Insurance is crucial for protecting a person’s assets. When the unthinkable happens and you need that insurance to cover the repair, replacement, or expenses associated with a loss, a denial of your claim can place you in an incredibly stressful position.
Insurance companies may deny claims, but there are still steps you can take to recover compensation after you receive a denial. Having an insurance claims attorney on your side can help make the process of appealing a denial less stressful, and can even help you maximize a potential settlement.
Let’s talk about what you can do if you receive a denied claim, and how a claims attorney may be of service to you in these situations.
1. Understand Why Your Claim Was Denied
Unfortunately, it is not uncommon for an insurance claim to be denied. There may be multiple reasons why a claim is denied, and some of them may even be due to simple technical errors, like not filing on time or filing incorrectly. Some common reasons for denials include:
- Application errors
- Lapses in coverage
- Damage that existed before the policy coverage dates
- Insurance fraud
- Filing a claim too late
- Bad faith insurance denials
The first step in attempting to resolve a denial is to understand fully why your claim was denied.
Read the Denial Letter
If your insurance carrier denies a claim, they must provide a written denial to you explaining why your claim has been denied. The reason should be clear, concise, and legally valid.
Speak with Your Insurance Company
Contact your insurance company when you receive the denial to ask questions and gain a better understanding of why your claim was denied and how you may proceed. Keep in mind that even if your insurance company tells you that you cannot appeal the denial or take any further action, this may not be the case. An insurance claims attorney can help explain your rights to you if you have been issued a denial letter.
Review Your Policy
Once you have a clear understanding of why your claim was denied, it is a good idea to thoroughly review your policy to make certain the denial aligns with the terms of your coverage. Policies can be difficult to interpret, and a claims attorney can help you understand your policy in plain terms.
2. Collect and Organize Relevant Documents
If you have questions about the validity of the denial, you can take action. Begin by collecting all documents relevant to your claim. These may include:
- Original claims submissions and letters. You will want copies of all claims submissions, whether they were online or via mail.Â
- Denial letter. Keep a few copies of your denial letter handy, along with any notes you took during telephone conversations with your carrier about the denial letter.Â
- Correspondence to and from your insurer. If you have retained telephone call notes, keep those along with the rest of your documents.Â
- Receipts from repairs and/or medical bills. It is a good idea to keep all receipts for therapies, treatments, medications, inspections, repairs, and any expenses you had to pay for out of pocket as a result of your loss.
- Photographs from accidents or incidents. If your loss involves an accident and you have photographs from the accident, collate them together with your appeal documents.Â
- Eyewitness accounts of the accident and/or incidents. After an accident or incident, eyewitness accounts may be useful for providing testimony later, especially if your claim is denied.Â
- Medical procedures and diagnosis letters. Keep copies of all correspondence from doctors, therapists, and other healthcare providers concerning diagnosis and treatment.Â
These key pieces of information will be useful to the appeals process and may be necessary to prove the validity of your claim. At this time, you should also review your claims submission process. If your claim was denied due to incorrect submission, correct the information and refile the claim.
If someone else filed the claim on your behalf, (like a doctor or employer) ask them to correct the information and refile the claim.
3. File an Internal Appeal
Insurance companies have their own set of rules for internal appeals. If you want to appeal the denial, you will need to know the rules that govern this process, such as:
- Specific timelines
- Resubmission forms
- Necessary documents that must accompany the appeal
For some types of appeals, like health insurance appeals, a note from a medical provider may help support your resubmission. It’s important to follow the steps outlined by your insurance carrier to avoid a denial due to a technical error.
If your first appeal is denied, there may be an option to file a second appeal. If that appeal is denied, you may still have options up to and including filing a lawsuit against your insurance carrier.
Legal Practice Areas
We can help with denied insurance claims.
Bad Faith Insurance Attorney
Commercial Property Insurance Dispute Lawyer
Denied Renters Insurance Claims Lawyer
Health Insurance Dispute Lawyer
Insurance Dispute Lawyer
Life Insurance Dispute Lawyer
Long-Term Care Insurance Denials Lawyer
Property Insurance Dispute Lawyer
Travel Insurance Dispute Lawyer
Wisconsin Insurance Dispute Lawyer
4. Explore Other Options for Resolution
Sometimes, a resolution may not be reached through the internal appeals process with your insurance carrier. In these cases, you may still have other options. Filing an external review, filing a claim with your state’s insurance department, and taking legal action against your insurance carrier are options that may help you get the compensation you need for your claim.
