insurance claim is denied

Insurance Claim Is Denied: What to Do Next

by Andrus Becki

There’s almost nothing more frustrating than finding out your insurance claim is denied. After all, you have faithfully made your payments each month to your insurance company, and when it’s their turn to help with a claim, they come up short. You may be wondering what the next steps are. What do you do next?

We tend to put a lot of trust in our insurance. We believe that when we need them to save us from financial devastation, they will be there and cover us the way they have represented that they would. When they deny a claim, it can feel like a slap on the face. It really can feel like a personal betrayal. Who do you talk to at this point? Is the situation out of your control?

Why Do Claims Get Denied in The First Place?

There are a variety of reasons an insurance company denies a claim. Your insurance company must give you a reason for their denial, which can help you respond accordingly. Some of the reasons for denial could include:

  • Your claim is not covered for a specific event or has exceeded the amount of coverage that you have.
  • You received care at a location that was not on your coverage plan. Always know what places are “in network” and covered under your plan.
  • You did not report your event in a timely manner. Suppose you were injured in an auto-pedestrian accident, for example, and did not call the police or report it to insurance until several months later. In that case, claiming that the symptoms just developed could be a questionable and suspicious claim.
  • You did not include important information on your insurance application. Insurance companies hire adjusters to watch applications and claims closely. If you include inaccurate or inadequate information, they will deny your claim, even if they would have accepted it otherwise.
  • You broke the law during the accident. For instance, you and your family were in a car accident, and no one was wearing seatbelts. The insurance company may deny your medical claims toward your car insurance company.

Types of Insurance That Can Have Claims Denied

Although there are many types of insurance that people can have, the three main types of insurance we will be discussing are:

  • Health Insurance
  • Automobile Insurance
  • Homeowner’s Insurance

Health Insurance Claim Denials

If you’ve sustained an injury, had surgery, or just visited the doctor for a minor issue, hearing that your insurance denied paying for your care is rough. These denied claims can be expenses ranging from a few dollars to thousands and can be quite a setback, especially when you are still trying to heal and recover.

They issue some health insurance claim denials for simple reasons like failing to obtain a pre-authorization for your surgery or procedure, receiving care from an uncovered facility, or not having proper history or notes from your physician.

No matter the reason they deny your insurance claim, don’t give up immediately. Depending on the basis, you most likely have options to receive payment still. First, review your health insurance policy and find things to support your claim as well as educate yourself on what needs to happen to appeal the claim denial. Sometimes, all it takes is a phone call to clear up a misunderstanding. Other times, it will take your doctor’s office to get involved in supplying additional information. On occasion, it may require help from an attorney to sort things out and give you a chance for a better outcome.

Auto Insurance Claim Denials

Auto insurance can cover the insured in many ways, but most policies have basic liability coverage included. This is the insurance that provides coverage if you caused harm or other damages in an accident.

If you receive a claim denial from your auto insurance company, it could be due to several different reasons. For example, they may say that the accident was your fault. Or that they won’t cover your medical expenses because records show you had an existing condition and that your injury wasn’t due to the car accident.

Denials from all types of insurance happen often. However, it isn’t anything to panic about. The good news is that you, as the policyholder, have the option to hire an attorney to take care of everything for you.

An insurance claim attorney has the know-how and experience working with insurance companies to help you get the money you deserve. The lawyer team of Wormington & Bollinger will put your mind at ease and help you navigate through many of the possible pitfalls and mistakes that could prevent you from obtaining the money that is rightfully yours.

Homeowners Insurance Claim Denials

If you’re a homeowner who has borrowed the funds to purchase your home, you must have homeowner’s insurance by your lender. All kinds of repairs can be required in your home, especially if mother nature does its part. So covering yourself financially can be a lifesaver.

A homeowner’s claim denial could be due to believed misrepresentation, already existing problems, or neglect. In addition, they may not cover other things under your insurance plan.

Contacting an attorney to represent you, develop your case, and appeal your claim denial will allow you the support you need to increase your chances of receiving the money you deserve.

Legal Representation if Your Insurance Claim is Denied

Obtaining legal representation for yourself after an insurance claim denial can afford you the foundation you need to appeal your claim denial and move towards the funds you should have had initially.

While a denied claim can be frustrating, disappointing, and draining to deal with, Wormington & Bollinger can ease the stress you are under by managing the many moving parts a legal case can bring. Denied claims that your insurance should cover is unacceptable, and we will help make it right.

For more information on how we can help when your insurance company denies your claim, contact us today.