Guide to Claims Against Insurance Companies

Introduction: Why Do Insurance Companies Deny Claims?

When you are injured in a traffic accident, a workplace accident, or any event covered by your insurance, the natural expectation is that your insurance company will pay you the compensation you are entitled to. However, in reality, insurance companies deny claims at a significant rate – sometimes on questionable grounds or even unjustly. Insurance denial can be difficult both emotionally and financially, especially when you need compensation to cover medical expenses, lost income, and pain and suffering.

This guide is designed to help you understand your rights as an insured person, know how to file a claim against an insurance company effectively, and deal with denial or rejection. With over 18 years of experience representing plaintiffs in tort and insurance claims, Mendelboum, Gor, Witzman-Gor & Co. will lift the legal burden from you and protect your rights.

What is a Claim Against an Insurance Company?

A claim against an insurance company is a legal or administrative request for compensation for damages caused to you, under the coverage of an insurance policy. The claim can be:

• Vehicle Insurance Claim – following a traffic accident, including bodily injury or property damage.
• Liability Insurance Claim – when someone else is responsible for your damage, and their insurance should cover the expenses.
• Supplementary Health Insurance Claim – for medical treatments not covered by national insurance.
• Work Insurance Claim – in case of workplace injury, in cases where an employer or third party is responsible.

Such a claim can be filed directly with the insurance company, through an insurance administrator, or through legal proceedings in court, depending on the type of insurance and the circumstances.

What Are the Main Types of Insurance Denial?

Insurance denial is when an insurance company refuses to pay a claim you have filed. The main types of denial include:

• Denial Due to Non-Disclosure of Information – the insurance company claims you did not disclose material facts when signing the policy, such as driving history or prior health issues.
• Denial Due to Breach of Policy Terms – for example, if the policy covers only private use and you caused an accident while using the vehicle commercially.
• Denial Due to No Coverage Claim – your insurance does not cover the type of damage or specific breach that occurred.
• Denial Due to Delay in Reporting – if you did not report the accident or damage within the timeframe specified in the policy.
• Denial Due to Safety Investigation – the insurance company claims the damage was caused as a result of negligence or reckless behavior on your part.
• Denial Due to Insurance Amount Limitation – the compensation owed exceeds the maximum coverage amount in the policy.

Each of these denials can be challenged legally and can often be successfully appealed with professional legal counsel.

Steps for Filing a Claim Against an Insurance Company – Complete Process

Filing a claim against an insurance company requires planning, documentation, and precision. Below are the key steps you should follow:

Step 1: Immediate Report of Damage

When an event occurs that could lead to a claim (traffic accident, work injury, property damage), you must report it to the insurance company as soon as possible. Most policies require notification within several days of the incident. Delay in reporting may result in insurance denial on the grounds of delayed notification. Keep a copy of every letter or email you send to the company.

Step 2: Gather Documentary Evidence

Collect all relevant documents:

• Witness statements (if available).
• Photographs from the scene (accident, property damage).
• Police report (in case of traffic accident).
• Medical bills and receipts.
• Medical report from the treating physician.
• Medical notices regarding future treatments or rehabilitation plan.
• Documentation of loss of income (if applicable).
• Copy of your policy and any letters sent to you by the company.

Step 3: File a Formal Claim

Submit a formal written claim to the insurance company. The claim should include:

• Personal details (name, policy number, policy date).
• Full description of the event and date of occurrence.
• Description of damages (bodily injury, property, income).
• Amount of compensation requested.
• List of attached evidence.

It is recommended to send the claim by registered mail or email with a read receipt, so you have proof of submission.

Step 4: Examination by Insurance Company

The insurance company will examine your claim. It may request additional information, order an independent medical examination (IME), or verify your status as an insured party. The process may take from weeks to months, depending on the complexity of the claim.

Step 5: Decision

The insurance company will notify you of its decision:

• Full Approval – The insurance approved the claim and is paying the full amount or part of it.
• Partial Approval – The insurance pays only part of the claim.
• Denial – The insurance refuses to pay, with explanation.

