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Beware These Insurance Claim Denial Tricks

In a perfect world, insurance companies would put their client’s best interests first. In reality, insurers need to make a profit – a goal that sometimes overshadows policyholder needs. If an insurer denies a valid insurance claim the first time, don’t give up. The company may be using one of these tricks to protect itself.

Watch Out for These Claim Processing Red Flags

If your insurer tries any of these tricks, reach out to a personal injury lawyer with experience settling cases against insurance companies to learn more about your insurance rights and legal options:

  1. Requesting a recorded statement. Many adjustors will ask if they can record your conversation for the claim. Never agree to give a recorded statement. The company will scrutinize the recording searching for reasons to downplay or deny your claim. An off-the-cuff remark about feeling a little better today could turn into evidence that you don’t need ongoing medical support after a car accident.
  2. Requesting authorization to look into your medical records. You may need to provide certain medical records to prove your claim, but you never need to authorize an insurance adjustor to peruse your entire medical history. Insurers can and will use a blanket authorization to search for reasons to reduce a settlement amount or deny your claim.
  3. Discouraging you from talking to an attorney. Insurance representatives will often sound like they have your best interests at heart in the beginning. They may encourage you to file the claim with whatever information you have and say there’s no need for an attorney before they deny your claim. You’re the one who decides if you want to talk to an attorney, not your insurer. At a minimum, a free case evaluation can help you understand your right to compensation before an insurer wrongfully denies your claim.
  4. Using your social media presence against you. In today’s digital world, many insurers go online to find reasons to deny claims. They look for pictures, videos, posts, and other information to counteract injury claims and to determine accident liability. If you have a public profile filled with pictures of you smiling at a restaurant after an accident, for example, they may use that post to minimize your injuries and your claim.
  5. Justifying a claim denial because of a “lack of evidence.” Insurers will use many documentation excuses to try to avoid paying a claim. The absence of a police report, particular medical record, or other document provides insurers with all they need to deny your claim. Claimants must understand their rights to avoid providing too much or too little documentation.
  6. Citing the fine print of a policy as grounds for denial. An insurer may go as far as to interpret the text of a policy in such a way that policyholders can’t claim coverage. Deductible requirements, coverage limitations, and exclusions can all serve as grounds for denial. Some fine-print-related denials are legal, while others constitute acts of bad faith. You may need the support of an attorney to determine if your insurer acted legally.

Insurance companies do not always treat claimants unfairly, but the risk of unfair treatment does exist. Claimants must use caution to avoid sneaky settlement-lowering tactics and denial tricks. If any of these red flags arise during the claims process, consider legal representation as a way to hold the insurer accountable.

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