Findlay Personal Injury Lawyers | February 16, 2026 | Blog

5 Mistakes That Could Get Your Claim Denied

Filing an insurance claim should be straightforward, but certain errors can derail your case. Insurance companies have strict policies and procedures, and failure to adhere to them often leads to claim denials. There are several common mistakes that consistently result in denied claims, many of which could have been avoided with proper guidance from an insurance claim lawyer.

Key Takeaways

  • Misrepresentations on insurance applications, even unintentional ones, can provide grounds for claim denial.
  • Insurance claims have strict deadlines; missing them can forfeit your right to compensation.
  • Insurers frequently cite insufficient documentation as justification for denying claims.
  • Failure to disclose pre-existing conditions often leads to denied disability and health insurance claims.
  • Social media activity during your claim period can be monitored by insurance companies and used against you.
  • If your insurance claim is denied, securing legal representation from a denied insurance claim lawyer typically improves your chances of a successful appeal.

Table of Contents

  • Misrepresentation on Insurance Applications
  • Missing Deadlines
  • Insufficient Documentation and Evidence
  • Failing to Disclose Pre-Existing Conditions
  • Social Media Mistakes
  • What to Do If Your Insurance Claim is Denied
  • FAQs About Denied Insurance Claims
    • Why was My Claim Denied?
    • How Long Do I Have to Dispute a Denied Insurance Claim?
    • What Should I Do If My Disability Claim Was Denied?
    • Can I Appeal If My Car Insurance Claim Was Denied for Misrepresentation?
    • What is the Success Rate of Appealing an LTD Claim Denied by Insurers?

Misrepresentation on Insurance Applications

Insurance contracts require complete honesty from both parties. When you provide inaccurate information on your application, whether intentionally or not, this constitutes misrepresentation and creates grounds for claim denial.

Common misrepresentations include:

  • Understating vehicle usage for auto policies
  • Withholding medical history for life or disability coverage
  • Failing to disclose home renovations for property insurance

Even minor inaccuracies, such as understating the distance of your daily commute, can be deemed misrepresentations. The consequences can be severe; even inadvertent omissions can result in a full denial of coverage.

Missing Deadlines

Insurance policies operate under strict timelines. Most policies require immediate notification of loss or injury, typically within 24-72 hours of an incident.

Beyond initial reporting, additional deadlines apply throughout the claims process. For auto accident benefits in Ontario, you must submit your application within 30 days of receiving the forms from your insurer. For tort claims against at-fault drivers, the Limitations Act imposes a two-year deadline from the date of the car accident.

Long-term disability claims involve multiple deadlines:

  • Notice of Claim (typically 30 days)
  • Submission of Proof of Disability (90 days after the waiting period)
  • Legal action against denied claims (two years from denial)

Home insurance policies generally require prompt notification and proof of loss documentation within 30 to 90 days, depending on the policy.

These timelines are contractual obligations and statutory requirements. Insurance adjusters often deny claims purely on procedural grounds when deadlines are missed, and courts further uphold these deadlines.

Insufficient Documentation and Evidence

The burden of proving your claim falls squarely on your shoulders. For personal injury claims, you need comprehensive medical documentation. This includes:

  • Initial emergency reports
  • Diagnostic imaging
  • Specialist consultations
  • Ongoing treatment records

Gaps in treatment or missing appointments can be interpreted as evidence that your injuries aren’t severe or aren’t related to the accident.

Property claims require detailed inventories of damaged or stolen items, along with proof of ownership and value. Without photographs, receipts, appraisals, or other supporting documentation, insurers can justifiably deny or undervalue your claim.

Employment and income documentation are necessary for disability and loss of income claims. Without proper pay stubs, tax returns, and employment records, your income loss claims may be disputed or denied.

Insurance adjusters commonly deny claims based on documentation deficiencies, such as missing medical appointments or failing to obtain police reports for auto accidents. These administrative issues can become obstacles to receiving fair compensation.

Failing to Disclose Pre-Existing Conditions

A common misconception is that only conditions directly related to your current claim must be disclosed. In reality, insurers require disclosure of all medical conditions, regardless of their apparent relevance to your claim. This includes conditions that were previously resolved or are currently asymptomatic.

For example, if you sustain a back injury in an accident but previously experienced back pain, the insurer may attribute your current symptoms to the pre-existing condition rather than the accident. Without proper disclosure and medical documentation distinguishing between previous issues and new injuries, your claim may be denied.

Disability claims are particularly vulnerable to denials based on pre-existing conditions. LTD insurers meticulously review medical records, often going back several years. Any discrepancy between your application and your medical history can result in a denied claim.

While disclosing pre-existing conditions might seem disadvantageous, non-disclosure poses far greater risks. Proper disclosure, accompanied by medical evidence establishing the distinction between pre-existing conditions and new injuries, provides the strongest foundation for a successful claim.

