Knowing how to appeal an insurance claim denial is a vital skill to have. Learning how to fight for the coverage you deserve can mean the difference between getting the care you want and receiving nothing at all.
Do you have an insurance policy for your home or business and have been denied a claim? If so, you are not alone. There are as many as 18% of all insurance claim denied in the United States for one reason or another.
Whether your denied claim is the result of bad faith or a simple misunderstanding, knowing how to proceed with the proper steps can mean the difference between getting covered and not.
For a successful appeal, you need to be well informed. Here are some useful tips to keep in mind. Read on!
Understand The Denial
If your insurance claim has been denied, understanding the denial is the key to beginning the process of navigating the next steps. Review all denial letter documents carefully, paying attention to the reason for the denial and the steps your insurance provider suggests as the next steps.
Common reasons for denial include:
- Failure to meet applicable deadlines
- Insufficient paperwork
- Unrequested or noncovered services
- Provider questions the validity or accuracy
If the documents cite a specific requirement that has not been addressed, you must fulfill that. Understand the language of the document, or if you want to challenge the decision, seek assistance from an expert. Read the insurance policy document to ensure you comply with the claim denial reasons set out in the policy.
Contact Your Insurance Company
It is important to reach out to the insurance company right away. This may be done by phone, over the Internet, or by mail. Make sure to have all the necessary paperwork ready ahead of time, such as the policy number and documentation related to the claim.
During the call, the adjuster should be concisely explained about the incident as well as any documents provided. Insurance companies typically have established circles of escalation for denied claims. If the adjuster is not able to help the policyholder, they can be advised to consult with a bad faith lawyer to determine if the insurer engaged in bad-faith tactics.
The lawyer can file submission documents, attend hearings, and negotiates with the insurance company to ensure that the policyholder is covered and the claim is properly paid.
Gather Supporting Documentation
Gathering supporting documentation is a critical step for any insurance policy owner that has been denied. It is key to demonstrating that your claim is valid and should be honored. Gather documents such as:
- Medical bills
- Proof of insurance coverage
- Photographs of the damaged item
This is useful in making your case for the denial of your claim to be overturned. Having a clear chronological record of all of the events leading up to the denial of the claim is also important.
This timeline should include copies of any correspondence that you have had with your insurance company from the moment the claim was entered to the time of denial.
File an Appeal
With denied insurance claims, policyholders should be aware of their rights and take the appropriate steps to file an appeal. Identify the exact reasons why the claim was denied. From there, the policyholder should determine if an appeal is worth their effort and if the denial was the fault of the insurance company.
The policyholder should review their policy documents for any information about the appeals process. Depending on the type of insurance policy, there may be an appeals process outlined within the policy contract. The policyholder should follow up with any additional requests or communication from the insurance company.
Seek Professional Assistance
Seeking professional assistance if an insurance claim is denied is a crucial next step when dealing with insurance companies. Insurance companies often make decisions that favor their financial interests over the policy owners. An attorney or advisor specializing in insurance claims can offer the objective advice necessary to move the claim.
This professional can provide insight into the legal and financial strategies available, as well as find avenues to appeal the denied claim. Moreover, a professional can also bring in experts to assist in evaluating the claim and offer extensive support for an appeal if necessary.
Mediation and Arbitration
Mediation and arbitration are potential processes that a policyholder may use to dispute the insurer’s decision. In the mediation process, an impartial mediator brings the parties together to seek an agreement that is acceptable to both sides. In arbitration, the parties present their case in front of an independent arbiter.
The goal is to reach a decision that is as fair and just as possible. Mediation and arbitration can be advantageous because they are typically less expensive and faster than a traditional court trial. They are private proceedings, which can allow for a resolution to be quickly reached without airing dirty laundry in a courtroom.
By pursuing a mediation or arbitration process to dispute an insurance claim that was denied, you could reach an equitable resolution with the insurer.
File a Complaint if the Insurance Claim Denied
If your insurance claim has been denied, it can be frustrating and leave you feeling helpless. It is important to understand your rights as a policyholder and what steps you can take to ensure that you receive the coverage you paid for. One of the most important next steps is to file a complaint.
You can file a complaint with the Department of Insurance in the state in which the policy is regulated. If the insurer does not process your claim fairly, a complaint may be the only way to get the claim reviewed. You may be able to consult a lawyer to review the claim and your policy and advise you on how to proceed.
Research Your Insurance Company’s Denial Policies
If you’ve had an insurance claim denied, don’t give up! Speak to an expert to understand your rights and continue the fight to get the compensation you deserve.
An experienced lawyer can help you navigate the process and provide meaningful advice to increase the chances of a successful outcome.
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Barry Lachey is a Professional Editor at Zobuz. Previously He has also worked for Moxly Sports and Network Resources “Joe Joe.” He is a graduate of the Kings College at the University of Thames Valley London. You can reach Barry via email or by phone.
