Uncovering and Fighting Common Tactics Insurance Companies Use to Deny Injury Claims

It should probably come as no surprise that insurance companies will seek out or embellish reasons to deny paying out claims, even to longtime, faithful policyholders. There are plenty of scammers out there, so insurers are continually doing their best to try to prevent fraud — which is beneficial, since it helps keep policy rates more reasonable. But there’s a fine line between due diligence and deceit. Which is why you’ll want to know some “tricks of the trade” that insurance companies may use if they’re attempting to delay payment or even completely deny your perfectly valid claim.

Here are a few of these tactics you should keep in mind if you suspect your insurer is playing games with your claim:

They say your policy has lapsed or wasn’t paid up at the time of the accident. You’re likely current with your insurance payments, but mistakes do happen to the best of us. Perhaps you misplaced a policy statement, or maybe a check was lost in the mail. So, to prevent this tactic from being used against you, be sure to keep your bills organized and pay them on time. Maintain payment records, digital or otherwise. If possible, pay your bill using a credit card or automatic withdrawal from a bank account. That way you can’t forget, and you can never be accused of missing a payment. Even so, many insurance policies come with a built-in grace period, so check your policy documents to verify you have time to catch up on any late payments without penalty. Remember – it’s against Michigan law to drive without auto insurance. So if your policy has lapsed and you get into an accident, you’ll be out of luck when trying to file a claim… not to mention you’ll face a hefty fine, or possibly find yourself in jail, too.

They accuse you of misrepresenting information (or even lying) when you applied for your coverage. In this situation, you can resolve the problem simply by proving you were honest with them from the start and that they – in good faith – should pay your claim. Most of the time, you can easily respond to specific allegations an insurance company might make concerning your application. For instance, if an insurance agent misinterpreted something you said when you were applying for coverage – or perhaps keyed in the wrong information – you can ask for your file to be corrected, thus resolving the situation. The key here is to be honest and upfront when you obtain insurance coverage to prevent this type of circumstance from ever taking place. Tell the truth, double check your policy details, and you won’t have to worry!

They state that you aren’t covered for a particular type of incident. One common issue of this type is getting into an accident after previously declining collision coverage on your insurance policy. In this case, any claim you make for crash-related damage to your vehicle will be automatically turned down. Fortunately, Michigan does have a helpful mini tort process through which you can receive up to $3,000 from the driver responsible for the collision (or their insurance company). This cash could come in handy if you intentionally chose not to carry collision coverage on your car insurance policy – which might be smart if you drive an older, less expensive vehicle. However, most people should consider paying the extra cost for collision coverage to enjoy the peace of mind of knowing they’ll be covered in a crash.

They claim you’ve exceeded your policy’s benefit limits. This can become a real problem, especially if you opt out of or only select a minimum allowed coverage amount, which can be as low as $50,000 for your own personal injury protection (PIP) if, for example, you’re on Medicare. Then there’s the state-minimum $50,000 for bodily injuries you’ve caused to other individuals. Medical bills you might have to pay following even a minor accident can easily surpass that limit. For this reason, we always suggest buying a policy with unlimited PIP benefits and significantly higher limits for bodily injury to others. Yes, that will cost you more, but it could save you and your loved ones from a financial calamity down the road.

They make a lowball settlement offer, perhaps when you’re at your most vulnerable. If you’ve been injured in an accident, you may not be able to appropriately respond to an insurance company representative who calls and attempts to settle your claim for a pittance. You could fall prey to a “friendly” person who doesn’t really have your best interests at heart. Our advice is to never speak to anyone but your own trusted doctor and attorney after you’ve been injured. And be sure that people who might act on your behalf if you’re incapacitated (for instance your spouse or other responsible family member) also know your feelings regarding how this situation should be handled.

They delay payment until you’re feeling desperate. After an accident, you might find yourself without a car, and could face high costs for renting a vehicle or buying a replacement. As days turn into weeks, the short-term solution of borrowing a car from a friend or family member could become untenable. That’s when it could be tempting to say “yes” when a long-awaited – but lower than you deserve – offer comes in from the insurance company. If you accept that paltry payment, it will be the end of the story. We recommend giving them a hard “no” to this kind of mistreatment and calling us for help. It’s possible a simple phone call or letter from a Mike Morse Law Firm attorney to your insurance company can speed up the process and result in more money in your pocket at the same time.

They try to keep you “on the hook” with empty promises until too much time has passed to file a lawsuit. Generally speaking, in Michigan you have a year to file a lawsuit against your PIP insurer after a crash (although that year can be tolled or extended in some circumstances) and you have three years to file suit against the negligent driver and/or owner that caused your crash. However, in many cases there are additional notice requirements you must meet along the way. If these notice requirements are missed, lawsuits against certain parties can be considered invalid. These notice periods can also be incredibly short. For example, you only have 60 days to provide notice to preserve your entire recovery in a bus crash case. Which is why they may use what’s been called the “Delay, Deny, Defend” tactic to prevent you from making a successful legal claim against them. First, they allow weeks to turn into months by slowing the claims process down at every turn. Next, they deny your claim and force you to formally appeal their decision in a process that consumes yet more precious time. Finally, they eventually try a last-ditch defense by sending you a check that’s far less than what you actually deserve – hoping you’ll give up and accept it as payment in full. Don’t let that happen to you. To protect your interests, contact us immediately. The clock is ticking – don’t let it run out.

They demand that you give a formal, recorded statement. There are some occasions when you will be legally required to testify about events surrounding an accident you’ve been in. If you receive a subpoena to appear in court or to provide a sworn deposition, you must obey the law or face the consequences. But in other circumstances, you may not have a  legal requirement to make a statement or provide any other information to an insurance company for that matter. If you’re ever pressured to say something “on the record” and you don’t feel comfortable doing so, it’s probably time to call and get some advice from a good lawyer.

They will almost certainly try to use your social media presence against you. When a large settlement is in play, you can be sure that the insurance company will do whatever it can to avoid writing you that check – including scouring the internet for anything you might have posted online regarding the car accident, work injury, or other situation that led to the need for them to pay you. Be careful of anything you say and of any pictures you post on your social media accounts — even if your privacy settings are restrictive. Despite your best efforts, these websites may not be private, and you might not be doing yourself a favor by being too open with friends online.

What to Do if You Encounter One or More of These Problems with Your Insurer

The bottom line is that most insurance companies and their representatives are trustworthy and honest. But let’s face it – there are always some exceptions. If you run into one of them, you could file a complaint with the Michigan Department of Insurance and Financial Services (DFIS). Officials there will recommend you speak with your insurance company’s customer service department first. If you’re unsuccessful in getting your claim resolved and need to make a formal written complaint, they promise to “send the insurer a copy of the complaint and ask them to explain their position.” While we’re sure the folks at DFIS will do their best to help you with your insurer, know that they receive thousands of complaints regarding auto and accident insurers from across the state annually — and have a limited staff to deal with them all. We believe a far more efficient solution would be to contact a diligent, dependable lawyer to represent your interests professionally. In fact, you can talk to one right now at no cost by calling 855-645-3946 or contacting us here.

Content checked by Mike Morse, personal injury attorney with Mike Morse Injury Law Firm. Mike Morse is the founder of Mike Morse Law Firm, the largest personal injury law firm in Michigan. Since being founded in 1995, Mike Morse Law Firm has grown to 150 employees, served 25,000 clients, and collected more than $1 billion for victims of auto, truck and motorcycle accidents. The main office is in Southfield, MI but you can also find us in Detroit, Sterling Heights and many other locations.