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Four Reasons Why Your Health Insurance May Deny Your Injury Claim

Many people rely upon their health insurance for a sense of security. They use it to ensure that they can afford medical treatment no matter what kind of injury they might sustain. Protection against unforeseen accidents is the reason why nearly 90 percent of Americans have health insurance.

The problem is that your health insurance may not keep you as safe as you might think. There may be a variety of reasons that your health insurance company will outright deny your claim. Let’s examine some of the reasons your health insurance company might deny your claim.

1. Non-Covered Medical Treatments

What you may not realize about your health insurance company is that they generally have the right to decide if a treatment you received is medically necessary. They may decide, for example, that putting a cast on a sprained foot was not something you needed.

The reason this happens concerns the way health insurance companies work. They try to cut costs as much as possible to ensure that can cover their figures for projected claims. That’s why their medical opinion may be less effective and caring than the opinion of your own doctor. Infertility treatments, cosmetic surgery and certain categories of care constitute the majority of non-covered treatments.

If your insurance company denies a claim that should be covered, then it may be time to seek legal aid. A personal injury attorney such as one with the Johnston Law Firm can be instrumental in ensuring that your medical expenses are paid by the group legally responsible for doing so.

2. Out-of-Network Care Providers

Many health insurance companies are strict in regards to the doctors you may use as care providers. They may require that they work at a nearby approved hospital or clinic for you to see them, or they may require special authorization before you receive treatment.

While most insurance plans will cover emergency medical treatment necessary for maintaining your life, more optional things may not be covered unless you receive care from a physician within your insurance network.

3. Errors in Forms

When hospitals, clinics and even your doctor’s office fill out forms, they can make mistakes. Something as simple as the wrong date or even bad print on a form could mean that your insurance company has ground to reject your claim.

Errors can be incredibly frustrating because they’re not necessarily something that you did incorrect. The only thing you can do is to try to correct them, and seek legal aid in cases where your insurance company continues to refuse your claims.

4. Pre-Existing Injuries

“Pre-existing injuries” can be one of the most daunting reasons for denial of your health insurance claims. Your insurance company may try to deny claims of a current injury because it is influenced by an injury you sustained in the past.

If your insurance company tries to do this, the first thing you should do is to continue to pursue your claim when it is valid. A personal injury attorney can help ensure that your insurance company provides you with the recovery that you are legally entitled to.

Dealing With Denied Insurance Claims

Although only four reasons have been examined here, there can be an endless supply of reasons that your insurance company might try to deny your claims. That makes it important to continue to pursue valid claims when your company gives you weak reasons for rejection.

If you do end up receiving something that isn’t covered, that doesn’t necessarily mean you have to foot the bill. You may be able to seek legal restitution from another party, such as in the case of a major car accident or an unsafe work environment, to pay for the fees associated with your recovery.

Author info: A professional content and copywriter who graduated from the University of San Francisco, Anica loves dogs, the ocean, and anything outdoor-related. She was raised in a big family, so she’s used to putting things to a vote. Also, cartwheels are her specialty. You can connect with Anica here.

Bob Kraft

I am a Dallas, Texas lawyer who has had the privilege of helping thousands of clients since 1971 in the areas of Personal Injury law and Social Security Disability.

About This Blog

The title of this blog reflects my attitude toward those government agencies and insurance companies that routinely mistreat injured or disabled people. As a Dallas, Texas lawyer, I've spent more than 45 years trying to help those poor folk, and I have been frustrated daily by the actions of the people on the other side of their claims. (Sorry if I offended you...)

If you find this type of information interesting or helpful, please visit my law firm's main website at You will find many more articles and links. Thank you for your time.

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