There are many different types of insurance, and most people understand the importance of having policies in place to provide protection against unforeseen events. If an insurance claim needs to be filed, most people would expect a quick and easy resolution. However, when a claim gets denied it can be very frustrating and confusing to the policyholder. Here are answers to some of the most common questions people have when their insurance claim has been declined.
Why Was My Insurance Claim Denied?
An insurance claim can be denied for a number of reasons, including:
- Coverage may not have been in effect due to missed payments or other factors
- There is a question of liability, or who was at fault, in the case of an accident
- The terms of the insurance policy may have been violated
- The information you provided on your original insurance application may be in question
- The claim exceeds the policy coverage limits
- You are filing a claim for coverage that you did not purchase as part of your policy
- The insurance company suspects fraud
- Important details have been left out of the filed claim
- The claim was not filed on time
- The insurance company believes your own negligence was a contributing factor
- The policy’s fine print may contain exclusions pertaining to the details of your claim
Can I Resubmit my Claim with Additional Information?
Yes, in many cases, you can resubmit your claim with additional information. If the denial was due to missing or incomplete information, providing the necessary details can help reconsideration. Ensure that you follow the insurer’s guidelines for resubmitting claims and meet any specified deadlines.
How Can I Appeal the Denial?
If your insurance claim was denied, the following steps can help in the process of appealing the decision:
- Review the Denial Letter – Understand the reason for the denial as stated in the letter from the insurance company.
- Gather Information – Collect all relevant documents, including the policy, claim details, and any supporting evidence.
- Contact Your Insurer – Reach out to your insurance company to discuss the denial and inquire about the appeals process.
- Submit a Formal Appeal – Prepare a written appeal with clear and concise reasons why you believe the denial should be overturned.
- Follow Up – Stay in communication with your insurer throughout the process and provide any additional information they request.
Should I Work with an Attorney to Get My Claim Resolved?
Some reasons for an insurance claim denial may be straightforward and reasonable, such as a missed premium payment. However, if you feel that the insurance company has unfairly denied your claim, and they are not responding appropriately to your appeal request, working with an attorney may be the best course of action.
Working with an attorney at Churchill, Quinn, Hamilton & Van Donselaar, Ltd. can be beneficial in the following ways:
- Expertise: Our attorneys specialize in insurance law and have a deep understanding of the legal intricacies involved in insurance claim denials. They can navigate complex policies and regulations to build a strong case.
- Negotiation Skills: We are skilled negotiators. Because of this, we can work with the insurance company on your behalf, increasing the likelihood of a favorable outcome.
- Documentation and Presentation: We know what information and evidence are crucial to a successful appeal, so we can help present the necessary documentation in a compelling manner.
- Legal Recourse: If the appeal process is unsuccessful, we can advise on further legal options, such as filing a lawsuit against the insurer. This step may be necessary to protect your rights and seek the compensation you believe you are entitled to.
- Reduced Stress: Dealing with an insurance claim denial can be stressful. Working with our team allows you to offload the legal complexities and focus on other aspects of recovery.
- Increased Success Rate: Appealing a denial can be complex, and many people do not have the capacity to achieve the outcome they desire. Oftentimes, those who seek our legal representation have a higher success rate in appealing denials compared to those who navigate the process on their own.
If you are dealing with an unfair insurance claim denial and you are seeking experienced legal guidance, contact us at 847-223-1500 to learn how we can help.