When Your Insurer Denies Your Claim for Coverage

Insurance policies are supposed to be a contingency plan for unexpected events, whether it is health insurance covering a surgery or car insurance covering an auto accident. In practice, however, many insurance companies are more concerned with saving money by denying claims and not paying out money for valid claims. President Obama himself submitted an op-ed to The New York Times back in 2009 to explain why erroneous insurance denials were a major reason for his insistence on health insurance reform. This happens with more than just health insurance: auto insurance companies deny claims for accidents and stolen vehicles, and homeowners’ insurance companies refuse to pay for home damage right here in Florida, a major concern for many homeowners during hurricane season.

Fortunately, insurances companies are being held to their own policies and being forced to pay for customers’ valid claims more often. Earlier this year, major insurance company Cigna was disciplined by the government for incorrectly denying policyholders’ claims. Medicare beneficiaries, including people over the age of 65 and younger people with disabilities, were denied access to benefits and services, and even after customers filed complaints, Cigna failed to follow up on those complaints. As a result, Cigna has been barred from enrolling new customers in these plans, a serious penalty for the insurance giant and likely a serious concern to Anthem, currently in the midst of acquiring Cigna. Sanctions will make things easier for some policyholders, but until insurance companies reform their internal policies of saving money rather than paying valid claims, you need to be your own advocate.

What to Do If Your Insurance Company Denies Your Claim

Understand Your Policy

It is extremely important to make sure you know what your policy says so you know what is covered and what is not covered. Appealing a denied claim will be much more difficult, if not impossible, if your policy clearly states that certain events are excluded from coverage. If you do not understand something in your policy, contact your insurance agent or company to get an explanation. It is especially helpful if you review the policy and ask all questions before choosing an insurance provider and signing any documents to ensure that you purchase the policy which is right for you. Make sure that you follow your policy’s rules and limitations to avoid hassles down the road if your claim is denied for technical reasons (i.e. prior authorizations for medical care or using a non-approved contractor for home repairs after damages).

Use the Appeals Process

If you read your policy carefully, you should be familiar with the process for appealing a denied claim. Your policy will tell you the initial steps to take in contacting the insurance company and what kind of information your appeal will need to include. Do not be afraid to use this process to the fullest extent by appealing as many times as possible if you believe your claim was incorrectly denied.

Don’t Give Up

As you can see from the cases above, an insurance company’s denial of your claim does not necessarily mean that you will not be able to get your claim paid. Many companies deny valid claims that should be paid, so be persistent! If you believe your claim is covered under your policy, do not take the insurance company’s decision as the final determination. Even if you appeal and the insurance company continues to deny your claim, there may be other options available to continue fighting.

Be Organized

Your appeal will be much easier if you keep all documents sent to you by your insurance company as well as detailed notes of everything you do to appeal your claim, including the events in question, conversations with your insurance company, and costs incurred as a result of the event you want covered by your insurance.

Contact an Experienced Lawyer

Finally, contact an lawyer with experience in insurance disputes to help you fight for the compensation you deserve. If you are in Ocala or surrounding areas, let our experienced insurance team at the Piccin & Glynn help. John Piccin has dealt with almost every insurance company over the years and knows when and how to pursue claims that have been wrongly denied. Call us at 800-969-5446 or 352-351-5446 or contact us online today.

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