You pay for insurance hoping you never have to use it, but when something goes wrong, you expect it to have your back. That’s the deal, right? You keep up with your premiums, and when life hits you hard (a car crash, a house fire, a medical emergency), your insurance is supposed to step in.
For far too many people, that’s not how it plays out. Instead of help, they get a denial letter. If you have faced insurance claim denials or want to make sure that it does not happen to you, here’s what you need to know. These are the common reasons for denied claims even when you always diligently paid your premiums.
You Waited Too Long to File
This is one of the most common insurance claim challenges, and yet it is completely preventable. Almost every insurance policy (it could be for your car, your house, or your health) has strict deadlines. If you don’t report your claim on time, the insurer might deny it outright.
Why This Happens
You might be dealing with the chaos of an accident or the stress of a health crisis. Filing a claim isn’t exactly top of mind, but insurance companies don’t really care about that. If you miss the deadline (which can sometimes be as short as 24 or 48 hours), you might be out of luck.
What You Can Do
If something goes wrong, tell your insurance provider as soon as possible. Even if you are still arranging for paperwork, at least let them know the basics. That one call could save your entire claim.
What Happened Isn’t Actually Covered
Not everything is covered by your policy, and that’s where a lot of people get blindsided. Just because you think something should be covered doesn’t mean your policy agrees.
What This Looks Like
- Your basement floods during a storm, but flood damage isn’t covered under your standard homeowner’s policy for a property damage claim.
- You crash your car while delivering food, but your personal auto policy excludes business use.
- You seek treatment for a condition your health insurance marked as “pre-existing.”
How to Avoid This
Review your policy before something happens, not after. If there is anything unclear (and remember, there usually is), ask questions. Better yet, get the answers in writing.
You Left Out Details or Made Honest Mistakes
We are not talking about fraud here. Even honest folks make mistakes like forgetting a detail, rounding off a number, mixing up dates. Those little things can make insurance companies deny claims.
Common Missteps
- Leaving out medical history when signing up for health insurance
- Estimating damages instead of providing receipts or repair quotes
- Telling the story of what happened differently each time (even unintentionally)
How to Stay Safe
Be as detailed and accurate as you can. If you are not sure about something, say so. And always, always document everything. Receipts, emails, reports, photos — the more paper trail you have, the stronger your claim.
Your Policy Was Inactive When You Filed
No coverage means no claim, simple as that. If your policy lapses even by a day, your insurer is not legally required to pay.
How This Happens
- You missed a premium payment
- Your job ended and so did your employer-sponsored health insurance
- You didn’t renew your homeowner’s or auto policy
Best Way to Prevent It
Set up auto-pay or calendar reminders for your premiums. If you change providers, make sure your new coverage starts before the old one ends. Gaps in coverage can cost you big time.
The Insurance Company Disagrees About Who’s at Fault
This one is particularly common with auto accidents, personal injury claims, or anything involving a third party. Your insurance provider might disagree with your version and say, “Sorry, we don’t think this is on us.”
Some Real Examples
- After a car crash, the insurer says you caused it, even if you don’t agree.
- A guest slips at your house, but your homeowner’s policy argues it was their fault.
- Your insurer claims a medical issue was caused by a non-covered event (like extreme sports or substance use).
How You Can Fight This
Get your own evidence: witness statements, photos, police reports, medical opinions. Don’t just accept their version. They are protecting their bottom line, not yours.
You Didn’t Provide Enough Proof
This is one of the most frustrating reasons for denial. Even if you are completely in the right, if you cannot back it up with paperwork, you might not get paid.
Things Insurers Usually Ask For
- Photos of damage
- Medical bills and doctor’s notes
- Estimates from contractors or mechanics
- Police reports or incident records
Stay Organized
Keep all documents, receipts, and records in one place. If you are emailing your insurance company, keep copies of every message. If you talk on the phone, write down who you spoke to and what was said.
Your Claim Raises Red Flags
Let’s be real: insurance fraud exists. Because of that, insurance companies are quick to flag anything that seems “off.” But sometimes, legit claims get caught in that net.
What Makes a Claim Look Suspicious?
- You filed right after increasing your coverage
- Your story changes over time
- The amount you are claiming seems higher than expected
If This Happens
Don’t panic. Just be ready to explain everything clearly and provide supporting documents. Consistency is key here. And having a lawyer on your side is a prudent move.
Additional Things to Remember About Insurance Claims
Sometimes claims get denied simply because the insurance company says you didn’t follow their rules. This may happen even if the care was totally necessary. For example, if you get a CT scan without first getting the green light (what they call “require prior authorization”) your health plan might reject the bill. And if the scan was done outside your plan’s network, that could be another reason they won’t cover it.
Even if the test procedures were meant to catch something early and prevent further damage, the insurer might still say no. They expect you to take what they call reasonable steps to make sure everything is approved ahead of time. And if you don’t, they might stick you with the non payment.
Get Our Personal Injury Lawyers on Your Side
If your insurance claim has been unfairly denied, delayed, or underpaid, you don’t have to take it lying down. At Gingras, Thomsen & Wachs, our personal injury attorneys have decades of experience holding insurance companies accountable. We don’t back down against pressure. We have the skills, experience, and resources to take on powerful insurers and fight for the largest possible compensation for your losses. To schedule your free consultation, call us at 855-954-1186 or contact us online.
