Reasons that an insurance company may dispute coverage

Have you read your insurance policies from start to finish, ensuring that you understand everything in them? Many people give an insurance policy only a cursory glance before deciding everything looks fine and filing it away.

When you file a claim, finding the insurance company rejects all or part of your request can be a shock. If the insurance company disputes your claim, it is best to seek an attorney experienced in insurance disputes, rather than waste your time getting upset. They can read through your policy and quickly spot if the insurance company is telling the truth, or if you have a case to challenge their decision.

Below are some of the questions you may ask yourself to determine why your insurer rejected your claim:

  • Is your event excluded from coverage? An insurance policy must expressly state any exclusions within the general scope of the plan. For instance, a travel insurance policy for Europe does not need to mention that it does not cover Mexico but would need to say if it excludes Greece. The insurance company must show where they set out any exclusions.
  • Is the wording of the policy ambiguous? When language is unclear, a court will generally rule in favor of you, the policyholder. The onus is on the insurance company to make their policies transparent.
  • Is the policy unconscionable? If a judge considers a policy or section unfairly favors the insurance company, they may rule it is unconscionable and uphold your claim.
  • Is the insurance company acting in good faith? Sometimes insurance companies try to make things hard for a claimant. They can repeatedly deny without proper explanation, offer derisory sums, or delay payments. If a court finds they are acting in bad faith, they may award damages.

Insurance companies have employees who contest claims for a living, do not try to take them on alone. An experienced attorney can help pursue your rightful claim.


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