August 18, 2016
How to Handle a Denied Claim
by Matt Rhoney
A denied claim can be a simple mistake, so don't be afraid to ask questions and get some clarification.
If you’ve been involved in an accident, you file a claim with your insurance provider and assume that it will act in good faith and protect you. However, just because “good faith” exists doesn’t mean your claim won’t be denied.
Has Your Claim Been Denied?
Nothing feels quite as disheartening as finding out your claim has been denied when you were sure your insurance company was on your side. If that happens you have the right to know why.
See also: Power of ‘Claims Advocacy’
A car accident, for instance, might be denied because: the accident was avoidable; there was no complaint or treatment at the time of the injury; or there was a pre-existing condition.
Often, a denied claim can be a simple mistake, so, before you settle for your insurance company’s decision, don’t be afraid to ask questions and get some clarification. If you have double-checked that the information you submitted is correct or have fixed some errors on your claim (and your claim is still denied), you have the right to dispute the denial.
See also: Bad-Faith Claims: 4 Ways to Avoid Them
If you choose to appeal a denied claim, a common procedure for some insurance (such as health insurance) involves writing a letter explaining why you believe your claim should be covered. When explaining your claim, be as detailed and specific as possible and include any evidence or information the insurance company may not have asked for or considered. You should also keep copies of everything you send to the insurance company and keep detailed notes of when and whom you spoke with.
Considering Legal Action
If you don’t know how to proceed with a denied insurance claim, you may want to consult a lawyer who specializes in insurance cases. If your insurance company still refuses to accept your claim after your appeal, legal assistance may be your best course of action, as you may be able to file a “bad faith” case against your insurance company.