- October 6, 2025
After an accident, the last thing you need is a difficult and frustrating fight with an insurance company to get the compensation you need to recover. Unfortunately, many people find themselves in exactly this position, dealing with insurers floating low-ball offers and claiming your injuries aren’t as bad as they seem.Knowing the common tactics insurance companies use to deny claims can empower you to navigate this complex process with greater confidence and protect your rights.
Key Takeaways for Tactics Insurance Companies Use to Denly Claims
- Insurance companies are for-profit businesses, and their financial interests can sometimes conflict with a claimant's need for full compensation.
- Common strategies used to minimize payouts include offering a quick but low settlement, delaying the claims process, and requesting recorded statements to find inconsistencies.
- An insurer might dispute the severity of a person's injuries by using their own medical examiners or by monitoring the claimant's social media activity.
- Insurers may attempt to shift blame for an accident to reduce their liability, leveraging state laws like Michigan's modified comparative negligence rule.
- Thorough documentation, careful communication, and a clear understanding of one's rights are important components of managing an insurance claim.
Why Do Insurance Companies Deny Valid Claims?
It can be confusing and disheartening when an insurance company, which you trust to be there in a time of need, pushes back on a legitimate claim. The reality is that insurance carriers are businesses. Like any business operating from the shores of Lake St. Clair to the banks of the Grand River, their primary goal is to maintain profitability for their shareholders. This business model means that every dollar paid out on a claim is a dollar less in profit.
This creates a fundamental conflict. While you are focused on getting the resources you need to recover from your injuries and cover your losses, the insurance adjuster assigned to your case is often evaluated on their ability to resolve claims for the lowest possible amount. They are not necessarily bad people, but they are working within a system that incentivizes them to minimize payouts. Understanding this dynamic is crucial. It helps you see their actions not as a personal attack, but as part of a business strategy. Knowing this allows you to approach the situation with a clear head, prepared for the tactics they might employ.
Common Tactics Insurance Companies Use to Deny Claims
. To protect yourself and your family, it helps to be aware of the playbook some adjusters use to reduce or reject a claim.
The Quick, Lowball Settlement Offer
One of the most frequent tactics is the quick settlement offer. Soon after your accident, an adjuster may call you, sound very sympathetic, and offer you a check right away. This can be incredibly tempting, especially when you have bills piling up. However, these initial offers are almost always far less than what your claim is actually worth.
The goal is to get you to accept the money and sign a release form before you know the full extent of your injuries and financial losses.
- Future Medical Needs: You might not yet know if you will need ongoing physical therapy, future surgeries, or long-term care.
- Lost Wages or Income: It may be unclear how long you will be out of work or if your injuries will affect your ability to earn a living in the future.
- Finality of Release: Once you sign that release, you give up all rights to seek further compensation for the accident, even if your condition worsens.
Accepting a quick offer can feel like a relief in the moment, but it can lead to significant financial hardship down the road if your costs end up being much higher than the settlement amount.
Delay, Deny, Defend
Another common strategy is often called "delay, deny, defend." It is a frustrating process designed to wear you down until you either give up or accept a fraction of what you are owed.
The process starts with delay. The insurance company might take an unreasonably long time to respond to your calls or emails. They may lose your paperwork, transfer your case to multiple different adjusters so you have to start over each time, or make endless requests for more documentation.
These delays are often intentional, hoping your financial desperation will force you to take any offer they make. Under Michigan law, insurers are required to act in good faith and not cause unreasonable delays. The Michigan Uniform Trade Practices Act (MCL 500.2006) outlines standards for prompt and fair settlements of claims.
If delays do not work, they may move to deny. The insurer might deny your claim based on a minor technicality or by misinterpreting a clause in the policy. They might claim your injury is not covered or that you failed to provide some piece of information.
Finally, if you continue to fight for your rights, they prepare to defend their decision, knowing that the prospect of a long and costly court battle is enough to deter many people.
Requesting a Recorded Statement
An adjuster will often ask you to provide a recorded statement about the accident. They may present this as a standard, harmless part of the process, but it is a critical tool for them. Their goal is not just to understand what happened; it is to get you to say something, anything, that can be used against you later.
They are highly trained in asking leading or confusing questions. For example, they might ask, "How are you feeling today?" A simple, polite response like, "I'm doing okay," can be twisted to suggest your injuries are not serious. They may also ask you to speculate on details of the accident, and any small inconsistency between that statement and later testimony can be used to question your credibility.
While you must cooperate with your own insurance company, you are generally not obligated to give a recorded statement to the at-fault party's insurer.
Disputing the Severity of Your Injuries
Even with clear medical records from your doctor, an insurance company may still dispute the extent of your injuries. They have several methods for doing this, which is why it is one of the more difficult tactics insurance companies use to deny claims.