Social Media Mistakes

Insurance investigators routinely monitor claimants’ social media accounts for evidence that contradicts their claimed injuries or damages. Photos showing physical activities that appear inconsistent with claimed disabilities, check-ins at locations that suggest higher mobility than reported, or posts describing activities that contradict medical restrictions can all be used to deny claims. Even innocent posts can be taken out of context and misconstrued as evidence of exaggeration or fraud.

A particularly problematic trend is posting about accidents or injuries while claims are pending. Comments about feeling “fine” after an accident or downplaying injuries to friends can be discovered and used as evidence against your claim. Similarly, discussing details of your accident, attributing fault, or speculating about causes can undermine your position.

Privacy settings provide limited protection, as courts have increasingly allowed insurers access to “private” social media content during discovery processes. The best practice during a pending claim is to limit social media activity or suspend it entirely until your claim resolves.

What to Do If Your Insurance Claim is Denied

Receiving a denial letter can be disheartening, but it is not necessarily the final decision on your claim. Insurance companies deny valid claims with surprising frequency, often testing claimants’ resolve to pursue their rights. Here is what to do if your insurance claim is denied:

  1. Review the denial letter to understand the reasons why the insurance company denied the claim. Insurance companies are required to provide clear explanations for their decisions.
  2. Request your complete claim file from the insurer, including all internal notes and assessments. This documentation can reveal inconsistencies or errors in their evaluation process that might strengthen your appeal.
  3. If your insurance claim denied letter cites misrepresentation or other contractual violations, examine your application and communications with the insurer to verify whether the alleged misrepresentations actually occurred. Sometimes, what insurers characterize as misrepresentations are simply misunderstandings or administrative errors.
  4. For disability claim denied situations, obtain additional medical documentation that specifically addresses the insurer’s reasons for denial. This might include specialized assessments, functional capacity evaluations, or more detailed physician statements.
  5. Submit a formal appeal in writing, directly addressing each reason for denial with supporting evidence. Remember that appeals have deadlines, so you need to act promptly.
  6. If your internal appeal is unsuccessful, you may need to escalate to litigation. This is when a denied insurance claim lawyer becomes necessary.

If you’re dealing with an insurance claim denied for any reason, contact Findlay Personal Injury Lawyers. Our experienced team has successfully overturned countless claim denials, securing the compensation our clients rightfully deserve. We offer free consultations to evaluate your case and determine the most effective strategy for challenging your denial.

FAQs About Denied Insurance Claims

Why was My Claim Denied?

Claims are denied for various reasons, including policy exclusions, coverage limitations, missed deadlines, insufficient evidence, or alleged misrepresentations. Your denial letter should specify the reason, but these explanations are sometimes vague or misleading. If you’re uncertain why your claim was denied, request clarification in writing from your insurer.

How Long Do I Have to Dispute a Denied Insurance Claim?

For internal appeals to the insurance company, deadlines typically range from 30 to 60 days after receiving the denial. For legal action, Ontario’s Limitations Act generally provides two years from the date of denial to initiate litigation.

What Should I Do If My Disability Claim Was Denied?

If your disability claim denied notification arrives:

  1. Review the specific reasons why the insurance company denied the claim.
  2. Request your claim file and all medical assessments conducted by the insurer.
  3. Consult with your treating physicians to obtain additional medical documentation that directly addresses the insurer’s concerns.
  4. Submit a formal appeal with this supplementary evidence, ensuring you meet all deadlines specified in your policy.
  5. If the internal appeal is unsuccessful, consider engaging legal counsel experienced in disability claims.

Can I Appeal If My Car Insurance Claim Was Denied for Misrepresentation?

Yes, car insurance claim denied for misrepresentation situations can be appealed, particularly when the alleged misrepresentation was unintentional or immaterial. Ontario law distinguishes between fraudulent misrepresentations and innocent errors. If you can demonstrate that the misrepresentation was inadvertent and would not have significantly affected the insurer’s decision to issue the policy or the premium charged, you may have grounds for a successful appeal. Provide evidence of good faith, such as previous disclosure of similar information or prompt corrections of errors when discovered. Legal representation is particularly valuable in misrepresentation cases, as they involve complex questions of materiality and intent.

What is the Success Rate of Appealing an LTD Claim Denied by Insurers?

The success rate for appealing an LTD claim denied by insurers varies based on multiple factors, including:

  • the insurer
  • the nature of the disability
  • the quality of medical evidence
  • whether legal representation is involved

Internal appeals directly to insurance companies typically have lower success rates than litigation, but can increase when pursued through legal channels with proper legal representation from an LTD lawyer and strong medical evidence.