Filing an External Review
Federal law provides that healthcare claims that are denied are eligible for third-party review. If you want to file an external review, you may do so within four months of receiving your notice of denial or final determination from your insurance carrier.
When you file an external review, an external reviewer will review your claim and the decision made by your carrier and either withhold the insurance carrier’s decision or decide in your favor. Your insurance carrier is required by law to uphold the decision of the external reviewer.
Filing a Complaint with Your State’s Insurance Department
It is also a possibility that you may file a complaint with your state’s insurance department. In Wisconsin, you may file a complaint with the Wisconsin Office of the Commissioner of Insurance online or over the phone. The office will review your claim and the denial issued by your carrier and determine if your claim was fraudulently or unlawfully denied.
Taking Legal Action
No one wants to take legal action if they don’t have to, but denied insurance claims can be extremely costly, leaving insured parties to pay thousands of dollars out of pocket for damages and expenses that they simply may not have. In these cases, taking legal action against your insurance company may be the best route to recovery.
Having an experienced insurance claims attorney on your side can help you with your appeal, and can help you fight the insurance company in a lawsuit if it becomes necessary to do so. Insurance claims attorneys can help you with denials of claims like:
- Health insurance claims
- Life insurance claims
- Property damage claims
- Travel insurance claims
No matter what type of denial you have experienced, an insurance claims attorney can help review your case, collect evidence to support the validity of your claim, and help you maximize your settlement.
When to Consult an Attorney for Insurance Claim Denial
You do not have to have an attorney to file an insurance claim, but it can be helpful to have an attorney on your side throughout the entire claims process. The sooner you have an attorney involved, the more knowledgeable they can be of your case, and the closer they can work with you and your insurance carrier to help you settle.
Keep in mind that insurance carriers always have attorneys overseeing their entire claims approval and denial process. They have a high-power legal department fighting for them and protecting their best interests and bottom line. Having the same type of protection on your side is key to avoiding lowball settlement offers, protecting against complications with filing errors and deadlines, and communicating effectively with the decision-makers at your insurance carrier’s office.Â
Even if you haven’t hired an attorney and have already received a denial, there’s still time to get legal representation. It is a good idea to hire an attorney before you begin the appeals process so that they can help you collect all the relevant evidence you need to fully support your claim and bolster the chances of your claim being accepted.
Bottom line: The insurance company will not be handling your claim without a massive legal team. The sooner you hire a lawyer to protect your interests, the better.
Discuss Your Claim with an Insurance Dispute Lawyer from Wallace Insurance Law
No matter where you are in the claims process, hiring an insurance dispute attorney to take your case can save you from the stress involved with denials and appeals. The attorneys at Wallace Law can help. We are available to meet with you to review your case and help take the reigns so you can focus on recovery, repairs, and regaining your footing.
Contact us today to schedule a consultation.
Related Content
Typically, renters insurance may cover a number of expenses and losses stemming from sudden, accidental damage, provided that negligence was not the cause. Renters insurance is more likely to cover a sudden and unanticipated event that occurs in your dwelling like a burst water pipe (provided you were not somehow negligent). Generally, renters insurance will not cover water damage caused by a flood.
January 6, 2025
Fire insurance is crucial for protecting your home and belongings from devastating losses. However, having your fire claim denied can be distressing and add frustration to an already difficult situation. Understanding the common reasons why insurance companies deny fire claims can help you navigate the process and protect your rights. If you are facing a […]
December 27, 2024
No one likes to be lied to, especially by a professional who is responsible for determining whether your insurance claim is valid. If you have been injured in an accident and have a sizable claim, you may find the tactics used by an insurance adjuster to be accusatory, shrewd, and downright dishonest.Â
December 26, 2024
You can navigate the challenges of dealing with an insurance company by understanding your policy and gathering compelling evidence to support an appeal. For more insights into handling insurance disputes, visit the Wallace Law guide on Wisconsin insurance disputes.
December 24, 2024
Just because your insurance company has rejected your claim or made an unreasonably low offer does not mean that it is the last word. You can fight back by retaining a dedicated insurance dispute lawyer. Wallace Law works hard to help clients better understand how insurance claims work so they can receive the payouts they deserve.
December 23, 2024
Talk to Us Today
Schedule Your Free Legal Consultation
