Razones por las que una aseguradora puede negarse a pagar un siniestro

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The mode of operation of insurance companies, in general, is very simple. A client pays a single or monthly fee, so that in the event of a loss, the insurer is liable for the damage, indemnifying or providing the convenient service to restore the service. However, on some occasions, insurers may refuse to comply with that part of the agreement, alleging the lack of certain conditions established in the contract.

It is precisely because of the above that it is so important to have lawyers in Torreon who are specialists in insurance, to make claims quickly and in a timely manner. Time and professionalism are determining aspects if the objective is to make the insurer comply with what is established in the signed contract. 

Main reasons why an insurer can refuse to pay compensation

Contracts, on many occasions, have fine print and even certain conditions that lend themselves to free interpretation. Many insurance companies rely on this ambiguity to refuse to pay a claim that, in theory, they should fully comply with. 

Hence the importance of reading the contracts in their entirety before signing them, asking any questions that may arise after reading them, and, if necessary, seeking external advice from specialist insurance lawyers . However, despite the above, it is possible to make claims when you are not satisfied with the actions of the insurance company, but it is important to do this procedure with the help of a lawyer, because it will be the best guarantee to obtain the best possible defense. and win the case. 

Below we share the main reasons why an insurer may refuse to pay compensation for a certain claim:

  • Risk aggravation

The aggravation in the risk is when a risk situation that is raised in the policy acquires a greater danger compared to what was originally stipulated. A practical example of this is when a person acquires insurance coverage for a pick-up vehicle and declares that the use of the vehicle is for the transport of people, but additionally it also transports materials, which increases the risk. 

If this activity is not explicitly declared and an accident occurs during the transfer of the materials, the insurance company may refuse to pay the claim, alleging an aggravation of the risk that was not stipulated in the contract.

  • false statement

Another reason that insurance companies use to avoid complying with previously established agreements is false statements, which are mainly derived from situations such as those outlined above. When the details are inaccurate or deliberately lying, the company can use this to deny payment of compensation.

This type of situation is considerably common in hospitalization insurance policies. On many occasions, the contracting party ignores or omits information on pre-existing illnesses and when the insurance company warns about this omission of information, it simply does not cover the claim. However, when the person has not withheld information and the illness appears after taking out the policy, the company cannot refuse to pay compensation if the condition is covered. 

  • Failure to pay premiums

A compelling reason why an insurer may refuse to pay a claim is due to non-payment of premiums. Payments can be established in various ways, and in the event that an insurer cannot confirm the payment of one of these installments, it will be more than enough for it to refuse to pay a certain claim. Despite the above, it is important to note that the contracting parties have a grace period that they can enforce in these circumstances.

Having the best lawyers in Torreón Coahuila can be decisive in dealing with these situations, with those small letters that many insurance companies take advantage of to deny payment of compensation for a claim that was duly contemplated in the signed contract. 

The importance of acting quickly and in a timely manner

The above cases are the most common used by insurance companies to deny payment of a claim, however, there are many other situations that they also use to not comply with their clients. In all these cases, acting quickly and in a timely manner can be decisive for the insurer to change its mind and cover the claim , as stipulated in the signed contract. 

In the judicial part, time is extremely important, and even more so in the case of accidents. Hence the importance of making claims quickly after an insurance company’s decision to refuse to pay the claim. The faster the claims in the case are made, the more likely it is to change the course of the situation in a more favorable way for the client.

In this entire process, it is also very important to have the advice of specialist lawyers in the area, because when a client risks making claims on their own, the chances of success can be considerably low.

It is always important, in all cases, to have the advice of experienced and highly qualified professionals, both to make claims, as well as to understand the contracts before signing them. In this sense, it is also advisable to hire lawyers specialized in life insurance , because it is also an area that puts many obstacles to paying the corresponding compensation. Understanding the contract and its scope will be much easier when consulting a specialist lawyer. 

Preventively or to make a claim, having a lawyer specialized in insurance of all kinds may be the best recommendation to claim our rights and also to know in advance what is the exact coverage of a policy that we wish to contract, as well as the scope of the same and all the established conditions that must be met so that the insurer decides to pay at the time a loss occurs. Professional advice can be decisive to avoid making an investment that, later, cannot respond when we need it .



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