What are common reasons insurance may deny a claim?

Sep 2019

Insurance in Texas is used to minimize risks, whether it is car insurance, health care coverage or business insurance. The idea is that you pay a monthly premium to guarantee that when something bad happens, you are financially covered by a company with the resources to do so. Turning to an insurance claim is often a last resort option and battling the insurance company alone can be a nightmare if they deny your claim. Before filing any type of insurance claim, be prepared for any of the following reasons a company may deny coverage. According to FindLaw, one of the most common reasons an insurance company may deny a claim is lack of coverage. The company may argue that your policy does not cover the claim. It is important to understand a policy’s coverage before an incident occurs that requires you to file a claim. Legally, the policyholder will often benefit from any ambiguity in the policy. There may also be a denial because of an application error. The insurance company may argue that there were misrepresentations that nullify the policy coverage. These would occur when you filled out your original application for insurance. Insurance companies often have timelines for how long you can go before you file a claim after an incident. Some are as short as 24 hours, so filing the claim in a timely manner is important. Some insurance companies will deny coverage on bad faith, meaning there is some sort of confusing reason for denying the policy. Rather than accepting this as the final decision, there may be reasons to determine if your insurance company simply does not want to pay for the claim. Dealing with insurance companies for a denied claim can be time-consuming, confusing and frustrating. Rather than spending your time and energy on the process you may benefit from hiring an attorney who handles insurance litigation. This is for educational purposes and should not be interpreted as legal advice.

GRAIG J. ALVAREZ
ANGELA GRAVES
KARA K. STAUFFER
DWAIN CAPODICE
LANCE R. BREMER
FRANK NEWTON
YEVHENIIA NYZHNIA
LAILA ELHAM
NYLA NAHAS

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