When Insurance Doesn’t Pay

When Insurance Doesn’t Pay

When you’re forced to file an insurance claim, it’s almost always because you’re in a stressful situation with few options. Maybe you were in a car accident or a loved one passed away due to the negligence of an employer. Or perhaps your own insurance provider denied your claim. Whatever the circumstances, you can be left in a tough position when insurance doesn’t provide you the financial compensation you deserve. Here’s how to handle it.

Step One: Hire an Attorney

The sooner you can do this, the better. After you file a claim, an insurance adjuster will contact you and start playing hard ball. Adjusters spend all day negotiating claims with customers, so naturally they are good at it. Their goal is to get you to accept the lowest amount possible to settle your claim. Even if you are an experienced negotiator, emotions can get in the way and leave you with an unsatisfactory (or unfair) outcome. It is important to hire a legal professional as soon as possible to handle the negotiations with the insurance adjuster for you.

Step Two: Document Everything

In many instances, you don’t realize you need to hire an attorney until after you start negotiating with the insurance company. It is important that you immediately stop your negotiations and document everything you remember while it is fresh in your mind. This includes:

  • Who you have talked to and their job title/role
  • When you talked to them and for how long
  • Everything you said to them regarding your injuries/needs
  • Everything they said to you regarding what they can and cannot provide
  • Any additional information that you remember

Once you have typed a summary of that information, send it to your attorney.

Step Three: Find your Insurance Policy

Note: This step is only applicable if you are working with your insurance—it does not apply if you are dealing with the insurance of the individual who harmed you.If your insurance company starts giving you pushback, review your policy and send it to your attorney. Your legal team needs to know the parameters of your policy and will identify if there is an applicable exclusion preventing the insurance company from paying out your claim.

Step Four: Look for any insurance notices

Insurance companies can reduce your coverage during the policy period, and may send you notices of reduced coverage. Search for emails or written documents that include any changes to your policy or your coverage. This can help identify why the claim is being denied.

Step Five: Let your lawyer fight on your behalf

Once you have gathered all of your documents and hired an attorney, your attorney will begin by contacting the insurance company on your behalf and requesting a written document that explains why your claim was denied. Your attorney will then look at the policy and advise you if this denial is legitimate, or an error. If they determine it was an error and you should have received coverage, they will advise you on whether to go through the insurance appeal process—if the company has one—or file a lawsuit.

Reasons Insurance Denies Your Claim

Some claims are valid, and insurance companies still deny your claim. Others are denied for issues you didn’t even know existed. The most common reasons for claim denial are:

  1. Lack of Coverage

In some instances, you are denied coverage because your issue falls into an applicable exclusion on your policy. For example, if you file an insurance claim because you were hit by another individual and you didn’t have uninsured motorist coverage, your claim will be denied.

  1. Expired Coverage

Your insurance policy doesn’t automatically renew, and if your coverage expires (whether accidentally or not), your claim will be denied.

  1. Not Within the Territory

Typically, your insurance policy will only cover certain areas, such as the United States. If you are injured in an automobile accident outside of that territory, your insurance will likely deny your claim.

  1. Not Seeking Immediate Treatment

If you are injured in some type of accident and wait to seek medical treatment, you may lose the ability to get that injury covered. Insurance companies can argue that your condition worsened because you failed to treat it immediately, or that your injuries aren’t a result of the accident. It is important to seek out immediate medical attention after an injury.

  1. Failure to Notify

You are required to notify your insurance company in a timely fashion of any accident or injury. Failure to do so could lead to the company denying your claim.

The Bottom Line

If your dealings with insurance have become a fight instead of a simple process, get help from an expert. There are certain steps you need to take in order to preserve your right to financial compensation. This can be difficult to navigate, especially when you are focused on your health. Once insurance denies your claim, or if you think they will deny your claim, your best course of action is to hire an attorney.