Methods Insurers Use to Wrongfully Deny Claims

Insurers may use several tactics to deny a claim. In many cases, claimants and policyholders accept a denial due to the assumption that the insurer is right in denying the claim and do not try to appeal the decision.

Indications of an Improper Denial Letter

There are, however, some indications that a denial is improper. The personal injury attorney may review a claim in order to detect a wrongful denial. Following are some key indications of a wrongful claim

  • At the time that the claim is denied, the insurer makes the claim that the policyholder intentionally made misrepresentations on the insurance application.
  • The insurer tries to retroactively end the policyholder’s coverage.
  • The insurer does not meet with the policyholder prior to the denial and then places unnecessary or irrelevant requests for information in the policyholder’s file.
  • The insurer asks for additional information related to the claim – even though it is being denied. The request may be a ‘fishing expedition’ to gather information to use against the claimant or policyholder at a later time.
  • Following the denial, the insurer might try to reserve the right to assert more policy defenses.
  • The insurer mentions conditions or policy exclusions that are irrelevant to the claim within the denial.
  • The insurer does not support the denial with facts related to the claim. This might be an indication that the insurer did not perform an investigation before the denial.
  • The insurer either refuses or fails to provide the claimant with copies of the policy under which it is making the denial.
  • In the denial, the insurer does not make reference to particular provisions in the policy.

Your personal injury lawyer may be able to examine a denial to determine whether it was improper. Additionally, a lawyer may overturn a denial on appeal or through litigation – once the appeals process has been exhausted.

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