When Your Insurance Company Won’t Pay Your Claim

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two agent are offering contract to signA popular national insurance carrier claims that it is “on your side”; another claims that it is “there,” “like a good neighbor.” Sadly, many policyholders have had the unfortunate experience of learning that these cute jingles are not always true. While we are generally unconcerned with how our insurance company handles the claim of someone else who alleges he or she was injured in the same incident as we were (or claims we caused the incident), we are deeply concerned with how our insurance company treats us. After all, we pay our premium, so isn’t our insurance company supposed to work with us and help us after a serious accident?

How an Insurance Company Makes Money

An insurance company is a business, the same as a retailer or other service-related business: in order to continue making a profit, it must regularly take in more money in through premiums than it pays out in claims for compensation (otherwise, the insurer eventually runs out of money). Whenever a claim for compensation is presented, whether from one of its insured or from another person who believes an insured is at fault for causing injury, the insurance company will make a business decision as to whether it is best to pay the claim, deny the claim, or settle the claim for less than is requested.
Just because you are an insured of the company does not mean that the insurer utilizes different options when deciding on a claim you file. Instead, the insurer will still make a determination of whether it will pay the claim, whether it will deny the claim outright, or attempt to settle the claim for a lesser amount. At the core of the matter, the insurer is driven by a cost-benefit analysis: whatever the option is that will resolve your matter the quickest and for the least amount of money is the option the insurer will likely choose (of course, the insurance company will consider other factors like its public image and public relations, the effect of losing you and your family as customers, etc.).

What Should I Do When My Own Insurer Refuses to Pay My Claim

It can be frustrating – even shocking and unbelievable – to receive notification from your insurer stating they are denying a claim you submitted. The insurer’s decision may not be final, however. Here’s what you can do:

  • First, reread your policy carefully and make sure that the type of claim you are submitting is covered under the policy.
  • Next, attempt to clarify the reason why your claim was denied. Was it submitted in an improper format? Was the claim submitted too long after the incident?
  • Third, you may attempt to speak to the insurance company yourself and negotiate a settlement by proposing a lower amount or some other resolution to the matter.
  • Finally, hire an experienced attorney to negotiate with the insurance company and, if necessary, file suit against the insurer.

Your insurance policy is a contract between you and the insurer to pay whatever amount you would be entitled to if you took the matter to court. Unfortunately, sometimes insurance companies are not concerned that they will lose anything in court until a claimant hires a lawyer.  If your insurance company is not living up to its end of the contract, contact Greenville attorney David R. Price, Jr. for assistance. He has negotiated numerous successful resolutions to insurance disputes with insurance companies on behalf of their insured but is not afraid to take the insurer to court if necessary. Schedule a free consultation with him by contacting David R. Price, Jr., P.A. at (864) 271-2636 or contacting the office online.


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