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Why might an insurer deny your claim?

When you have to make a claim to your insurance, you likely expect the process to go smoothly, After all, you have paid your premiums and any deductible and followed all the requirements laid out by your insurer.

You have handled your part of the deal, so you expect the insurer to handle its part. Unfortunately, this is not always what happens. You may run into a denial of your claim, and Value Penguin explains why this might happen.

Policy issues

Even if you have paid every premium and cost for your insurance policy, the chances are your insurer may deny your claim because of something with your policy terms. The most common issue is that your policy does not cover the issue. For example, if you make a claim for repairs on your vehicle after an accident but you only carry liability coverage, your insurer will deny the claim. You do not carry coverage on your vehicle.

Another issue may be that your claim exceeds your coverage limits. You can only get a payment for the amount you paid for. For example, if your policy is for $100,000 but your claim is for $125,000, the insurer may approve up to $100,000 and deny the rest.

Other issues

While policy limit issues are generally allowable, the insurer may try to deny your claim for other reasons that are not quite as reasonable. The insurer may say you waited too long to report your accident or make your claim. Unless it is specified in your policy, you may be able to fight this.

The insurer may make a denial because you did not get medical treatment from responders on site, or the company may claim you did not provide all the information needed. In these situations, you may be able to negotiate or appeal the decision.