Step 6: Appeal of Denial or Delay

If your claim is rejected or if you believe the compensation is unfair, you have options:

• Request for Reconsideration – Ask the insurance company to reconsider its decision, with new evidence or stronger legal arguments.
• Appeal to the Insurance Authority – If the insurance is from the National Insurance or liability insurance, you can appeal to the Insurance Authority's appeals committee.
• Request for Mediation or Arbitration – Some insurance companies offer mediation or arbitration to resolve disputes.
• Legal Action – If all administrative options fail, you can file a lawsuit against the insurance company in court.

Insured's Rights: What Insurance Companies Must Do

As an insured party, you have legal rights protected under the Insurance Law and additional laws in Israel. Below are your central rights:

Right to Receive Complete Information About the Policy

The insurance company must provide you with clear information about the policy terms, coverage, limitations, and your responsibilities. If the information was unclear or if you made incorrect assumptions when signing, this could be a good defense against claim denial.

Right to Fair Claim Review

The insurance company must examine your claim fairly and within a reasonable timeframe. It cannot reject a claim without justification or with arbitrary reasoning. If it denies the claim, it must clearly explain why.

Right to Privacy

The insurance company may investigate your claim, but it must respect your privacy. It cannot collect personal information without your consent, except for information necessary to investigate the claim.

Right to Object to Denial

If the insurance company denied your claim, you have the right to object. You can file a request for reconsideration, appeal to an appeals committee, or file a legal claim.

Right to Compensation for Breach of Contract

If the insurance company breached the insurance contract (for example, unjustly rejected a claim), you may be entitled to compensation for damages resulting from the breach, including loss of income, legal expenses, and emotional distress.

Comparison Table: Types of Insurance Claims and Their Handling

Note: Every claim is unique and its handling depends on specific circumstances, policy terms, and applicable law. It is recommended to seek professional legal advice to ensure your claim is handled properly.

Tips for Winning a Claim Against an Insurance Company

To increase your chances of winning a claim against an insurance company, follow these tips:

1. Immediate and Written Notification

Report the incident to the insurance company as soon as possible, preferably in writing (email or registered mail). Keep evidence of the report. Delay in reporting may give the company grounds for denial.

2. Collect Strong Evidence

Photos, witness statements, police reports, medical invoices, and medical reports are all very strong in a claim. The more evidence you have, the harder it is for the insurance company to object.

3. Understand Your Policy

Read your policy carefully, including the fine print in the footnotes. This will help you know exactly what is covered and how to argue that your claim falls within the coverage.

4. Do Not Sign Anything Without Legal Counsel

If the insurance company offers you a settlement or asks you to sign a statement, seek legal advice first. Insurance companies sometimes use statements to limit your rights in the future.

5. Do Not Abandon Your Claim Easily

If the insurance company denies your claim, it is not the end. Request a detailed written explanation, check whether the explanation is legally valid, and object if you believe the denial is unjust. An experienced legal professional can help you determine whether you have a strong argument.

6. Calculate Full Compensation

Do not accept an initial offer from the insurance company without calculating the full compensation you are entitled to. Include bodily injury damages, loss of income, medical expenses, future treatments, pain and suffering, and anything else caused to you as a result of the incident.

7. Maintain Documentation of All Correspondence

Keep copies of every letter, email, phone call (preferably documented in writing after the call), and any document received from the insurance company. This can be critical if the matter reaches court.

Why Choose Mandelbaum, Gor, Witzman-Gor & Co. for Insurance Claims

When dealing with insurance denial or a complex claim, you need an attorney who understands the details of insurance law and has experience dealing with insurance companies. Mandelbaum, Gor, Witzman-Gor & Co. provides:

• Over 18 years of experience representing claimants in tort and insurance matters since 2008.
• Representation of claimants only – we do not represent insurance companies, so there is no conflict of interest. We fight for you.
• Personal and dedicated service – each client receives full attention and advice tailored to their circumstances.
• Free initial consultation – we can evaluate your claim, identify issues, and suggest a path forward.
• Boutique family law firm – we are small enough to give you personal attention, but large enough to have resources to handle complex claims.
• Located in Ramat Gan – close to the District Court and insurance centers in Israel.

If you have been injured in an accident, your insurance was denied, or you are unsure about your rights, contact Mandelbaum, Gor, Witzman-Gor & Co. today for a free initial consultation.