One common method is to require you to attend an "Independent Medical Examination" or IME. This sounds neutral, but the doctor is chosen and paid by the insurance company. While many of these doctors are professional, they have a financial relationship with the insurer, and their report may downplay the severity of your injuries or suggest they were caused by a pre-existing condition. Another way they might dispute your injuries involves surveillance. They may:
- Hire a private investigator to discreetly film you doing daily activities.
- Thoroughly review your past medical records to find any prior injuries they can blame.
- Monitor your social media profiles for pictures or posts that contradict your injury claims, like a photo of you at a gathering in Sterling Heights or attending an event in Grand Rapids.
These tactics are designed to create doubt about the legitimacy of your injuries and justify a lower settlement offer or an outright denial.
Shifting or Misrepresenting Blame
To reduce the amount they have to pay, an insurer will often try to shift as much of the blame for the accident as possible onto you. Even if the other driver was clearly at fault, they may look for any reason to assign you a percentage of the responsibility.
This is particularly important in Michigan because of our state's "modified comparative negligence" rule. Under this law, found in Michigan Compiled Laws section 600.2959, your ability to recover certain damages can be reduced by your percentage of fault. If you are found to be more than 50% responsible for the accident, you may be barred from recovering damages for pain and suffering altogether. An adjuster might use your statements or the police report to argue that you were partially at fault, even if it is not true, purely as a tactic to pay you less.
Misinterpreting Your Policy Language
Insurance policies are notoriously long and filled with complicated legal language. An adjuster may take advantage of this complexity by telling you that your specific situation is not covered under the policy. They might point to an exclusion clause or a technical definition that they claim absolves them of responsibility. In many cases, their interpretation may be incorrect or self-serving.
They are banking on the fact that most people do not have the time or legal background to read and fully understand every detail of their insurance contract. This can lead to a wrongful denial of a claim that should have been covered.
How to Protect Yourself During the Claims Process
While facing these tactics can be intimidating, there are steps you can take to protect your interests after an accident. Being organized and cautious from the moment you get home can make a significant difference in the outcome of your claim. According to the Michigan Department of Insurance and Financial Services (DIFS), keeping good records is a key part of the claims process.
Your focus should be on creating a clear, consistent, and comprehensive record of your experience.
- Keep All Documents: Create a file and keep everything related to your accident. This includes medical bills, receipts for prescriptions, car repair estimates, the police report, and any letters you receive from the insurance company.
- Track Everything in a Journal: Write down details about your doctor's appointments, your symptoms, and how your injuries are affecting your daily life. Also, log every conversation with the insurance company, noting the date, time, who you spoke with, and what was discussed.
- Be Mindful of Social Media: It is best to avoid posting anything about your accident, your recovery, or your daily activities on social media. As mentioned, investigators often look for posts that can be used to argue you are not as injured as you claim.
- Follow Your Doctor's Orders: It is critical to attend all your medical appointments and follow through with the recommended treatment plan. Gaps in treatment can be used by an insurer to argue that your injuries were not serious or that you have already recovered.
Staying organized and being careful in your communications can help you build a strong foundation for your claim and counter the insurer’s tactics.
FAQs: Tactics Insurance Companies Use to Deny Claims
Here are answers to some common questions people have when their insurance claim is being questioned or denied.
What is "bad faith" in an insurance claim?
"Bad faith" is a legal term that refers to an insurance company's attempt to avoid its obligations to a policyholder without a reasonable basis. This can include actions like failing to conduct a proper investigation, intentionally misinterpreting policy language, or making unreasonable delays in payment for a valid claim.
Can an insurance company legally monitor my public activity?
Yes, in general, insurance companies can monitor your activities that are in public view. This includes observing you in public places and looking at your public social media profiles. They are looking for evidence that might contradict the severity of your claimed injuries.
What should I do if my own insurance company is denying my claim?
If your own insurance company denies your claim, you have the right to challenge that decision. You should first request a detailed explanation for the denial in writing. Understanding their specific reasoning is the first step in building a case to appeal their decision or take further action.
You Deserve to Be Treated Fairly
Dealing with the aftermath of an accident is one of the most difficult experiences a person can go through. When you are trying to recover physically and emotionally, you should not have to fight an uphill battle against an insurance company that is more concerned with its profits than your well-being. Knowing their tactics is a powerful tool, but you do not have to face them alone.
If you have been injured in Southfield, Grand Rapids, Sterling Heights, or anywhere in Michigan and feel that an insurance company is not treating you fairly, the team at Goodman Acker is here to listen. We are a team of dedicated and caring people who are committed to helping injury victims get back on their feet. For a complimentary consultation to discuss your case and learn more about your options, contact us 24/7 at (248) 831-1507 or through our online form.