You’ve done your research, put in the work, and are ready to receive the benefits of your hard-earned insurance policy. But when it comes time to file a claim, you find that your insurance company has denied it.
What now? Well, first off, don’t worry. This can be a more common occurrence than you may think, and you’re certainly not alone. And while it can be a frustrating and confusing experience, understanding what to do when your insurance claim is denied can help you get back on track.
In this article, we’ll cover all the details of what goes into an insurance claim denial and how to handle it properly. We’ll even throw in some tips for future claims so that you can make sure your application is processed without any hiccups along the way.
Why Claims Might Be Denied
There can be a lot of confusion and frustration when it comes to denied insurance claims, especially when it’s a claim that you thought should have been covered. But the truth is that insurance companies can deny claims for various reasons.
The most common reasons include the following:
- Insufficient information to support the claim.
- The policyholder is not abiding by contractual obligations.
- The claim is for a service/treatment/product not covered by the policy.
- An issue with the filing process or paperwork errors.
Familiarizing yourself with the details of your policy will go a long way in avoiding common pitfalls and minimizing your chances of having your claim denied. Additionally, ensure you complete all forms properly and provide all required documentation (from medical records to test results) to avoid common filing errors.
What Are Your Legal Rights When a Claim Is Denied?
You must know your rights when your insurance claim has been denied. Your insurance company must provide a written explanation for the denial and any legal rights you may have to dispute or appeal it, as provided by State law.
The next step when your insurance claim has been denied is to know what potential legal remedies are available to you. Depending on where you live, some possible legal remedies may include:
- A right to examination of records relating to the claim decision
- A right to reasonable notice before termination or nonrenewal of a policy
- A right to notification that supplemental benefits are available upon diagnosis of certain conditions
Appeal The Denied Claim
Don’t give up if your insurance claim is denied. Instead, you have a right to appeal the decision. The best way to start is by writing a letter of appeal. This letter should include the reason for the denial, why you think your claim should be approved, and any other documentation that can help support your case. Keep copies of all correspondence and information relevant to the appeal.
Once you send in your appeal letter, you’ll typically receive a response within 30 days. After sending in your letter and supporting evidence, here are some tips for dealing with a denied claim:
- Ask questions: If the insurer denies your appeal, reach out and ask why it was rejected so you can address their concerns in future appeals.
- Contact customer service: If available, call or email customer service representatives directly to see if they can answer any questions about the claim or provide additional information or resources on how to file another appeal.
- Submit additional evidence: Gather more evidence or documentation that could support your case, such as doctor’s notes or statements from witnesses that can help prove the validity of your claim.
Request a Reconsideration
When managing a denied claim, your first course of action should be to request a reconsideration from the insurance company. This can be done by submitting a formal written request. In this, you should explain why the original claim was denied and why you think it should have been accepted, providing any additional evidence that may have been requested or overlooked.
As part of your reconsideration appeal, it is important to include the following:
- Name and contact information.
- Name of the policyholder.
- Policy number.
- Claim number.
- Explanation of the reason for denial.
- Documentation supporting the claim.
- Evidence of services that were denied previously.
A well-crafted and documented appeal can give you an edge in getting your denied insurance claim accepted. Make sure to review your documents carefully and submit a comprehensive letter that accurately outlines the reasons for appealing.
Keep Track of Your Appeal and Supporting Documentation
When appealing a denied insurance claim, it’s important to stay organized and keep track of the entire process. Make sure you have all the relevant documents with you at all times so it’s easy to refer back to them as needed.
Copy all your paperwork related to the insurance claim and appeal, such as medical bills, notes from doctors or specialists who treated you, letters from the insurance company regarding the claim denial, and so on. You may want to scan or photograph all these documents so they can be easily accessed on any device.
Document Every Interaction
If you decide to contact your insurance provider directly over the phone or meet with a representative in person, make sure you record each conversation. This could include jotting down key points discussed in meetings or conversations, who was present during those interactions, and what was said by each party.
Use Online Tracking Systems
If technology is your thing, many insurance companies offer online tracking systems where you can follow the progress of your appeals case in real time. Check with your provider if this is an option for you — it might make all the difference when it comes to timeliness and accuracy.
Why Seek Legal Help?
In most cases, a well-written letter from an attorney quickly gets the attention of the insurance company’s legal team. Plus, these lawyers can review your policy and spot potential problems or gray areas that can benefit you. Here are some other reasons why it might be beneficial to have an experienced lawyer on your side:
- They know when to call the insurance company’s bluff and how to proceed when they’re acting in bad faith.
- They can review all documents related to the claim and pinpoint any problem areas on behalf of their client.
- They will work with your insurer on a settlement amount that is fair for all parties involved
- They can review any paperwork related to the denial of your claim and will help explain complex legalese in plain language
Contact Frankl Kominsky Injury Lawyers Car Accident Lawyer Servicing Miami
If, after all your efforts to appeal a denied claim, your insurance company still refuses to pay out, it’s time to contact Frankl Kominsky Injury Lawyers experienced car accident lawyer team servicing Miami.
Our team of car accident lawyers servicing the Miami area specialize in litigation involving auto insurance claims and has over two decades of experience helping families to fight the big insurance companies. We have access to the same evidence used for the original denial decision, so we have a good chance of overturning it.
Furthermore, our car accident lawyers will ensure you receive fair compensation for losses due to a car accident. They understand that damaged property and medical expenses incurred as a result of another’s negligence can be one of the biggest financial burdens facing car accident victims. That’s why they provide comprehensive legal services suited to each individual’s needs and goals. Contact us today at (561) 800-8000 for a free consultation.