Nine Useful Tips When Your Insurance Company Tries to Deny Your Insurance Claim
Did you know that less than 1% of claimants query the decision when a claim is denied? Yet, over 50% of those who do fight back get results. Tip 1 -- Don't Assume NO is Final - Did you know that less than 1% of claimants query the decision when a claim is denied? Yet, over 50% of those who do fight back get results. So, you've got a good chance of winning if you fight back.
40% of claims are unjustly denied, so if you are aware your claim is legitimate, and you've not indulged in any creative claiming, you have a good chance -- even if they've said no.
It's also a fact that most claimants who query their claim end up with a better settlement... or having a denial reversed!
Tip 2 - Get it in Writing
Insist on a review of the case, and a written comprehensive explanation of the reasons for rejecting the claim. It's surprising how many insurers don't give their "no" in writing, and it is a legal requirement.
Tip 3 - Now Check Your Policy
Once you have it in writing, check the reason for denial against your policy. Look for ANYTHING that doesn't add up or make sense. Then query this in writing, referring to quotes from the policy where necessary.
Many claims come down to interpretation of the policy, so a good case explaining why you believe your claim is valid may lead to reconsideration.
Tip 4 - Never Accept Claims Process Errors
The insurer will have a claims process or filing process. For example, you need to file the claim within a certain window of time. The insurance company may deny your claim (or try to) just because you filled in a form incorrectly, or didn't file within the designated time limit.
An insurance company cannot usually refuse to pay a claim that is otherwise valid just because of a claim filing error in most legal jurisdictions, unless it can show that your error either harmed the company, or prevented it from investigating adequately.
(BTW, each country and state has its own regulations about claims and responding to them, so do check your own location's rules and regulations before implementing the ideas on this list.)
Tip 5 - Try Asking Your Agent for Assistance/Advice
This isn't frankly very likely to do any good, but you never know until you try. They may be able to help, or to direct you to the right people to contact for the following tips...
Tip 6 - Call the Authorities
In the US, call your State Insurance Department or the Department of Insurance. In the UK, the Insurance Ombudsman. Wherever you are, check first with the legal authority that governs insurance about what your rights are.
Tip 7 - Secure an Agent
Actors and writers use agents to represent them in the marketplace. Insurance companies also use agents so they don't have to deal with you personally.
Tip 8 - Consider a Policyholder Attorney
Consider hiring a qualified policyholder attorney to represent you in the claim. Good attorneys will pay for themselves in major claims.
Insurance companies tend to sit up and take notice when lawyers are brought in. On the other hand, once an attorney is hired, you may find that the insurance company and your own agent (if you have one) will only be able to communicate through the lawyer, which can be a God-send.
Tip 9 - Be Persistent
Telephone the insurance carrier regularly -- every 1-2 weeks. Be polite, but be persistent. Keep asking for the person's supervisor or manager if you don't get a suitable response.
Log all phone calls in writing, with the date, time and names of the people you spoke with. Follow each call up with a letter explaining the conversation and the issue you have with it, and ask for a written response within 14 days. Then call again if/when you don't get a response.
It goes without saying to also keep copies of all letters you send, and send everything by certified mail with return receipt.
We obviously can't guarantee that these tips will get your claim paid out, but they certainly can help. And remember, less than 1% of people query a rejected claim, yet over 50% of those who do get somewhere! We hope these insurance tips were useful.
ABOUT THE AUTHOR: Bill Voss
Bill Voss and the attorneys at The Voss Law Firm, P.C. have expertise in areas of commercial and business litigation, business law, insurance litigation, wrongful death litigation, offshore injuries, catastrophic personal injury litigation, employment litigation, oil and gas law, rare coin fraud and first party insurance claims.
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Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer. For specific technical or legal advice on the information provided and related topics, please contact the author.