Why Do Insurance Adjusters Deny Claims and What Can You Do About It?

Companies may refuse to approve your request for compensation if your claim lacks sufficient support and evidence. The insurance company can justify your denial by claiming that it believes your injuries already existed at the time of the accident or that your own behavior worsened the injuries. In many cases, an adjuster will initially claim that there is no coverage. However, as soon as you indicate that you will not abandon your claim, the adjuster will start negotiating a settlement anyway. If, after that, you cannot reach a satisfactory agreement due to a coverage issue (or any other problem), you will have to adopt other negotiating strategies to reach an agreement.

Unfortunately, insurance companies can deny policyholder claims on occasion, and in fact they do. Some of the most common reasons for denying claims are exceeding the policy limit, lacking the necessary coverage, and breaking the law. In addition, sometimes claims are incorrectly rejected. Learn what you can do to resolve a dispute over a claim. These anomalies are not isolated events in the strange world of insurance.

Many insurers deliberately make it difficult for policyholders to file claims, let alone obtain the coverage they have been paying premiums for. Insurance policies are often written in a way that consumers find it difficult to understand, but Alabama law is clear about what insurers must consider to properly handle a claim. Essentially, the company says that your insured is not at fault or that you don't have enough evidence to show that your insured is at fault. This letter can pressure the appraiser to give you the information, since the claims supervisor will not like that letter to appear in the insurance company's file. An investigation by the American Association for Justice (AAJ) into the insurance industry revealed that insurance companies would find any excuse to deny a policyholder's claim, however absurd it might be.

If you finally go to the insurance commission or file a lawsuit to file your claim, the presence of these types of letters in the claim file would demonstrate the insurance company's lack of cooperation (and could suggest inadequate negotiation tactics or even bad faith).For example, if you live in California, the Department of Insurance's Auto Claims Mediation Program will help you negotiate a disputed claim with your auto insurance company in many circumstances. Claims adjusters, people who investigate insurance claims for a living, say that these are the most common justifications that insurers use to deny a claim or pay less than the full amount. An insurance adjuster may contact you soon after the accident, sometimes on the same day, and ask you to describe your injuries. Insurance companies have an underlying animosity toward policyholders, from the CEO to the most experienced claims assessor. In addition, listening to an insurance adjuster can hurt your arguments for long-term financial recovery.

When recovering from an injury, it is important not to focus on negotiating with an insurance adjuster. It is critical to note that an insurance adjuster is not on your side during this conversation. If they refuse, write a letter confirming their refusal and make it part of your claim file. The insurance claims attorneys at Caldwell Wenzel & Asthana know how insurance companies work and what tactics appraisers use to unfairly deny claims. If you try to deal with an insurance adjuster on your own, they may try to convince you to stop treatment and tell you that the insurance company won't pay for it. If you find yourself in this situation and need help resolving a dispute over a denied claim, there are several steps you can take.

First and foremost, contact an experienced attorney who specializes in insurance law and can help you understand your rights under Alabama law and how best to proceed with filing a claim or appealing a denial. You should also consider filing a complaint with your state's Department of Insurance if you feel that your insurer has acted in bad faith or has violated any state laws regarding claims processing or payment of benefits. Additionally, if necessary, consider filing a lawsuit against your insurer if all other attempts at resolution fail.