Got A Denied Insurance Claim? Here’s What To Do

Your insurance plan is there to offer you protection from financial burdens due to accidental damage or injury. If you are in an accident involving a motor vehicle, your property, or an injury to you or your loved ones, you will have to file for an insurance claim. However, there is no guarantee that your insurance company won’t deny your claim. Here’s what you can do if you have an insurance claim denied. 

Why Your Claim May Be Denied

There are a few reasons why an insurance claim might be denied. Most claims with documented injury or damage should be approved, however, in some cases, there can be complications that lead to a denial. Here are a few common reasons why insurance claims can be denied. 

• Your claim could be more than what your policy covers. If you have maximum coverage for certain types of claims, but your medical or repair fees exceed that amount, you will be denied coverage for the excess. If that has not been stated in your claim, it may be questioned or denied. Make sure you are claiming only the maximum of what your plan covers. 
• Make sure your coverage includes the type of damages you are claiming. It could be that you don’t have comprehensive coverage, so your claim does not qualify under your coverage plan. 
• A claim can be denied if inaccurate or contradictory information exists. Failing to mention certain aspects in your claim could lead to a denial. Make sure all your information is accurate and collaborates with your initial insurance claim. 
• If you were found to be breaking the law during the incident relating to the claim, it may be denied. If your car was damaged, or you had an injury in a DUI, for example, you may not be able to make an insurance claim. 
• You may be suspected of insurance fraud for not reporting the injury or accident promptly. If you did not seek medical attention or report an accident to the police, then file for an insurance claim, there may not be grounds to approve, or you may be suspected of fraud. 

What To Do If Your Claim Is Denied

Check All Your Documents

If you have had a claim rejected, the first course of action to take is to make sure all your documents were filled in correctly and there were not any mistakes with information. Many claims are rejected because of an honest error, so double and triple check the information you gave is honest, consistent, and correct. 

Ask For Clarity On Their Reasons 

Often insurance companies will use jargon or ambiguous wording, don’t be afraid to ask for clarification on any language they use. It is also worth highlighting all the relevant information in your insurance plans that say you are covered and ask for further clarification on their reason for rejecting. If you receive a rejection, don’t just let it slide, make sure you understand the reasons for the rejection clearly. 

Contact Your Insurance Company And Write A Complaint Letter

If you still feel your claim has been unfairly rejected, it may be time to contact their complaint handlers or to write a formal letter of complaint. This will encourage them to take another look into your case and see if the reasons for the rejection were valid or not. You should follow a formal complaint template and include the following information.

Your name, date, and policy number. Title the letter ‘Complaint’. Include all evidence supporting your complaint. Explain clearly why your claim should not have been rejected and what you would like the company to do about it. You can also state any action you may take if you are unhappy with their response. 

Seek An Independent Assessment And Take Action

If you have received a final response from your company, or there has been no response for over 8 weeks, it may be time to seek outside advice and action. Contacting an attorney to look into your case and take any necessary legal action on your behalf may be the next step. The attorneys at Gartlan Injury Law say that most denied claims can be reversed with a good legal defense. Having an expert look at your case and advise you on the best course of action could be the difference between receiving anything and nothing. 

Your insurance is there to protect you from the financial burdens you would face if you didn’t have insurance. If you pay your monthly rates and maintain honestly with all your documentation, there is no reason why you should not get the insurance you deserve from your accident. And if you feel you have been unfairly treated, take legal action to ensure your claim is not rejected.