What to Do When Facing an Insurance Claim Denial

insurance claim denial

Roughly 6 in 10 insured adults experience problems when they use their insurance plan. Many of these issues are claim denials.

Insurance companies are legally obligated to handle claims fairly and honestly. This means that they must investigate the claim and pay it if they find it is valid.

Unfortunately, these companies often act in bad faith.

They may deny a claim without investigating it. Or they may delay payment for an unreasonable amount of time.

The good news is that you can fight back against an insurance claim denial. Here are some steps you can take.

Review the Reason for the Denial

Insurance companies are required by law to provide a written explanation of why they denied your claim. This is called an “adverse determination notice.”

The notice should include the reason for the denial, how to appeal the decision, and what to do next.

If you don’t receive an adverse determination notice, contact your insurance company and ask for one. Or request a copy of your insurance policy file to see if there is any information that they overlooked or misinterpreted.

Gather Supporting Documentation

Insurance companies need proper documentation to justify paying a claim. If anything was missing from your initial claim, now is the time to gather it.

This could include medical records, police reports, photos of the accident scene, or more. If you have questions about what documentation you need, contact your claim adjuster. They can provide you with a list of the documents they require.

File an Appeal

If you feel that the insurance company has made a mistake, you can file an appeal. Your appeal letter should state your situation and the claim denial reasons.

It should also include why you believe they should pay your claim and your supporting evidence. Send the letter by certified mail, or submit it online. Include phone and email contact info so the company can reach you with questions.

Consult with the State Insurance Department

Every state has a department that enforces insurance laws and protects consumers. If you’re having trouble with your insurance company, contact the state insurance department.

They can help you understand your rights and file a complaint if necessary. The department may also provide information about other resources available to you.

Consider Legal Action

If all else fails, hire a bad-faith attorney who specializes in insurance claims. They will review your case and advise you on whether it’s worth pursuing in court.

If they think there’s a good chance of winning, they’ll take on your case at no upfront cost.

If they win, they’ll take a percentage of the settlement and if they lose, you won’t owe them anything. For an excellent bad-faith lawyer, visit https://insuranceclaimhq.com/new-orleans-bad-faith-lawyer/ today.

Insurance Claim Denial: Get the Insurance Coverage You Deserve

If you have experienced an insurance claim denial, it’s important to know that you have options. You don’t have to accept the denial or let it go without a fight. Instead, take action and get the coverage you deserve.

For more insurance tips and tricks, check out the latest articles on our blog!