Why Do Insurance Companies Deny Claims?
The health insurance industry rocketed to nearly $ 1 trillion in revenue in 2019, with more than $ 3.5 billion in profits. While some describe this as the ” golden age ” of insurance, the reality is not so golden because these staggering numbers come at the expense of consumers. People are paying higher premiums and receiving lower payments on their claims so insurers can meet these milestones and margins. yes. France, insurance companies do not hide the fact that they are working to take advantage of your customers.
After a serious accident, you have bills to pay, injuries to heal, and rising medical costs for your treatment, prescriptions, and care. If your injuries have occurred as a result of a car accident, you probably have auto repairs and property damage repairs to worry about as well. Time spent in the hospital, visiting doctors, or taking care of repairs can mean lost work and lost wages. You deserve fair and full compensation.
You can file a complaint if you believe your claim was unfairly or illegally denied. One of the best ways to approach this situation. However, it is with the help of an experienced and qualified personal injury attorney. Whether you are just beginning the claim process, roadblocked, or have already been denied, a personal injury attorney can help advise you of your options and even potentially rectify the situation. With a free, risk-free consultation from Thompson Law, what do you have to lose?
Top Reasons Your Insurance Claim Is Denied
Although the reasons for an insurance claim denial vary widely, they have one important thing in common: they are all motivated by the insurance companies’ drive to avoid paying your fair settlement. They make money by withholding as much of your payment as possible.
Insurance agents even earn bonuses and performance rewards for their success in denying and minimizing claims.
Here are 10 of the top reasons health insurance and/or auto insurance claims are denied:
- Previous injuries or surgeries: If insurance companies have access to older medical records and discover a record of previous injuries or surgeries, they may try to link these steps. t events to your current health status. This may be a tactic to sideline or deny the fact that the accident for which you have filed your claim is the cause of your current injury. It is very important not to sign authorizations for insurers to see your medical records. If you have questions about forms they are giving you or are not sure why your insurer needs the information she is requesting – trust her instincts. Contact your Thompson Law injury attorney for advice on how to proceed before you sign.
- Pre-existing conditions: Insurers are very likely to deny claims that they say are related to your state of health before the accident. Similar to the above-mentioned prior injuries or surgeries, though even broader in scope, pre-existing conditions include my past illnesses or other genetic health factors that may make me susceptible to injury.
- Time-lapse between accident and seeking treatment: If you don’t seek medical care promptly after your accident, insurers will likely deny your claim, arguing that you were injured from something else, not the accident. This is frustrating as injuries sustained in an accident can have a delayed onset, once the adrenaline is in the accident, it has already worn off. Or they can get worse over time with other injuries. First of all, it is important to take care of your health by seeking medical treatment immediately. But it is also essential to the expediency of your claim that your injury is validated and diagnosed by a medical authority promptly.
- State law violation: Insurance companies will attempt to deny your claim if you were driving illegally at the time of the accident. For example, if you were driving under the influence of drugs or alcohol, driving without a valid license, driving without valid insurance, driving in a place where you were trespassing, or engaging in other behavior that may have made the accident avoidable, the insurer You can deny for these reasons. Overcoming these denials is tricky because it involves discussions about intent. It Helps to Have an Excellent Dallas Personal Injury lawyer representing you and fighting for you when these types of arguments are at stake.
- Policy limits: When you buy auto insurance, you select coverage levels and policy limits to build a comprehensive policy. If an accident exceeds these limits, there is not much else you can do. To recover more funds, you will need to sue the guilty parties directly. This policy limits issue can be quite significant in Texas, which has a 30/60/25 minimum coverage requirement. This means $30,000 for each
- person, $60,000 per accident, and $25,000 for property damage. The average cost of a new car in 2019 was more than $36,000so totaling just one car in a crash with a minimum ally insured driver can mean that the policy limits are maxed out on property damage to one car alone.
- Non-Covered Charges: Non-Covered Charges denial is Similar to a policy limits denial, in that the claim goes beyond the scope of your policy. Rather than the claim exceeding your policy limit, however, the claim is for a type of coverage that you don’t have at all. Claims for non-covered charges will be denied. For example, if you file a Personal Injury Protection (PIP) claim to pay but you don’t have PIP on your policy (it can be waived in Texas) you will be denied. With health insurance, certain cosmetic or elective surgeries are often excluded from benefits packages, so if part of your injury treatment was deemed cosmetic, it could be an excuse the insurer uses to deny you. life insurance