It is the wish of every insured person to submit their claim application, and have a timely compensation as per the initial agreement. Unfortunately, this is not always the case for many people. The insurance company can sometimes deny your claim, and leave you worried about what step you will take next. Claim denials are common, and they happen due to many reasons. You should, therefore, not lose your hope on the compensation if your claim application has been denied.
Here is a step by step guide of what you should when an insurance firm denies your claim:
1. Understand The Main Reason For Their Denial
As mentioned above, there are many reasons as to why your insurance firm might reject the claim. The first step, therefore, is to find out the exact reasons which lead to the rejection of your application. On many occasions, the insurer will send you an official letter stating the reasons for the rejections. Read through it to confirm if the reasons are valid.
Here are the common reasons why claims are rejected:
- Incorrect Information- the insurer could have dismissed the application because you provided wrong information about the case. You can correct this by providing accurate details.
- Wrong Coverage- perhaps the insurer does not provide that type of coverage.
- Coding Mistakes- your medical practitioner might have signed in the wrong medical information, incorrect medical procedures, or the improper drug prescriptions. They might also have signed in the wrong date; thus, driving the insurance firm into confusion.
- Past Due Applications- every insurance coverage has its deadlines under which the insured should submit the application. A delay in the submission can, therefore, cause a rejection.
- Unnecessary Treatment- the insurer might have found the treatment you underwent unnecessary hence, unworthy for the compensation.
- Late Payment Premiums- it is essential to pay your premiums at the right time. A single delay can cause a claim application rejection.
Some of the reasons mentioned above might be legit, while others might be wrong. So, review the denial reasons carefully to find if they are legit.
2. Inform The Insurance Firm About The Mistake
Most insurance firms provide a guide of the steps that you should follow in case the denial of the claim is not legit. Go through those instructions and then write an official letter to discuss the mistake. If the insurer had made a mistake that led to the wrongful decision on your side, provide the right information by attaching evidence. Some of the things that you can use as evidence for the case include X-rays, pictures, videos, tests, police reports, and so on. Ensure that the documents you attach for proof are genuine and legit lest you put yourself in further legal issues.
The insurance firm should give you a response within 72 hours if the appeal is urgent. However, the answer might sometimes take up to 60 days if you have already received the medical treatment. If the waiting takes longer than expected, remind the insurer politely. During the waiting period, you can contact the manager, the supervisor, or any other authoritative person in the insurance person. Be sure to keep the contacts, as well as a record of your communications with them.
3. Seek Third Party Help
It might be essential to seek the advice of a third party if the insurance company denies you the compensation once more. The third-party support is also necessary if you feel that the insurance firm is breaching the contract or bullying you. The most effective third party help that you can get is by hiring a lawyer. There are many types of lawyers, and you should, therefore, browse the site to learn more about how a specialized lawyer can help you deal with your case. Ensure that the lawyer deals with the wrongfully rejected claims, delayed compensations, and the wrong cancelations of applications. The right lawyer will first investigate the case and determine the property damage or injuries that you have suffered. After that, the lawyer will make a follow up of the situation on your behalf.
A claim denial is one of the hardest things that anyone can go through, especially if the damage is severe, or there are several costs to be settled. You can, however, do a follow-up and file an appeal for the breach of the contract. If this happens to you, start by understanding the main reasons for the rejection. After that, communicate to the insurance firm regarding the issue. If the issuer fails to respond, contact an attorney for legal help.