Insurance Claim Denied: Next Steps

When denied a settlement for an insurance policy, the individual may need to hire a lawyer to fight the denial when the situation calls for a payout despite what the carrier says. Through legal representation, it is possible to receive a full settlement for the damage, healthcare or problem the policyholder faces in light of the circumstances.

One of the first things a person should accomplish when a denial occurs through an insurance carrier with a claim is to read the policy fully. Understanding the coverage is crucial to know if the denial is valid. There are often certain rights and obligations of the policyholder that may apply to the coverage. Additionally, the summary of benefits within the policy may explain why a denial occurs. Frequently, the carrier needs certain documentation or a process with all necessary activities performed by the policyholder. Then, he or she may try the claim again or seek legal representation.

The Policy and the Lawyer

Many insurance policies have an appeals process, certain paperwork needed and for various actions to occur before benefits may distribute to the policyholder. However, some may need to proceed through the first-level and second-level appeals before any monetary benefits are available. Some may process through a third-party with no connection to the carrier, and this may require an additional procedure with no ties to the company. If at any time the policyholder performs everything perfectly and still receives no benefits, he or she may need to hire a lawyer to determine if the claim is valid. Bad faith insurance companies may deny and provide no reason why.

In the Face of Denial

When facing a denial, the policyholder should take action immediately. This action may consist of writing down all questions that policy coverage documents do no cover or that remain confusing. The individual should also ensure he or she has all pertinent paperwork. Then, it is either time to contact the insurance carrier or a lawyer. This may depend on communication with the company. If no contact is possible, the policyholder may need to hire a lawyer to force a phone call or letter through or to pry details from someone that works at the company. If the carrier is receptive to communication, the person may press for further details about the denial.

When the matter of denial occurs through clerical errors, this could occur on either side. An employee may make a mistake, or the policyholder may place the wrong details on a different form. Additionally, the individual may see his or her claim sent to the wrong carrier, or a third-party requires additional details that the original company did not supply. If communication is possible, the error is generally easy and quick to fix. However, without any contact or further letters, a lawyer may need to become involved to attempt to resolve the matter. He or she may also press the carrier into initiating a settlement for the insurance claim.

Contacting a Lawyer

The most important aspect of the denial of an insurance claim is the reason. When the insurance carrier provides no reason or refuses to communicate, it is possible that there are illegitimate factors at work. If the company has bad faith practices, the carrier may attempt to keep any payouts for valid claims by ceasing all contact with the policyholder. In this event, it is crucial to contact a lawyer for support. Legal help may first attempt communication and then start the process to acquire the insurance claim monies.

Contacting legal support is essential to move from the confusing stage to the action stage. Once the information in the policy coverage is fully understood, the person may have all the paperwork and details to pursue a claim against the company. If the lawyer is able to receive contact from the carrier, he or she may sufficiently intimidate the company into providing a settlement offer for the valid claim. However, if the reason for the denial is legitimate, this could end the situation entirely. At that point, there is usually nothing else possible. However, for a false denial, the policyholder needs to push further for the settlement.

The Lawyer in Insurance Denials

Legal professionals that help with a denial may start the court process to litigate against the company when there is no other option. This could lead to pleading a case for a valid claim before a judge to receive as much compensation as possible for these circumstances.