8 Possible Reasons Your Insurance Claim Got Denied

insurance claimThe reason you purchase insurance, of course, is to financially protect yourself or your business.  The costs incurred from an accident, illness or other catastrophic event could be devastating without insurance protection.  So you pay your monthly premiums and assume your provider will have your back if you need them.  Unfortunately, that’s not always the result when filing an insurance claim.  Having your claim denied can be frustrating, and it may leave you wondering if there is any way to contest the denial.  Although it might be a difficult road, it is possible to get a denial reversed.  A qualified attorney, like those at Churchill, Quinn, Richtman & Hamilton, Ltd, can make a difference in whether you emerge victorious in your insurance claim dispute.

Every Insurance Policy is Different  

Each insurance carrier has their own set of rules and exclusions, and they can vary greatly between companies.  For example, what is covered, what is not covered, and under what circumstances, are all specified within the policy itself.  When an insurance claim is filed, the claims adjuster is responsible for determining if the claim is valid, based on his or her interpretation of the terms of the policy.  If the adjuster makes the decision to deny the claim it can be very difficult to get the decision changed.

Why a Claim Might Get Denied

A claims adjuster will deny a claim if he or she believes that the claim does not meet their criteria for approval.  Some examples of reasons for denial include:

  • The claim exceeds the policy coverage limits
  • You are filing a claim for coverage that you did not purchase as part of your policy
  • You misrepresented information when applying for the insurance policy
  • The insurance company suspects fraud
  • Important details have been left out of the filed claim
  • The claim was not filed on time
  • The insurance company believes your own negligence was a contributing factor
  • The policy’s fine print may contain exclusions pertaining to the details of your claim

What You Can Do to Dispute a Denied Claim

If you feel that your claim was unfairly denied, you can always ask the insurer to reconsider.  In the best-case scenario, they reverse their decision and your claim gets paid.  However, disputes involving insurance are typically not that easy, and most people don’t want to take on an escalated fight alone.  Insurance companies can seem large and intimidating, as they are often supported by a strong team of legal experts.  Accordingly, it would make sense to have an equally strong defense to argue your case.  An experienced attorney can help determine why the claim was denied, and therefore create the best strategy for a defense.

The attorneys at Churchill, Quinn, Richtman & Hamilton, Ltd have successfully represented many clients in a variety of insurance claim disputes.  From the real estate industry to auto policies to life insurance disputes and more, our team has the experience to help you get the results you want.  To learn more or to schedule an appointment, contact our office at 847-223-1500.


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