Why Do Insurance Companies Try To Get Out Of Paying?

insurance companies

Some people perceive insurance companies as being tricky especially they try to get out of paying their clients.

You bought a new car and after hearing different stories from people on how beneficial it is to insure your car and you go on to do that. You take in a breath of fresh air thinking you are fully covered.

Then years down the line, you found yourself in a complicated situation, you have been in an accident with your car.

You reach out to the insurance company you have trusted so much and you are disappointed as they couldn’t live up to expectations. 

The fact that these insurance companies lure people with their slogans does not guarantee that they will stand by them when they need them most. According to The Medical Billing Advocates of America, one in every seven insurance claims is denied.

So while they portray themselves to you as a friend, in the end, they are still a business venture and profit-making remains the goal and this alone has huge consequences for you.

Then you are left to wonder what could be the reason insurance companies try to get out of paying their insured. Below are some of the reasons.

See also: How Accident Insurance Works| Everything You Should Know.

Reasons Why Insurance Companies May Deny Accident Claims

There are a thousand and one reasons why an insurance company may decide to deny a car accident claim. Some of them are as follows

1. Coverage Has Elapsed

An insurance company may try to get out of paying when they find out that your insurance coverage has elapsed. This could be a result of many factors. It could be as a result of failure to pay premiums on time, the insurance company no longer exists, etc.

2. Cause Of The Injury Is Contested 

An insurance company may also try to get out of paying if you fail to provide a substantial claim that the injuries are a result of the accident. This is because sometimes people have injuries on their bodies before getting into another accident. In such cases, the insurance company might say that the injuries were a result of previous injuries that are unrelated to the present issue at hand.

3. Your Claim Can Be Denied Because You Caused The Accident 

If you cause the accident, it is possible that you will be refused to claim damages. It will be seen as negligence on your part and as such your claim could be easily denied.

4. Medical Examination Was Not Done 

After you have been in an accident and you have called the necessary authorities, the next thing you should do is a thorough medical examination. 

The insurance company will only pay for damages when you have been examined by a medical professional. It is this record that will prove that your injuries were caused by the accident.

5. Your Claim Could Be Denied Because You Violated The Policy Terms 

In whatever you do with insurance companies, try to have sufficient evidence to support your claim. You can’t just claim you were injured without any evidence. So proper documentation like your doctor’s notes, x-rays, and any other paperwork that can strengthen your claim are necessary.

6. Your Claim Could Be Denied If It Raised Suspicion

Your reaction after an accident matters a lot. Did you delay seeking medical attention? Was the police called immediately after the accident? Did you wait long hours before contacting the insurance company?

These and more are some are what insurance company considers before handling any claim. They expect that when an accident occurs, there should be no delay in contacting the appropriate authorities. 

When there is a delay, they begin to suspect foul play. Although you may have genuine reasons for the delay, they view it as red flags that could lead to the denial of claims.

This is because they will think that a person who is injured will act immediately unlike someone who is faking it.

7. Your Claim Exceeds Your Maximum Insurance Coverage 

If the amount you are seeking as compensation is more than your coverage limits, the insurance company will deny your claim.

8. Insurance Companies Are Money-Making Ventures

Insurance companies have one goal in common and that’s to make maximum profit for their owners. The way insurance companies make money is that they charge their customers premiums. The money that’s collected is invested in stocks and they expect dividends.

So they make more money by minimizing their expenses of which paying claims is one of them. That means the fewer claim they pay as compensation, the more money for the shareholders.

Ways Insurance Companies Will Try To Avoid Paying Claims

Insurance companies have various ways they evade paying their insured claims. Let’s look at a number of them

i. Denying claims

The first thing that an insurance adjuster will try to do is to refuse to recognize your claims. They go as far as rewarding adjusters that successfully deny claims to car accident victims while going as far as terminating the appointment of those adjusters that failed in their jobs to deny claims to accident victims.

ii. Delay claims

There are times when insurance companies will use delay tactics to avoid claims. If the victim is old and sick, they may decide to hide your papers. With this strategy, they hope that the victims may die and in that situation, they will doge paying out any claims. 

iii. Intentionally Stonewalling 

After a car accident, the first person you try to reach out to is the insurance company. They will try to drag the settlement process as long as possible. They hope that you will just get tired and accept whatever they offer you or get tired and forget about the claim entirely.

iv. Using Your Words Against You 

Accidents do happen fast and you may not be able to take in all that happened. You may still be in shock and not in the best state to describe how the car accident happened. Insurance adjusters know this and can try to take advantage of this situation to trap you with your words.

If there’s one thing an insurance adjuster knows how to do best is to twist your words and use them against you in court if need be. That’s why it’s good to have your lawyer with you when you speak to the adjuster. 

They may pose a question as simple as “How are you” after you have been in an accident and you merely answering “I’m fine ” could be grounds to reduce your claim.

v. Using Surveillance 

Yes, that’s right, an insurer may decide to spy on you. They may send a private investigator to watch your home or follow you on social media just to find evidence they may use against you. This is why it’s important that you keep every bit of evidence locked up safely.

vi. Convincing You That You Don’t Need a Lawyer 

An insurance adjuster can trick you into believing that you don’t need a lawyer after an accident. They know that the involvement of a skilled lawyer could be a game changer for you as the lawyer will be able to detect whatever trick or clause that you may not decipher. 

Equally having a lawyer means that the insurance company will pay higher compensation as opposed to engaging in negotiation by yourself.


In this article, we have been able to establish that one could sustain injuries in a car accident, and yet the insurance company may try to get out of paying for several reasons. 

This can only be the handwork of insurance adjusters. This is because their priority is to help the insurance company get out of paying any compensation by latching on to any mistake you make when you’re involved in an accident. It’s on these grounds that many people are unable to secure any settlement even when they have insurance coverage.

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