Insurance benefits are supposed to help people in their time of need. But what people are not aware of is that claiming insurance benefits can be quite frustrating. The chances of insurance companies denying your claim are pretty high.
Following are some of the reasons why an insurance claim may be denied:
- Providing the wrong information
- Not disclosing necessary information like your age, income, occupation, etc.
- Claiming for something that is not covered in your policy
- Claiming for a pre-existing injury
- Claiming more than the insured amount
- Unpaid premiums
Knowing the common reasons for insurance claim denials can help avoid these mistakes. Remember, an insurance denial is not the end of the world. Visit jpricemcnamara.com and other reputed sites to learn what you can do about your denied insurance claim.
You have the option of an appeal and other forms of resolution. Speak with a lawyer if you think your insurance claim was wrongly denied.
Dealing with a Wrongly Denied Insurance Claim
Review Your Policy
The first thing you should do following an insurance claim denial is to review your policy. You should make sure that the mistake is not yours. Review your claim limit, any exclusive conditions, and other terms and conditions. By doing this, you can understand whether it is your mistake or the insurance company’s mistake. Follow the below steps to review your policy:
- Read your policy carefully. Pay attention to full stops and commas. Review the coverage limits and any specific conditions related to your policy.
- Review the limitations and exemptions. All insurance policies will have some kind of limitation or exemption. Review that to make sure that you didn’t exceed any limitations.
- Check your premium payments. You may not be able to claim if you haven’t paid premiums. Check whether you are up to date with your payment.
- Contact the agent. Speak with your insurance agent and ask them to explain the policy to you word for word.
Speak with Your Insurance Company
Call your insurance company or the insurance adjuster and discuss the denial. Ask them why they denied your claim. But remember one thing: insurance adjusters are not there to help you. Their goal is to reject your claim. So when speaking with them, it is better to have a lawyer by your side. Follow the below instructions when you speak with them:
- Ask for clarification on why the claim was rejected. Understanding why your claim was rejected can help you appeal the decision
- Be calm, polite, and professional when speaking with the insurance adjuster. Making a good appearance is crucial since good behavior can get you a second chance
- Ask for written clarifications. If and when the conversation leads to important information, ask them to give a written clarification. During the appeal process, you can use this documentation as evidence
Appeal the Denial
After carrying out the first two steps, if you think your claim is wrongly denied, appeal the denial. Look at the denial letter to learn about the appeal process. Follow the instructions to the dot.
Write an Appeal Letter
To appeal a denial, you need to submit a written request to the insurance company. In this letter, you should explain why you think your claim was wrongly denied. Follow the below tips when writing an appeal letter:
- Collect the necessary evidence before writing the letter
- Keep the letter in a professional tone
- Be polite. Don’t show your frustration in the letter
- Explain the error on their side
- Request an appeal
It is best to seek the help of a lawyer when writing the appeal letter.
Follow Up on Your Appeal Letter
Insurance companies tend to delay the appeal process as long as they can. This is a common strategy. They will delay the process in the hopes of you giving up. Do not let that happen. Constantly follow up on your appeal request with the concerned person. It is a good idea to ask your lawyer to do these follow-ups because insurance companies fear lawyers.
Hire a Lawyer
Dealing with a claim denial can be frustrating, especially when you are dealing with a health issue. Hire a lawyer and let them take on the insurance company. This gives you peace of mind and reduces stress.
Moreover, a lawyer can intimidate the insurance company into taking proper action without intentionally delaying the claim. They will also collect evidence and help with drafting the appeal letter. A lawyer can help you in the following ways:
- Review your policy. Insurance policies are intentionally written in a way that is hard to understand for the average person. A lawyer can understand the policy details easily since they are experts at it
- They understand the appeal process better than anyone. A minor mistake in the appeal process can lead to losing the appeal. A lawyer can help you avoid mistakes
- They can also help in gathering evidence. Lawyers will have many resources that can investigate a case and gather evidence
- Following up is an important process that a lawyer can help you with. A lawyer will be persuasive in what they do. The insurance companies will respond to lawyers
- Legal assistance in the dispute resolution phase. You can resolve this issue through arbitration or mediation. Regardless of the method you choose, your lawyer will be there to provide support.
- They will negotiate with the opponent and get you the compensation you deserve
You can get an outcome through arbitration or mediation. The insurance company will try to deny your claim. Don’t let that happen. All you need to do is hire an experienced lawyer to deal with the insurance company. From reviewing your policy to getting your money, a lawyer will help you with everything you need.
Insurance companies may try to lower the claim amount if they cannot reject your claim. A lawyer can stop that too. If your claim is denied, hire a lawyer and let them handle it. This way, you will be less stressed and focus on other things that require your attention.