re entitled to. They hope that financial pressure will lead you to accept the insufficient amount rather than pursue the full compensation.

Requesting Unnecessary Information

Adjusters may request extensive documentation that isn’t necessary for processing your claim. This can include asking for unrelated medical records, proof of income beyond what’s needed, or additional statements and forms. These requests can overwhelm and frustrate you, causing delays or discouraging you from pursuing the claim.

Using Surveillance and Social Media

Insurance companies often conduct surveillance to find evidence that contradicts your claim. They may hire private investigators to monitor your activities or scrutinize your social media accounts. Photos, videos, or posts showing you engaging in activities that seem inconsistent with your claimed injuries can be used against you.

Steps to Take to Avoid Issues:

  • Limit Social Media Use: Avoid posting about your activities, health, or the incident that led to your claim. Even seemingly innocent posts can be misinterpreted.
  • Adjust Privacy Settings: Ensure your social media accounts are private and only accessible to trusted friends and family.
  • Be Cautious with Friend Requests: Be wary of accepting friend requests from people you don’t know, as they could be investigators.
  • Monitor Tags and Mentions: Be aware of photos or posts where others tag or mention you, as these can also be scrutinized.
  • Stay Consistent: Ensure your statements and actions are consistent with your claimed injuries and limitations.

Claiming Non-Compliance

Insurance policies require policyholders to comply with specific procedures and deadlines when filing a claim. Insurance companies might deny your claim by alleging that you failed to report the incident promptly, didn’t seek immediate medical attention, or didn’t follow up with the requested information in a timely manner.

Blaming Pre-Existing Conditions

Insurance companies may argue that your injuries are due to pre-existing conditions rather than the incident in question. They might scour your medical history to find any prior injuries or health issues that can be used to attribute your current condition to something other than the covered event.

Engaging in Bad Faith Practices

In some cases, insurance companies act in bad faith, meaning they don’t honor their legal obligations to policyholders. This can include outright denying valid claims without investigation, failing to communicate important information, or using deceptive practices. Bad faith actions are illegal, and policyholders can take legal action against insurers who engage in such behavior.

How to Protect Yourself

Navigating these tactics can be daunting, but there are steps you can take to protect yourself:

  • Document Everything: Keep detailed records of all communications, medical treatments, and expenses related to your claim.
  • Read Your Policy: Understand the terms, conditions, and coverage limits of your insurance policy.
  • Seek Legal Advice: Consult with an attorney who specializes in insurance claims to help you navigate the process and advocate for your rights.
  • Stay Persistent: Don’t be discouraged by delays or denials. Stay persistent and follow up regularly on the status of your claim.

By being aware of these common tactics and taking proactive steps, you can improve your chances of receiving the compensation you deserve. The goal of the insurance company is to minimize payouts, but with knowledge and persistence, you can level the playing field and secure your rightful benefits.

Photo credit: HWM.

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