What to Do After a Denied Insurance Claim

One of the most upsetting things a person may go through is having their insurance claim refused. If you were involved in an automobile accident, a slip and fall accident, or any trauma in which someone else was at fault for your injuries, you must be reimbursed for your medical bills, damages, and lost income. On the other hand, insurance companies look at every aspect to establish if you were to blame for the accident to avoid having to pay for an insurance claim.

Steps to Take After A Denied Insurance Claim

When your insurance claim is denied, you may believe that your only alternative is to pay for your medical injuries and damages out of your pocket. You do, however, have another alternative. You may file an appeal and make a formal demand for compensation.

Learn why the claim was denied.

Before attempting to appeal your claim, you must understand why it was denied. Did you take too long to notify your insurance carrier of the accident? Is your insurance coverage going to cover the injury? Were there any policy exclusions for your injuries that might result in your claim being refused, and is your insurance still active? Your insurance company may use any of these circumstances to reject your claim. Other reasons why an insurance claim may be refused include the following:

  • You were partly to blame for the injuries.

  • Incorrect information on claim paperwork

  • Medical billing and health record errors

  • Your insurance coverage may not cover the medical treatment you need or be judged medically necessary.

Examine the rejection letter to determine whether the insurance company gave a reason for declining your claim. Once you know why, you may take the necessary measures to substantiate your case to the insurance company, preventing them from denying your claim a second time when you reapply.

Submit a Demand Letter

You must write a demand letter outlining your case and why you should be compensated. The letter should go into further depth about why you believe the other person is to blame for your injuries and why you want compensation or treatment. You may also have other papers, images, or other material that you can provide with the demand letter to demonstrate why your insurance claim should be approved.

The Appellate Procedure

Most insurance firms will have an appeals mechanism in place, and many jurisdictions may compel insurance companies to use arbitration or an appeals process for all refused claims. The duration of this procedure might vary. It is preferable to have legal counsel since your attorney will be better knowledgeable about these claim situations and the steps of arbitration with the insurance company. Then they may use their legal knowledge to help you win your claim and get the money you deserve.

When Should You File an Appeal?

Any insurance claim that you believe should be reimbursed should be appealed. You could also file an appeal if you believe the insurance company is participating in unethical claim rejection tactics. Your attorney will be able to analyze state laws regarding banned conduct and file a separate claim against the insurance company for participating in such unlawful tactics that violate state laws. If you have exhausted all your options for appealing a rejected claim and the insurance company still refuses to compensate you, you may choose to launch a lawsuit.

Obtaining Representation in the Case of Insurance Claim Denials

If you are harmed in an accident caused by someone else’s negligence, you should be reimbursed for your injuries, even if your insurance company dismisses your claim. Horton Law may analyze the facts of your case and the rejection of your insurance claim. Then we may give you a consultation to go over the specifics and advise you on how to proceed with the appeals and arbitration processes. Make an appointment with our office now to go through your claim.