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What to Do After an Insurance Claim Is Denied

Wednesday, July 25th, 2018 By

accident injury One of the worse things for a person to experience is having their insurance claim denied. Whether you were in a car accident, slip and fall accident, or experienced some other trauma where someone else was liable for your injuries, you need to be compensated for your medical expenses, damages, and lost wages. However, insurance companies look at every angle to determine whether you were at fault for the accident so that they don’t have to pay for an insurance claim.

Steps to Take When Your Insurance Claim Is Denied

Once you receive a denial to your insurance claim, you may think that your only option is to just pay for your medical injuries and damages out of your own pocket. Yet you do have another option. You can appeal your claim and make a formal demand for compensation.

Find Out Why the Claim Was Denied

Before you take any steps in appealing your claim, you want to understand the reason for the denial. Did you wait too long to inform the insurance company about the accident? Is the injury covered by your insurance policy? Were there any policy exceptions that your personal injuries fall under where your claim could be denied, and is your policy still active? All of these instances can be used by your insurance company to deny your claim. There are also other reasons why an insurance claim may be denied:

  • You were partially at fault for the injuries
  • Inaccurate information on the claim documents
  • Errors on medical bills and health records
  • The medical procedure you need may not be covered by the policy or deemed a medical necessity

Always look at the denial letter to see if the insurance company provided a reason for denying your claim. Once you know the reason, you can take the steps necessary to prove your case to the insurance company so that they will not be able to deny your claim a second time when you reapply.

File a Demand Letter

You will need to draft a demand letter that states your case and the reasons why you should obtain compensation. The letter should go into greater detail on why you think the other person is at fault for your injuries, and why you are requesting the compensation amount or treatment. You may also have additional documents, photos or other information that you can send with the demand letter that further proves why they should approve your insurance claim.

The Appeals Process

Most insurance companies will have an appeals process, and many states may require that an insurance company to go through arbitration or an appeal’s process for all denied claims. The length of this particular process can vary. It is always ideal to have legal representation as your attorney will have more knowledge about these claim cases and arbitration stages with insurance company. Then they can leverage their legal experience to help you win your claim and seek out the compensation amount that you demand.

When to Appeal a Claim

You should appeal any insurance claim that you feel should be compensated. You should also appeal your claim if you feel that the insurance company is engaging in improper claim denial practices. Your attorney will be able to review state laws in regards to prohibited acts and make an additional claim toward the insurance company for engaging in such illegal practices that go against state laws. If you go through all the steps in appealing a denied claim and the insurance company still will not offer compensation, you may decide to file a lawsuit.

Getting Representation for Insurance Claim Denials

If you are injured in an accident and someone else is at fault, you should be compensated for your injuries even when the insurance company denies your claim. The law firm of DuBoff & Associates Chartered can review the circumstances of your case and insurance claim denial. Then we can offer you a consultation to go over the details as well as provide advice on how to go through the appeals and arbitration process.  Contact our office today to set up an appointment to review your claim.

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