Five Steps to Take if Your Insurance Claim is Denied

Insurance is intended to protect you against the “what ifs” of life. We pay for insurance coverage hoping to never need it, but when you do, you expect your insurer to provide the assistance you’ve been promised. So, it’s a huge shock when, instead of the money you need to make repairs and cover bills, you receive a notice that you claim has been denied. Loss of anticipated funds can leave one with massive bills and no means to pay them. 

If this has happened to you, don’t panic—you may still have options. Here’s the five most important steps to take if your insurance claim has been denied. 

Review Your Policy 

If your insurance claim has been denied, the first thing you need to do is review the details of your policy. Specifically, look for clauses which may explain why it was denied. While you should always thoroughly review any insurance contract you have before signing, reviewing it again can reveal gaps in your coverage which may explain why you were denied. Likewise, you may also find clauses which support your claim, at which point you should move to the next step– 

Contact Your Insurer and Gather Information 

The reason this step is second rather than first is because the way you approach this conversation is important. You need to be level headed and calm in order to get all the information you need. While the situation can be infuriating, it is unlikely the person you will speak to is directly responsible for denying your claim, but they can provide you with vital information.  

When you contact your insurance provider, be sure to speak to someone with the authority to review your denied claim. Write down their name and direct phone number if possible. Politely ask for clarification regarding why your claim has been denied. In some cases, your claim may have been denied erroneously. Giving your insurer the opportunity to correct this issue can save you time and money. 

File an Official Appeal 

If your provider still denies your claim, you can appeal their denial. By issuing an official appeal via formal letter, you grant them a second opportunity to review your case and decide their next option. This formal notice of appeal will likely bring your case to the attention to an internal review board. This group of insurance appraisers can overturn the denied status of your case. When your case is placed into review, it can put a hold on collections for bills accrued by the inciting incident. 

Get an External Review 

Because internal review boards are employed by your insurance company, working with a public adjuster in South Florida eliminates that inherent bias. A public insurance adjuster has no loyalty to any specific company, so you are more likely to get a fair result. Additionally, a North Miami Beach public adjuster at Cohen and Associates Public Adjusters can help you move forward with getting the money you are owed. Our knowledge and experience give you the advantage when dealing with an unyielding insurance provider. 

With Cohen and Associates, we don’t get paid unless you do. Your success is our success. Contact us today to get started. 

Prepare for Legal Action if Necessary 

You took out your insurance policy in good faith that your provider will honor the terms of your agreement in the instance of a covered event, such as an accident or illness. If your insurance company fails to do so, you may be able to file a ‘bad faith’ lawsuit. By allowing a judge or jury to make a final ruling, you may be awarded the compensation you deserve. Such a ruling is legally binding, forcing your provider to honor your insurance policy. Having an appraisal from a public adjuster in South Florida can help support your claim in court and provide expert testimony in your favor.  

Learn more about how Cohen and Associates Public Adjusters can help you at any stage of appealing your denied claim. Contact us today. 

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