10 Tactics Insurance Companies Use to Deny Your Claim

INSURANCE ADJUSTERS ARE USUALLY QUICK TO ACT AND HOPE TO CATCH YOU OFF GUARD, BEFORE YOU’VE HAD TIME TO HIRE A LAWYER TO REPRESENT YOU AND BEFORE YOU’VE HAD TIME TO DETERMINE THE EXTENT OF YOUR INJURIES.

Adjusters are usually affable types who are able to engage you in conversation and draw you out. While outwardly friendly and concerned, they are not interested in your well-being and, although they will probably make representations to the contrary, they are not there to help you. They are there to protect and promote the interests of the company that pays them.

 
 

6

Delaying payment of your claim.

When you’ve been injured, you may be facing financial difficulties because you are unable to work and have high medical expenses.

INSURANCE COMPANIES ARE AWARE OF THIS AND WILL OFTEN DELAY THE PROCESSING OF YOUR CLAIM UNTIL YOU ARE DESPERATE ENOUGH TO SETTLE FOR ANYTHING THEY OFFER.

If you are facing severe financial difficulties and are tempted to take a settlement for less than the full value of your case, your lawyer can often make suggestions that will help you weather the storm so you’ll be able to stand firm in demanding what you are rightfully owed.


7

Conducting surveillance.

When you make a claim for a serious injury, the insurance company will usually hire investigators to follow you around and photograph or video you doing some activity that would indicate that your limitations are less significant than you’ve claimed. Honesty is the best policy, and you should not claim injuries you don’t have, which could ruin your credibility.

BUT EVEN WHEN YOU’VE BEEN COMPLETELY HONEST, A WELL-STAGED PHOTO COULD CREATE A FALSE IMPRESSION, SO BE AWARE THAT YOU ARE PROBABLY BEING WATCHED.


8

Misrepresenting the amount of insurance coverage available to pay your claim.

The adjuster may tell you that the party responsible for your injuries or a death in your family carried only the minimum required liability insurance. Don’t take the adjuster’s word for it.

IN MANY CASES, THERE IS MORE COVERAGE THAN THE ADJUSTER WILL ADMIT TO.

Your lawyer will need to read the policy carefully to identify all coverages that apply. Insurance policies are often written in dense “legalese,” making them difficult for the layman (or even an inexperienced lawyer) to understand, so you need an attorney with personal injury claims experience to analyze the policy and determine what coverage is available.

If the at-fault driver is uninsured or underinsured, you will look to your insurance policy. In Arizona, an insurer must offer you uninsured motorist coverage equal to the amount of bodily injury coverage you carry. If you decline, you must sign a statement indicating that it was offered and you chose not to purchase it. Your insurer may deny that you have UM coverage. If they cannot produce the signed statement declining coverage, they must cover you. Your lawyer will know how to handle a denied UM claim.


9

Denying liability, either all or in part.

THESE ARE SOME OF THE WAYS THEY WILL ATTEMPT TO DENY OR LIMIT THEIR LIABILITY FOR PAYING A CLAIM:

  • Saying the accident was your fault, not the fault of their insured.
  • Saying the accident was only partially their insured’s fault, but that you contributed to the  accident and were also at fault.
  • Claiming that another party was entirely or partially at fault.
  • Arizona uses a pure comparative fault tort system under the Uniform Contribution Among  Tortfeasors Act (UCATA) to ensure that the liability for the accident is apportioned fairly. This means  that a jury must consider the fault of every party that contributed to the injury, death, or other  damages, even if that contributor is not a named party to the action.

Under the UCATA, fault means “an actionable breach of legal duty, act, or omission proximately causing or contributing to injury or damages sustained by a person seeking recovery, including negligence in all of its degrees, contributory negligence, assumption of risk, strict liability, breach of express or implied warranty of a product, products liability and misuse, modification or abuse of a product.”

If the injured party—the plaintiff—contributed to the accident, the recovery will be reduced by the percentage of responsibility the victim contributed to causing the accident. A defendant can name a nonparty as being at fault, even if the plaintiff is not able to sue or recover from that nonparty.


10

Disputing your damages and the necessity of medical treatment, or attributing the injury to a pre-existing condition.

If you had a medical degree, would you be working for an insurance company as a claims adjuster? Highly unlikely. But an adjuster will often decide that certain treatments were unnecessary, or that treatment for your injuries took longer than it should have.

YOUR MEDICAL TREATMENT SHOULD BE DETERMINED BY YOUR DOCTOR, WHO IS A TRAINED MEDICAL PROFESSIONAL, NOT BY AN INSURANCE ADJUSTER WHO LOOKS AT A CHART TO SEE AVERAGE RECOVERY TIMES OR TYPICAL TREATMENTS FOR A PARTICULAR INJURY.

Medical care must be individualized to meet the patient’s needs, something beyond the abilities of an insurance adjuster.

 

Who are the top 10 worst insurance companies in America for using these tactics?

SURELY ALL COMPANIES DON’T USE THESE TACTICS? YOU MIGHT ASK. THE AMERICAN ASSOCIATION FOR JUSTICE HAS PUT TOGETHER A LIST OF THE NATION’S WORST INSURANCE COMPANIES FOR DENYING CLAIMS.

 
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