Insurance Company Denied My Claim Now What?
We have all been in a position where we have reached out to our insurance company to make a claim, then to find out that your claim has been rejected. This can be very devastating, especially if you have had a fire or had your personal possessions stolen.
In this post we are going to try and explain what could have caused your insurance claim to be rejected and things that you can do to ensure that your claim is accepted.
Why Your Insurance Claim May Have Been Rejected
Lack of Due Care
This means that valuables have been left out on show or your mobile has been misplaced whilst riding the bus. Many of these situations are not covered by your terms of your policy.
Poor Answers to All Questions on the Application
This can relate to not telling the insurance company about a medical condition which existed before taking out the policy or a previous criminal conviction which you did not state in your policy.
Incorrect Information Supplied
If you have given wrong information at any stage to your insurance company, maybe how something got damaged, it will affect your claim.
Should you be unhappy with the reasons your insurance company has given for rejecting your claim, then you are able to make a complaint to your insurance provider. If you have purchased your insurance through an insurance broker they may make the complaint for you, it would be worth asking to avoid the hassle yourself.
What Do I Do If My Insurance Company Denied My Claim?
Here are a few things you can do if you feel your claim should have been accepted.
Check over your policy
Checking over the details of your policy documents to see if you can fit the reasons given by your insurance company to the facts within your policy.
– If you took the time to answer all the questions on the claim application and have answered them as fully, honestly and to the best of your knowledge as you possibly can, then the insurance company cannot reject your claim. If you insurance company ask for information which they said you should have voluntarily enclosed, you should make a note of this.
– Write down or get a highlighter to make note of what exactly is covered within your policy, as you will need to be able to quickly find this information at a later time.
– Check that all the information you have given when taking out your policy is 100% correct.
– If you don’t understand any of the words in the policy, it would be best to highlight or make a note of these as the information which is supplied by the insurance company should be clear and concise.
How do I appeal an insurance claim denial?
“First, figure out what led to the denial of coverage and learn your insurer’s procedure for appeals. When you call your health plan to get the information, take notes and get names. If the problem can’t be readily resolved, you should ask the insurer for some key documents to reconstruct what led to the rejection.
You will need the denial letter. You should also get a copy of your plan’s full benefits language, sometimes called the “Evidence of Coverage,” as well as the detailed guidelines that explain what the company considers medically necessary. Some companies, such as Cigna Corp. and Aetna Inc., post their medical policies online.
After you gather the facts, set a strategy. You may want to start by seeking help from one of the array of nonprofit and for-profit entities that offer advice. Many states have health insurance consumer advocates.” From the article How to Appeal a Health Insurance Denial
Getting In Touch With Your Insurer
Once you’ve read through your policy, taking the time to highlight and make notes, it is time to get in contact with your insurer. There are several ways to do this, phoning their customer complaint line, writing a formal letter to send to their head office or by sending them an email. All of these methods will result in someone resolving the issue you are having.