March 7, 2022 | Insurance Claims

We buy insurance to ensure that we are protected when faced with an unexpected loss or damage. Insurance gives us the confidence that there is something we can fall back on in case of an emergency. While we may not encounter an emergency, we continue to pay our premiums to ensure that we will have that cushion if an emergency ever occurs.

Reasons Insurance Companies Deny Claims

When an insurance company denies a claim, they must provide the applicant with a letter detailing why they denied the claim. Some of the most common reasons that insurance companies deny claims include:

• Failure by the applicant to report the claim in good time
• The procedures or services required not being covered by the policy
• Typographical errors in your claim application
• Seeking services from a patient that is not within their network
• The claimant being late on their premium payments
• Evidence that contradicts your claim application e.g. posts on social media that show you are not seriously injured
• Imprisonment
• Evidence that the damage or loss may have been due to the claimant’s negligence

These are just a few of the most common reasons insurance companies deny insurance claims. The specific reasons for denial of your claim may not be listed, but the insurance company will provide you with details of their reasons in a denial letter.

What to do when your insurance claim is denied

Many people with legitimate insurance claims give up when they receive the denial letter. They lose hope and seek other means to cover their losses. If you give up on getting compensation after receiving the denial letter, you may be giving up on what is rightfully yours. It is important to take a stand and fight the denial. Here’s how you can do so.

1. Consult with an attorney

The first step to take when your claim has been denied is to seek the legal opinion of an experienced attorney. An experienced attorney will assess your denial letter as well as the circumstances of your case. They will help you understand your rights and the options available to you. You can then determine whether you will pursue the claim or not.

2. Send a letter of appeal

The next step in fighting the denial is sending a letter of appeal to the insurance company. This letter should let the insurance company know exactly why you believe your claim is valid. It should also request the insurance company to reverse their decision to deny your claim.

You may have a limited time within which to make your appeal. You should therefore begin the appeal process as soon as possible after receiving the denial letter. Your attorney will assess your policy and help you write your appeal letter in line with the requirements outlined by the insurance company’s policy.

Sending an appeal letter is a vital step in fighting a denied insurance claim. The appeal letter ought to trigger the review of the denial of your claim. It is therefore important that the appeal letter contains all the relevant information to support your reasons for appealing the denial. It should include supporting evidence such as documentation to support your position. Having an attorney prepare the appeal letter on your behalf is the best way to ensure that you cover all your bases. Attorneys are experienced at making appeals. They know what insurance companies look for and how to grab their attention in order to get your claim reviewed.

3. Filing a lawsuit

If the insurance company is not willing to change their position, you may have to file a lawsuit against them. You can file a lawsuit for breach of contract if you believe the insurance company wrongfully denied your insurance claim or that you were underpaid for your insurance claim. Laws in different states differ about how you can go about filing a lawsuit against an insurance company. It is important to seek the counsel of a legal professional. They will help you determine the best approach to take in order to maximize your compensation. They will also seek evidence and build a strong case on your behalf.

It is important to note that many states limit the time within which a lawsuit can be filed against an insurance company for the denial of a claim. You should therefore consult an attorney as soon as possible in order to pursue the compensation that is rightly yours.

How much does an attorney cost?

Many people have their insurance claim denied are hesitant to seek professional legal assistance. This is because they believe that hiring an attorney to assist them with the process will be expensive. However, this isn’t always the case. Many attorneys work on a contingency fee basis. This means their fees will be a percentage of the compensation you are awarded for your claim. You can therefore afford to hire the best legal representation for your case. Contact us if your claim has been denied.

How to Fight a Denied Insurance Claim