Insurers Deny Applications Based On Claim History

Auto insurers can deny an application based on claim history, and there are several reasons why this might happen. Firstly, if your claim exceeds your coverage limits, or you have already exhausted your coverage limits for the policy term, your application may be denied. Additionally, if you are filing a claim for coverage that you did not purchase, such as repairs without collision or comprehensive coverage, your application could be denied. Another reason for denial is violation of state law, including driving without a valid license or insurance, or driving under the influence. Furthermore, insurers may deny your application if you did not report the accident immediately or seek medical attention promptly, casting doubt on the legitimacy of your claim. It is also possible for your application to be denied due to misrepresented information or errors in your original application form.

Pre-existing conditions

Insurers are likely to deny claims if they argue that your health status before an accident contributed to the claim you are making. This could include prior injuries or surgeries, as well as illnesses you have suffered or other genetic health factors that may make you more susceptible to injury. For example, if you have a pre-existing back injury and are involved in a car accident, the insurer may argue that your claim for back injuries caused by the accident is invalidated by your previous condition.

In these cases, insurance companies may try to access your older medical records to establish a link between your current claim and past health issues. It is important to note that you are not obliged to sign authorizations for insurers to see your medical history. If you are unsure about what information insurers need, it is recommended that you seek legal advice before signing anything.

To avoid issues with pre-existing conditions, it is advisable to be upfront with your insurance company about any previous health issues. While this may seem counterintuitive, being transparent can help to avoid issues with claim denials later on.

If you feel that your claim has been unfairly denied due to a pre-existing condition, you can challenge the insurance company's decision. This is best done with the help of a qualified personal injury attorney, who can advise you on your options and potentially rectify the situation. They can help you gather evidence and build a strong case to support your claim.

Lapse in time between accident and treatment

A lapse in time between an accident and treatment is one of the top reasons that auto insurers deny claims. If you do not seek medical treatment promptly after an accident, an insurer is likely to deny your claim, arguing that another cause, not the accident, led to your injury. This is especially frustrating as injuries sustained in an accident can have a delayed onset, once the initial adrenaline has worn off.

It is important to seek medical treatment as soon as possible after an accident, not only to aid your recovery but also to strengthen your claim. A medical professional can validate and diagnose your injury, providing evidence that it was caused by the accident. This can be crucial in proving that your injury is not the result of another cause, as the insurer may argue.

In some cases, injuries sustained in an accident can compound over time with other injuries, or their symptoms may not be felt immediately. For this reason, it is important to seek medical attention even if you do not initially feel injured. A medical professional can assess your condition and provide treatment or advice as needed.

Additionally, it is important to document your injuries and medical expenses meticulously. Share this information with your attorney, who can use these records to demonstrate the financial burden you have endured as a result of the accident. This can be crucial in negotiating a settlement or award that adequately compensates you for your losses.

To avoid a denied claim, it is also essential to notify your insurer of the accident as soon as possible. Policies typically dictate how soon an accident must be reported for it to be covered. By notifying your insurer promptly, you can reduce the likelihood of your claim being denied on the basis of a lapse in time.

Violation of state law

Auto insurance companies can deny your claim if you were driving illegally at the time of the accident. This includes driving under the influence of drugs or alcohol, driving without a valid license, driving without valid insurance, trespassing, or other behaviours that may have made the accident avoidable.

Insurance companies will also deny your claim if you were in violation of state law in other ways, such as:

• Driving without a valid license: Driving without a valid license is illegal in most states and will result in your insurance claim being denied.
• Driving without insurance: Driving without the minimum required insurance is illegal in most states and will result in your insurance claim being denied.
• Driving under the influence: Driving under the influence of drugs or alcohol is illegal and will result in your insurance claim being denied.
• Trespassing: If you were trespassing at the time of the accident, your insurance claim will likely be denied.

It's important to note that getting past these denials can be challenging as it involves arguments around intent. Consulting a qualified attorney who specialises in personal injury or insurance law is recommended to help you navigate these complex issues and protect your rights.

Policy limits

Insurance policies include various types of coverage limits, such as property damage liability, bodily injury liability, and personal property caps. It is crucial to select the right limits to balance potential risks against personal assets and financial capacity. For example, maintaining sufficient coverage limits for bodily injury liability can shield you from the burden of exorbitant medical expenses resulting from lawsuits.

When selecting the right limits for your auto insurance policy, you need to weigh the prospective costs of an accident against your personal savings, assets, and state legal restrictions. While higher auto insurance coverage limits may result in higher premiums, insufficient insurance could leave you with hefty out-of-pocket costs post-accident.

Most states have minimum auto insurance requirements, including specific amounts for bodily injuries per person, per accident, and property damage. However, these state-mandated minimums may not be sufficient to cover all damages in a serious accident. Therefore, it is recommended to have higher liability coverage limits than the state minimums.

Non-covered charges

Another example is if you have medical insurance and require treatment that is considered cosmetic or elective surgery. In this case, the insurance company may deny the claim as these types of procedures are often excluded from benefits packages.

It's important to carefully review your insurance policy to understand the types of coverage included and any exclusions or limitations. This can help you avoid unexpected claim denials due to non-covered charges.

Additionally, it's worth noting that non-covered charges are different from policy limit denials. Policy limit denials occur when a claim exceeds the monetary limits of your policy, whereas non-covered charges refer to specific types of coverage that are not included in your policy.

Frequently asked questions