What Tactics Do Insurance Companies Use to Deny Claims?

It’s one of the worst parts of getting hurt or being in an accident—you’ve done everything right. You filed the paperwork, sent in the bills, maybe even talked to the adjuster. And still, you get that letter in the mail or that phone call you were dreading: “Your claim has been denied.” No real explanation. No clear next steps. Just rejection.

According to experienced slip and fall accident lawyers in Belleville, insurance companies often use different tactics depending on the case. Let’s walk through the most common tactics used by insurance companies to deny claims.

Delays That Wear You Down

One of the oldest tricks in the book is dragging things out. Yes, even that can lead to a denied claim. If they can’t find a solid reason to deny your claim outright, they’ll just slow the process. For example, they ask for more paperwork, then lose the paperwork, then tell you the file is under review, then say the adjuster is out for a few days. Meanwhile, the bills pile up, the stress builds, and eventually, some people give up. That’s the goal.

The idea is simple: the longer it takes, the more desperate or frustrated the claimant becomes. Maybe you’ll settle for less just to be done with it. Maybe you’ll drop it altogether. They don’t have to say no. They just have to not say yes.

Blaming Preexisting Conditions

Another tactic that catches people off guard is the “preexisting condition” angle. You hurt your back in a car accident, and they say, well, your medical records show you complained about back pain five years ago. That’s probably what’s causing this. Not the accident. Case closed and claim denied.

This kind of argument works best when your medical history is long or complicated. And let’s be honest, whose isn’t? We’ve all had aches and pains, injuries that come and go. But insurance companies love to dig through your records and look for anything they can use to shift blame away from the incident you’re filing for.

Lowballing Early, Then Standing Firm

Insurance companies may offer you a number that feels like an insult. You’re expecting $20,000 to cover your losses. They offer $2,000. Then they say, take it or leave it.

That offer is rarely based on what you deserve. It’s based on what they think you’ll accept. If you’re in a bind financially, they know you might grab it and move on. If you’re not working with an attorney, they know you might not even realize how far off the mark it is.

The problem is, once you accept a settlement, even a small one, it’s often final. You can’t go back and ask for more later. So they push you to take that first offer fast. And once you do, that’s it.

Using Your Own Words Against You

One of the sneakier ways they operate is by using your own words to weaken your claim. This usually happens in recorded statements or phone calls you think are harmless. Maybe you say something like, “I’m feeling better now” or “It wasn’t that bad at first.” That gets noted and can be used to argue that your injuries weren’t severe.

They might also twist timelines. You said the pain started a few days after the crash? Great, maybe it wasn’t related to the crash at all. You mentioned you walked around after the fall? Perfect, clearly you weren’t seriously hurt. They listen closely, not for truth, but for any phrasing they can use to build doubt.

Claiming You Waited Too Long

Timing is everything. If you wait a few days to go to the doctor after a car accident, or if you delay filing your paperwork by a week, the insurance company may use that gap to suggest your injury isn’t connected to the event. They’ll say if it really hurt, you would’ve gotten help sooner. If you were serious, you would’ve filed right away.

This is tough because real life isn’t that neat. People don’t always rush to the hospital. Some wait to see if the pain goes away. Some have to find childcare or wait until the weekend’s over. But insurers don’t deal in real-life patience. They deal in timelines and loopholes.

Surveillance and Social Media Snooping

You might think this one sounds like a bad TV plot, but it happens more than people realize. Insurance companies sometimes hire private investigators to watch claimants. If they catch you lifting groceries, jogging, or even just smiling in a photo with friends, they might argue you’re not as injured as you say.

Social media is especially tricky. You could be posting an old photo or putting on a brave face, but if it shows you active and happy, it could be used to argue that your pain and suffering aren’t as bad as claimed. They’re not looking at context—they’re looking for anything that helps them minimize the payout.

Twisting the Policy Language

Most insurance policies are written in legalese that takes effort to understand. And that’s part of the problem. If there’s even a little gray area in the wording, insurance companies will try to interpret it in their favor.

They may claim certain treatments weren’t “medically necessary.” Or that certain damages aren’t “covered events.” Or that your policy only pays under very specific conditions. Unless you know the language well or have someone reviewing it for you, it’s easy to get overwhelmed or misled.

Saying You Were at Fault

Another common way to deny a claim is to shift the blame back on you. For car accidents, especially, they might argue that you were partially or totally at fault. Even if the police report suggests otherwise. Even if the other driver admitted fault at the scene.

In some states, if you’re even 1% at fault, they can reduce what they owe. In others, being 51% at fault shuts your claim down completely. So they look for anything—an unclear lane change, a missed signal, even a vague comment you made about being tired—to push the needle in their favor.

What You Can Do About It

So where does that leave you? The truth is, most people don’t see these tactics coming until it’s too late. That’s why it helps to document everything. Keep copies of letters, emails, bills, even text messages. Be careful with what you say in recorded calls. Get medical help as soon as you can. And most importantly, talk to someone who knows how this game works.

Some claims are denied for good reasons. But many aren’t. Many are denied because delay saves money, confusion discourages people, and loopholes are easier to find than solutions. If something feels off, trust that instinct. Because while insurance companies have their playbook, that doesn’t mean you have to let them run the game.