Next to delay in claim processing, denial of a claim is the most common complaint received by the insurance department against insurance providers. If you have taken all the necessary steps to file the claim properly and if you were honest, then there are several actions you can take in case your claim is denied.
The information below will educate you on what to do if your insurance won’t pay.
If your claim is denied, do not give up. It is a fact that around 10% of the claims are denied for unjust reasons and among those only 1% follow-up to make it right.
In many states, it is illegal for the company not to provide you a written documentation supporting their denial. Make sure to get a written explanation from your provider.
You need to read your policy thoroughly to ensure the denial agrees with the policy terms. Only then, the denial is legitimate.
In general, filing errors or delay in filing cannot be the sole reason for rejecting a claim. However, if the company claims that your error has harmed the company in some way or your delay has prevented it from conducting the required investigation, then your claim can be denied legally for filing errors.
The person, who helped you get a policy or who manages your policy, would be able to help you in understanding and following up in this process.
If the above solution does not work within a month, then you need to call your insurer directly. Work up the levels if needed and document or record all the conversations. Follow up your call with a letter, mentioning your understanding of your conversation, and requesting some action or response in 30 days.
If your calls are not returned or no action is taken following them, then send a courteous written correspondence with all the documentation.
In many states, not responding to claims letters is an unfair practice. If you do not get any response, continue sending follow-up letters, attaching a copy of your original correspondence.
One of the free sources of outside help is your state’s insurance department. Some state departments will help resolve the issue through mediation. You can also take the paid help of a lawyer or an arbitrator (professional). You can even take the help of your doctor to help challenge your claim.
In any case, understand your policy; know your rights; keep perfect records; and enlist the right help if your insurance won’t pay you.