We’ve all been there – dealing with water in the basement, a fender bender, or unexpected medical bills. Filing an insurance claim should help ease these headaches, but saying the wrong thing can actually make matters worse. Insurance companies listen carefully to the words you use, and certain phrases can trigger automatic red flags in their system. What you say when reporting a claim can be just as important as what happened. Ready to learn which words might sink your claim before it even gets started?
Don’t say “flood” for water damage
Water damage in your home can be devastating, but be careful how you describe it. The word “flood” has a very specific meaning in insurance – it refers to water coming from outside your property due to natural disasters or overflow of bodies of water. If you tell your agent there was a “flood” in your kitchen when your dishwasher leaked, they might automatically deny your claim based on standard flood exclusions in most homeowner policies, even though appliance leaks are typically covered.
Instead, describe exactly what happened: “Water leaked from my dishwasher and damaged the kitchen floor.” Be specific about where the water came from and what was damaged. This precision helps ensure your claim is processed under the correct coverage section of your policy. Many people lose out on valid claims simply because they used the wrong terminology when describing water damage. Remember that different types of water damage have different coverage rules, so accuracy matters.
Avoid saying “It was my fault”
After an accident, many of us naturally want to apologize even when we’re not entirely at fault. However, saying “It was my fault” or “I’m sorry” to an insurance adjuster can seriously damage your claim. These statements can be interpreted as admissions of liability, which might lead to claim denial or reduced payment. Insurance companies are looking for ways to minimize their costs, and your words can give them the perfect excuse to do just that.
Stick to reporting only the facts of what happened without assigning blame to yourself or others. Say “The accident occurred at the intersection” rather than “I caused the accident at the intersection.” Let the insurance companies and relevant authorities determine fault based on evidence and investigation. This approach protects your rights and keeps your options open. Even if you think you might have been responsible, there could be factors you’re unaware of that contributed to the incident.
Never mention “whiplash” specifically
If you’ve been injured in an accident, be careful about how you describe your injuries to the insurance company. The term “whiplash” has unfortunately become associated with exaggerated or fraudulent claims, even though it’s a legitimate injury. When you use this word, adjusters may immediately become suspicious and scrutinize your claim more closely. This added scrutiny can lead to unnecessary delays or even denial of your legitimate injury claim.
Instead of self-diagnosing with terms like “whiplash,” simply describe your symptoms factually: “I’m experiencing neck pain, stiffness, and headaches since the accident.” Then report that you’ve seen a doctor who has diagnosed your condition. Let your medical records speak for themselves. Medical professionals’ documentation carries much more weight with insurance companies than your own assessment. This approach focuses on your actual experience rather than using terms that might trigger bias in the claims process.
Don’t describe treatments as “experimental”
When discussing medical treatments with your insurance company, avoid describing any procedure as “experimental,” “investigational,” or mentioning it’s part of a “clinical trial.” Insurance policies typically contain specific exclusions for experimental procedures, regardless of how necessary they might be for your condition. Using these terms can automatically trigger a denial, even if the treatment is becoming standard practice but hasn’t been updated in the insurance company’s coverage guidelines.
Instead, focus on how the doctor has recommended this treatment as medically necessary for your specific condition. Ask your healthcare provider how they would classify the treatment when communicating with insurance companies. They often know exactly how to describe procedures to maximize the chances of coverage. If a treatment has been effective for certain conditions similar to yours, that information can be helpful to share. The key is to frame the discussion around established medical necessity rather than the novelty of the approach.
Avoid saying “I think” or giving opinions
When filing an insurance claim, uncertainty can work against you. Phrases like “I think,” “maybe,” or “possibly” suggest you’re not sure about what happened. Insurance adjusters look for solid facts to process claims, and uncertainty gives them reason to doubt your account. These speculative statements can lead to additional investigations, delays in processing, or even denial if the company decides there’s not enough clear evidence to support your claim.
Stick to statements you know are factual and can verify. “The incident occurred at approximately 2:15 PM” is better than “I think it happened sometime in the afternoon.” If you truly don’t know certain details, it’s better to say “I don’t recall” or “I don’t have that information” rather than guessing. Take time to gather your thoughts before speaking with adjusters so you can communicate clearly. Remember that insurance companies record conversations with claimants, and inconsistencies between different accounts can raise red flags.
Never say “I’m fine” after an accident
After an accident, many people instinctively say “I’m fine” when asked about injuries, either out of politeness or because adrenaline is masking pain. However, this simple phrase can seriously undermine your claim if injuries develop later. Many injuries, particularly soft tissue damage and concussions, don’t show symptoms immediately and may take days to manifest. If you’ve already told the insurance company you weren’t hurt, they’ll question why you’re suddenly claiming injuries weeks later.
Instead of declaring you’re uninjured, say something like “I’m still assessing how I feel and will be seeking medical attention to check for injuries.” This leaves the door open if problems develop later. Many people don’t realize that what seems like minor soreness can develop into serious, long-term issues. Always get checked by a medical professional after any accident, even if you feel okay initially. The medical record created will be crucial evidence if you need to make an injury claim later.
Don’t agree to give recorded statements
Insurance adjusters often ask to record your statement early in the claims process, making it sound routine and necessary. However, these recordings can be dangerous because anything you say becomes permanent evidence that can be used against you later. If you misspeak, forget details, or accidentally use problematic language we’ve discussed earlier, it’s now on record. Insurance companies may use these recordings to find inconsistencies or statements that can limit your claim.
Politely decline to give recorded statements, especially to the other party’s insurance company, until you’ve consulted with an attorney for serious claims. You can say, “I’d prefer to provide a written statement after I’ve had time to gather all the facts.” This gives you time to organize your thoughts and review what you’ll say. For minor claims with your own insurer, if you must give a recorded statement, prepare carefully beforehand and stick to the basic facts. Remember that your policy might require cooperation, but that doesn’t mean you must record statements immediately.
Never mention previous claims or injuries
When talking to insurance adjusters, avoid volunteering information about previous claims or pre-existing conditions unless specifically asked. Insurance companies may use this information to argue that your current issues are related to past incidents rather than the current claim. For example, if you mention you had back problems years ago, they might attribute your current back pain after an accident to your previous condition, even if the new injury is completely different or made an old condition much worse.
If directly asked about previous injuries or claims, be honest but precise. Clearly distinguish between past issues that were fully resolved and your current situation. “I had a minor back strain five years ago that completely healed within two months. The pain I’m experiencing now is different and in a different location.” Being caught in a lie about previous claims is far worse than properly explaining your medical history. Insurance companies have access to claims databases and medical records, so they’ll likely discover previous claims anyway.
Words matter when dealing with insurance claims. Being careful about how you describe your situation isn’t about being dishonest – it’s about being precise and avoiding terms that can automatically trigger denials. Take time to prepare before speaking with adjusters, stick to the facts, and consider consulting with a professional for significant claims. The right language can mean the difference between a prompt, fair settlement and a frustrating denial that leaves you covering costs that should have been insured.
