When you buy an insurance policy, you trust it will provide financial protection. It should be there when you need it the most, especially after accidents or natural disasters. Unfortunately, it is not unusual for insurers to reject claims and leave you wondering what to do next.
But the shock does not have to leave you paralyzed. Discover what you can do with the help of a local insurance attorney in this guide.
Reasons for Insurance Claim Denials
There are several legal justifications for an insurance claim denial. Some of the most common reasons include these real-life examples:
- Insurance policies often have policy exclusions that limit coverage. For example, a homeowner’s insurance policy may exclude flood damage.
- Adjusters may deny claims if they believe that the loss was intentional or fraudulent. For example, setting fire to a business to collect insurance money is illegal.
- Insurance companies may deny claims if they believe that the details are incomplete or inaccurate. For example, you could fail to disclose a pre-existing condition on your health insurance application.
- Insurers establish requirements to receive coverage. For example, a car insurance policy may depend on you having a valid driver’s license.
- Health insurance companies may deny claims if they believe your policy does not cover your condition.
Identifying the reason for your insurance claim denial is crucial to the next steps. For instance, you may resubmit your claim if you did not have enough detail the first time. However, if the denial was due to a policy exclusion, you may need legal advice and representation.
Steps You Can Take After an Insurance Claim Denial
There are several steps you can take yourself to challenge the decision before hiring an attorney. Many individuals in similar situations found success by completing these tasks:
Review the Denial Letter
The letter from your insurer should have specific information about the reason for the denial. Carefully reviewing it may identify errors or inconsistencies you can demonstrate to your adjuster. It is also a vital part of preparing your appeal or complaint to the state insurance commissioner.
Gather Evidence and Documents
You need all relevant documentation, such as medical records, receipts, photographs, and witness statements. This evidence can help demonstrate the extent of your losses or damages. Also, it helps to refute any allegations made by the insurance company.
Submit an Appeal
Review the instructions provided in your denial letter before submitting a claim appeal. You must follow the directions precisely. Include all relevant documentation and organize it into a compelling argument. If you don’t feel confident about this part of the process, ask an insurance attorney for help.
File a Complaint with the State Insurance Commissioner
The insurance commissioner may investigate your case and determine whether the insurance company violated state regulations. Be sure to include any correspondence with the insurance company along with your evidence in the complaint. Taking this action may lead to a resolution of your claim or even enforcement actions.
Hire a Lawyer
If all else fails, you may need to hire a lawyer who specializes in insurance law. Learn how an attorney will defend you from insurance fraud. An experienced attorney can help you navigate the legal system and fight for your rights as a policyholder.
Steps a Lawyer Can Take After an Insurance Claim Denial
If you are facing an insurance claim denial, a lawyer can provide valuable assistance in challenging the decision. These are a few of the most notable actions they complete on your behalf:
- Collecting evidence, reviewing policy documents, and consulting with experts
- Determining the strengths of the case and potential legal options
- Negotiating a fair settlement with the insurance company
- Filing a civil action with the appropriate judiciary
- Representing you in court, if necessary
Schedule Your Consultation With an Insurance Claim Lawyer
Dealing with a denied insurance claim can be frustrating and frightening. Nonetheless, you have options. Seek help from a skilled insurance lawyer who can get you through appeals or court hearings. Learn what you can expect form our service.
You do not have to allow an insurance company to deny you the coverage you deserve. Contact us today to talk to a local insurance lawyer. You only have to complete a brief online form or call (866) 345-6784!
About the Author
Aaron is a professional legal writer with a B.S. in English Education from Southern Illinois University – Carbondale. He has written, published, and edited thousands of legal articles for RequestLegalHelp, which has connected over 5 million people to legal help in the United States.
With over five years of experience writing thousands of legal articles for law firms across the U.S. and Canada, Aaron specializes in covering federal, state, and city-level legal issues ranging from auto accidents to wrongful terminations. Contact Aaron at [email protected] for article suggestions, collaborations, or inquiries.
