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How to Appeal a Denied Claim

One of the most difficult and inconvenient issues to deal with after an accident or incident that disrupts your life is having an insurance claim denied. A claim denial is like adding insult to injury. There are ways to push back against the insurance company’s decision and get the compensation you deserve after an initial claim denial.

Understand the Details

There are many reasons why an insurance company may deny your claim. One of the explanations is that your policy does not cover the damage. Insurance policies cover very specific issues, and the company will not help if the contract does not include your loss.

Another common reason may be because the company categorizes the procedure you are claiming as experimental, cosmetic, investigational, or not medically necessary. If they feel that you do not absolutely need it, they may argue that it is not something they are required to cover. They can also deny your claim for more procedural reasons, like the lack of a referral if that is required or typographical errors on your claim.

Another excuse for denying you is the deadline. You are only allowed a certain amount of time after the incident before you are no longer allowed to file a claim. It is vital to check your filing deadlines well before beginning the process so you can be sure that you are not denied support from your company because you exceeded the time limit for filing a claim.

Organization Is Key

The first step you should in take in appealing a denied claim is correcting any minor errors that may exist with your paperwork. An incorrect ID number, or misdated receipt can lead to a denial. Double check your documentation to make sure there aren’t any simple fixes you need to make before proceeding.

In order to successfully appeal the denial of your claim, you’ll need proper documentation. You need to make sure you are fully prepared with the necessary evidence and information to refute the denial. Service receipts, medical records, and prescriptions from a physician can all aid your case, as they are documented expenses or evidence of ongoing serviced required.

Insurance Companies Must Practice Good Faith

When you purchase a policy from an insurance company, both you and the company are signing a contract that includes the requirement to act in good faith. If an insurance company denies your claim without legitimate cause, they are acting in bad faith, which is a breach in the contract between you and your insurer. There are many ways that a company may be acting in bad faith. If they refuse to conduct an investigation, or delay proceedings unnecessarily, they are acting in bad faith. Insurance laws are complex and heavily nuanced. An experienced attorney can outline exactly what a bad faith action may be in your particular case.

When dealing with an insurance company that is refusing to cover your incident, be sure to be organized and well-informed on the specifics of the incident and the details of your contract. An experienced attorney will have dealt with bad faith insurance companies and be able to assist you in building a successful case.