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Reasons Insurance Companies Deny Claims

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It can be very disconcerting to have your claim denied by the insurance company when you have been injured in an accident. There are several reasons insurance companies deny claims. While some reasons might be valid, others are because the insurance companies are trying to avoid having to pay out on your claim. If your insurance claim has been denied, you may need to get legal help from an experienced personal injury lawyer. We understand the tactics that some insurance companies use to try to minimize how much they might be forced to pay in claims.

Reasons Insurance Companies Deny Claims

There are several reasons insurance companies deny claims that are valid and reasonable. For example, if your accident could have been avoided or if your conduct led to the accident, your claim may be denied. An insurance company may also deny a claim if you have engaged in conduct that renders your policy ineffective. Your claim might also be denied if someone who was excluded from the defendant’s insurance policy or who did not have a license was operating the defendant’s vehicle at the time of the accident.

In addition to these common reasons insurance companies deny claims, companies may also refuse claims for reasons that are not valid and which may indicate that the company is acting in bad faith.

Prior Injuries or Surgeries

Insurance companies commonly ask injured claimants to sign medical authorization forms. It is important that you do not agree to sign these forms without talking to an experienced personal injury lawyer. The insurance companies use these authorizations to search through your medical history for previous injuries or surgeries. If you have had a previous injury or a surgery, the company may then try to blame that injury or surgery for the injuries that you suffered in your accident. Likewise, the company may use your previous injuries or surgeries to argue that the extent of your injuries from the accident was less serious.

Pre-Existing Conditions

Insurance companies may also try to deny your claim if you suffer from a preexisting condition. The company may try to argue that your condition caused your injury rather than the accident. For example, if you have a pre-existing back injury but you suffered additional injuries or new injuries in your accident, the company may deny your claim and argue that your new injuries or the exacerbation of your pre-existing condition did not result from the accident.

Lapse in Time Between the Accident and When You Sought Treatment

It is important for you to seek immediate medical attention after you have been in an accident. If you wait, the insurance company may deny your claim and argue that your injuries were caused by an intervening event instead of the accident. A lapse in time before you report an accident may also prompt the insurance company to deny your claim. Many companies have specified time frames within which you have to report the accident to them. However, sometimes it is reasonable to wait or there are circumstances that justify the delay. You should speak to a lawyer about this.

Insurance companies may also deny claims if you state that you are not injured while at the scene of the accident. When you are in an accident, it is best for you to avoid denying injuries until you have been fully checked out by a medical expert. You should promptly seek a medical evaluation. There are some injuries that may not cause symptoms to appear for days after an accident, meaning you might be injured even if you do not initially believe that you are.

What to Do If You Receive a Denial of Your Car Accident Injury Claim

If your claim is delayed, denied, or partially denied by an insurance company, you will likely need to seek help from an experienced personal injury lawyer. Insurance companies make their profits by taking in higher amounts in premiums than what they are forced to pay on claims, giving them an interest in denying or disputing claims. Insurance companies may take you more seriously if you have the help of a lawyer.

An experienced, reputable personal injury lawyer will conduct a full investigation of all the facts on your behalf. Your lawyer may then draft and send a settlement demand letter on your behalf to the insurance company. This letter, if properly done, will outline your arguments about what happened in the accident, how and why you were injured, and include a formal demand for compensation for the damages. Sending a demand letter may prompt the insurance company to extend an offer to you via your attorney or to provide a specific reason for its denial. If the insurance company is unwilling to settle for a fair amount, your attorney may file a formal lawsuit and go through the litigation process on your behalf.


There are many valid reasons insurance companies deny claims, but unfortunately some companies use dubious tactics to save money. If you have been injured in an accident andyou are getting nowhere with the insurance company, it is important for you to talk to an experienced personal injury attorney. Contact the Law Offices of Bryan Musgrave to schedule a consultation by calling 417-322-2222 or filling out our online form.

Files under: Personal Injury