Insurance Denials

You have for filed a claim under your policy for your injuries after an accident and your claim is denied.  What is the next step?  The first step you should take is to review the denial letter to make sure you understand the insurance denial.  If it is because you failed to provide information or take some other action, take the necessary steps to rectify the problem as soon as possible and that should get your claim back on track.  If for some reason, you are having difficulty providing inYou have for filed a claim under your policy for your injuries after an accident and your claim is denied.  What is the next step?  The first step you should take is to review the denial letter to make sure you understand the insurance denial.  If it is because you failed to provide information or take some other action, takeformation for a reason that is beyond your control, keeping in touch with your claims representative and updating them on your progress can solve many problems.

Denial Letters and Reasons

If your insurance claim has been denied, take a good look at your denial letter.  If the denial is based on something, you needed to do correct it immediately.  Constant contact with your claim adjuster when you are having difficulties providing something they need may resolve many issues.  If you are not at fault for the insurance claim denial review, your policy to determine if it requires a certain procedure is followed if you dispute the insurance company’s decision and follow it.  Your state insurance commission is also a source of information for understanding your policy and help in pursuing a claim denial.  You can also file a complaint against your insurance carrier though the insurance commission.  Finally, your insurance policy is a contract; the insurance company is required to act in good faith in processing your claim.  If they have not acted in good faith, you may have a claim for damages.  Contact experienced counsel for guidance with any lawsuit in this area.

Review Your Policy

If your denial letter gives you some reason for the insurance denial that is not related to something you were supposed to do or provide.  Review your policy.  The insurance policy is your contract with your insurance carrier.  It may provide for a procedure that you must follow if you disagree with their decisions regarding your claim denial.  The denial letter may also include information about how to object to the insurance denial.  Follow those requirements before you take any further action on your claims denial.  If you feel your insurance carrier is not operating in good faith, you may be able to file a legal action against them.  If you have paid your premiums, the insurance company is required to pay your claim within policy limitations.

Insurance Commissions

Another avenue to pursue with your claim denial is to contact your state insurance commission, agency, or administration.  They can review and explain your denial letter. Each state regulates the insurance commission based on their laws. 

Some common violations include:

• Improperly denying or delaying payment of all or portions of a claim
• Improperly terminating your insurance policy
• Raising your insurance premiums without the proper notice or in excess of what the law allows
• Making false statements to you in connection with the sale of insurance or the processing of insurance claims
• vercharging you for services, including premium finance charges
  

Getting Legal Help

Insurance policies are complicated contracts even though they are written in plain English.  An attorney experienced in this area of the law can explain the confusing languages and clauses and the denial letter.  They understand bad faith litigation.  If you were successful in a claim for bad faith for insurance denial against your carrier, part of your damages would be your legal fees for pursuing the breach of contract.  This is not an area of the law for self-help.