What to do When Insurance is Denying Your Claims?

Despite the fact that insurance is compulsory in most states, accidents are always bound to happen. So, as this is a fact, subscribing to an insurance policy will be essential. Whether for medical reasons or to protect your property or for another reason entirely, they will enable policyholders to share the risks with insurers. Still, ever so often a claim will be denied and the reasons can sometimes be vague. However, you should not despair, as there are things you can do to upend the results. That said, if you feel that you have been wrongfully rejected, here is what you can do.

Typically, you will want to start by checking your policy and see where things could have gone wrong. Read it carefully and highlight any mistakes that could exist. You will also need to mark down the areas that explicitly say you are ‘covered’, as well as any ambiguous information included. After having done so, you will need to identify the possible reasons for your claim being denied.

Identify Why Your Claim Was Denied

Your claim can be denied for many reasons and in order to contest this denial, you need to know why. The possible reasons are:

• Providing incomplete or inaccurate information. This includes omitting information regarding the diagnosis of your claim.
• A lack of prior authorization, as the service could be rendered as a non-emergency.
• Filing the claim past the period of contestability.
• A violation of the terms of the agreement, which can include non-accidental damage, or the service being excluded from the policy.

There are other reasons as well, though these are the most common. If you fall into any of these categories, then there is very little you can do. Some errors can be fixed, such as supplying the insurance with the information that is missing, whereas others are conclusive, such as filing the claim after the period of contestability has passed.

What You Can Do

On the condition that your claim has been wrongfully denied, you will have two typical routes to choose from. You may either begin by hiring an attorney or leave doing so for the final stage. However, this will depend on the nature of the case. Bad faith insurance claims attorneys will work with many types of claims, which can include home or commercial property insurance where the damage could have come from a wildfire, wind, water or other force majeure events. So, if your claim payment has been unreasonably delayed or if you received inadequate payment or if you were denied altogether, an attorney will fight to change the outcome. They may sue if:

• After the period of contestability has passed, the insurance denies your claim based on a misstatement.
• The information they offer for your denial is either absent or insufficient.
• Liability is reasonably clear, still, the insurance had denied your claim.
• The insurance had not approved or denied your claim within a defined period of time.

As for the other route you may take, it includes starting by writing a formal complaint to the insurance company. The complaint must include a date, your name and policy number, any evidence that proves eligibility, clearly expressing the issue along with the reasons why your claim should not have been denied. To ensure that you have included everything you need to include to be successful, it is definitely in your best interest to have a denver insurance claim attorney make sure you have included all the details you need. However, in the possibility that the insurance remains adamant about having you denied and have given you their ‘final response’, your lawyer may tell you to proceed as follows:

• Third Party Independent Assessment

You will need a third-party independent assessment. The assessment will be provided by a loss assessor, who will charge you for the report they issue. This report will be sent to the insurance company as evidence. This is important to do before you proceed onto the second step.

• Financial Ombudsman Service

Only after having received the insurance’s ‘final response’ or if you have not heard back for over 8 weeks, can you then approach the Financial Ombudsman Service. It is an independent institution that will offer their services free of charge. Start by downloading the complaint document from their official website. Look to include the ‘final response’ in your complaint. The Financial Ombudsman Service will then conduct their separate investigation and make their ruling. It will be incontestable without the chance of an appeal. The Financial Ombudsman Service possesses the power to have the insurance issue an apology and pay compensation.

Following these steps should be sufficient to change the outcome of your claim. However, if they are not and you disagree with the Financial Ombudsman Service’s decision, you may then follow with the appropriate legal procedures. Hire an attorney and they will take care of the rest. However, seeing as lawsuits can take forever, it is always best to start without one and leave it as your contingency plan.