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5 Reasons Behind an Auto Insurer’s Claim Denial

Wed Jun 30th, 2021 on     Insurance Claims,    

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If you’ve been injured in a car accident and are in the process of submitting a damage claim to your auto insurance company, then you may be concerned that the insurer will deny your claim for some reason or another — this is a reasonable concern.

Most insurers will look for any justification to deny coverage, even if they have to scrape the bottom of the barrel for arguments supporting the denial.  After all, insurers maximize their profit by denying legitimate claims.  When policyholders fail to pursue those claims and resign themselves to the decision-making of the insurer, then the insurer secures a profit that they would otherwise have lost.

Here at Ver Ploeg & Marino, P.A., our team of experienced attorneys has worked with countless policyholders in Miami and throughout the state of Florida, helping them challenge insurance denials and obtain the damages they need to make a full recovery.  Contact us today to schedule a consultation with a Miami insurance claim lawyer at our firm.

For now, let’s briefly explore five reasons that auto insurers use to deny a policyholder’s claim.

Incorrect Insurance Information

Insurers are entitled to deny a claim — even a legitimate one — if the policyholder included incorrect information in their original insurance application (so long as that information is relevant).  This is applicable due to the fact that the insurer could have rejected the application for insurance coverage to begin with, had they known the “correct” information.

For example, suppose that you did not include complete information regarding your auto accident history.  Had the insurer known that you were involved in more accidents, they might not have extended coverage to you — as such, they could use this to deny your claim and argue that your insurance coverage is void.

Excessive Delays

Delaying the submission of your claim for too long, or delaying other aspects related to your claim (i.e., waiting too long to see a physician after a car accident) can be used as a justification for insurance denial.

If you wait too long before securing medical attention, for example, then the insurer may argue that your injuries were exacerbated as a result of the delay.  They may argue that they cannot be held liable for damages that are not directly linked to the accident, and that were caused by you — the policyholder — failing to act with immediacy.

Fraud Concerns

Fraud is a serious concern for insurers, and they have their eyes wide open when evaluating a claim submission.

For example, suppose that you are involved in a serious car accident.  The insurer asks you how fast you were going, and you say that you were traveling at the speed limit (i.e., 50 miles per hour).  As the insurer further investigates the case, however, they obtain video footage showing that you were traveling at 60 miles per hour at the time of the accident — in other words, you were speeding.

Though your speeding was minimal, and though the incorrect information could be due to a memory lapse, your insurer may attempt to paint it as “fraudulent.”  In other words, they may attempt to argue that you are submitting an exaggerated claim to secure damages.

For this reason, it’s critical that you consult with an experienced Miami insurance claim lawyer for guidance.  Your attorney will prevent you from disclosing any information that could be inconsistent with the facts and will ensure that all communications with the insurer are supported by the evidence — that way, the insurer will not have an opportunity to challenge your claim on the basis of fraud.

Insufficient Documentation

Insurers often deny claims based on inadequate or insufficient documentation supporting the claim at issue.

For example, if you are injured in a car accident, then your insurer may expect a complete record of the accident (including police records), medical documentation relating to your injury and treatment (and related injuries in the past), employment records linked to any vocational difficulties that you may be having as a result (i.e., career challenges post-injury, need for time off, etc.), and more.

Many claims are submitted without a comprehensive documentary record in support of the claim.  Insurers deny such claims easily on this basis.  This can delay the processing of your claim and create additional barriers.

One of the responsibilities of an attorney is to help you identify, gather, and submit the necessary documentation.  With the assistance of an attorney, you can ensure that the submission is complete and maximize the likelihood that the insurance company pays out for the claim.

Coverage Exceptions

Every auto insurance plan is different, though there are some common, shared exceptions that tend to be included in most plans.

In any case, where the insurance company believes that an exception applies, they will generally argue in favor of that exception — this is also likely in scenarios where the insurance plan language is “ambiguous.”

For example, suppose that your insurance plan includes an exception for damages caused by an intentional act of the driver.  It may be silent, however, on damages caused by an intentional act that was necessary under the circumstances (i.e., merging into an adjacent lane suddenly and at a dangerous speed in order to avoid an unforeseen road hazard).

The insurer may attempt to argue that the ambiguity should be interpreted in favor of the exception.  In Florida, however, ambiguous language in an insurance contract is interpreted in favor of the policyholder.  This puts you — the policyholder — at a distinct advantage when arguing against an exception to coverage.

Less ambiguous coverage exceptions may seem insurmountable at first glance, but they can also be challenged.  In some cases, a coverage exception may be considered unenforceable by law (for example, due to it being fundamentally unfair).

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