You’ve diligently paid your insurance premiums so that you can achieve peace of mind knowing that you’re covered if the unexpected occurs. But when it comes time to rely upon that insurance policy, you may find your insurance provider less than willing to pay your claim, regardless of whether your case involves health, home, life or auto insurance. In fact, they might delay your claim or outright deny it in a way that’s contrary to law. If you don’t act to protect your interests here, then the insurance company will get away with their actions, leaving you in a tough financial spot.
Fortunately, you can take legal action to hold your insurance company accountable and recover the compensation that you deserve. But navigating the legal process can be confusing and difficult, leaving you unsure of how to build your case. We hope that this post will give you an idea of where to start that process.
How to build an effective case for an improperly denied insurance claim
There’s a lot of work to be done after your insurance claim is denied. Here are some initial steps that you might want to take to build your case:
- Review the denial letter: The insurance company should send you a letter specifying why your claim is denied. Really pay attention to the insurance company’s reasoning here, as it’ll give you an idea of where you need to start building your legal arguments.
- Review your policy: Once your claim is denied, review your policy so that you have an idea of where your claim should’ve fit in. You can also scrutinize the policy’s terms to see if the insurance company improperly relied upon certain exclusions. These documents can be dense, so be sure to read them through a few times to ensure you fully understand the provisions that are in play and how they may have or should not have been utilized in your case.
- Gather documentary evidence: If you’re going to appeal a claim denial, then you need compelling evidence to support your position. This will include evidence that shows how your situation met the policy’s requirements. So, track down and retain all medical documentation, pictures of the damage that’s been caused and emails you’ve had with the insurance company.
- Familiarize yourself with the appeals process: While you can try to convince the insurance company that they got your claim wrong and therefore need to pay what you’re owed, there’s a good a chance that you’ll have to file an appeal. To maximize your chances of successfully navigating the appeals process, you have to have an understanding of what it entails. That way you’ll be better equipped to craft your arguments and tailor them to address the appellate standard that’ll be applied.
- Continue to seek supporting opinions: Some claims are denied because the treatment or repairs in questions are deemed “unnecessary.” You might be able to fight back against these assertions by continuing to secure opinions from professionals and experts who can attest to the necessity of your incurred costs. So, be diligent here in securing the opinions that you need to build your case.
Be holistic in fighting back against your insurance claim denial
The insurance company isn’t your friend. They’re certainly not going to pay your claim if they can find a way to deny it. So, anticipate the insurance company’s next move so that you can build a compelling argument that counters them.
