Mansell, Engel & Cole

Being proactive, resolute in the wake of an insurer’s denial

When a big dog gets up close and barks, many people freeze. Some panic and run.

That’s not a good idea where an insurance denial is concerned. Although the inclination of many policyholders receiving a denial letter from an insurer that has an unmistakable “this is nonnegotiable” tone to it is to just give up, those claimants are well advised to think again.

Because an insurer’s bark is often worse than its bite.

Here’s a bottom-line reality concerning insurance claims: Insurers are legally tasked to pay them in legions of cases where they first insist they have no duty to do so.

The relationship between a policyholder and an insurer is contractual. If the former acts in good faith concerning legal obligations, he or she can reasonably expect an insurance company to do the same. Failure to do so is bad faith that opens up a coverage entity to legal liability and damages.

A recent Forbes article addressing health insurance denials and strategies for contesting them rightly advises a denied claimant to fight back rather than surrender to an insurer’s rejection. In doing so, it duly notes that an estimated 65% of appeals are ultimately approved.

That doesn’t mean they’re easy. In fact, many policyholders wage a letter-and-appeals war that is protracted and seemingly overwhelming on occasion for its official nature and subject-matter complexity.

A proven pro-policyholders’ legal team can help materially with that, acting on behalf of a client from the vantage point of professional experience that knows how to demand accountability and good faith from an insurer.

If you are a denied policyholder, be proactive rather than passive. It is the surest route to a positive result in any insurance denial or other dispute.

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