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What factors commonly trigger insurance claim denials?

On Behalf of | Sep 12, 2019 | Denied Insurance Claims

We wouldn’t reasonably expect at Mansell, Engel & Cole that our readers across Oklahoma could comprehensively cite all the applicable responses relevant to the above-posed headline query in today’s blog post.

We feel confident in assuming, though, that most followers of our insurance law blog could easily compile lengthy lists.

Here’s why: Claim denial is part and parcel of what insurance companies are all about. That is not to say that insurers have an automatic “deny” response to every claim presented to them, of course. It is certainly common practice, however, for them to look hard for contractual reasons allowing them to shoot down policyholders’ claims.

As duly noted by the writer of a recent article spotlighting common catalysts cited in claim denials, “insurance companies only make money when they DON’T pay claims.” That resist-and-profit reality gives them ample motivation to “take advantage of any and every opportunity to deny a claim.”

So, unsurprisingly, the reasons supplied by insurers’ in their denial justifications are many and varied. Here are a few:

  • Policy lapse
  • Policyholder’s tardiness in remitting payments
  • Insured’s misrepresentation on a policy application
  • Claim is made within a so-called “contestability period”

It is vitally important for all policyholders to note that no insurer’s determination is final or immune from challenge. There are often weaknesses linked with insurers’ claims relevant to all the above bullet points and other arguments that seek to justify denial.

Indeed, the author cited above strongly recommends that any denied policyholder promptly enlist the aid of a proven insurance law legal team. Experienced pro-policyholder attorneys will thoroughly investigate claims and demand fair play from an insurer dragging its feet or engaging in bad-faith tactics to avoid payment.

We welcome contacts to our Oklahoma City law firm from policyholders having any questions or concerning regarding an insurance company’s conduct in response to a bona-fide claim demand.