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Why insurance claims are denied

The top reasons for being denied include false claims, incomplete documents, and filing claims not covered by your policy.
By Ging Valles |

Many insurance claims have been denied or returned for re-filing because of one reason or another—but more often as a result of failure to submit all requirements to the insurance company.


Below are some of the most common reasons for denying an insurance claim:


Any violation of policy conditions. Your insurance claim will be denied if the loss is not covered by your policy. For example, if your building is covered by fire insurance but the damage is on an attachment to that building—which is not covered—your claim will be denied, says Eleonor C. Relente, head of the claims department of PNB General Insurance.


Any violation of the insurance code or failure to pay the premium. Failure to pay the insurance premium is always a case for rejecting any insurance claims. This is basic. However, if the company making the claim has a credit term, “we usually give due course to the claim,” Relente says.



Fraud. A company may fake documents to support claims that fire hit an insured area, or that arson had caused it. However, any claim will be denied if it is established that the fire was set deliberately. The fire should not have been caused deliberately “because what is actually being insured against are unfortunate or fortuitous events,” says Relente.


The insurance company establishes the cause of fire and damage caused through its own investigations and a report from the Fire Protection Bureau. “We usually hire forensic experts to look even into the ashes as they can validate the cause of the fire,” Relente says. “But as long as any claim is validated, we give due course to it provided the documents are complete.”


The damage is not accident-related. In motor insurance, claims are denied if the damage is not accident-related, says Ted Alonzo, provincial manager of PNB General Insurance. If you are covered for fire, floods and earthquakes, you may not claim insurance if the damage to the roof of your building was caused by a falling tree. However, if you claim that the tree was felled by an earthquake, the insurance firm will check with institutions like the weather bureau to validate it.



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