When an individual takes out an insurance policy and then needs to make a claim, he or she expects that the claim will be paid and there will be no issue. However, insurance companies may deny claims for a variety of reasons.
Common denial reasons
One of the most common reasons a claim is denied is because the policyholder failed to pay his or her premium and the policy lapsed. It’s important to continue to pay premiums each month. Also, if a claim is submitted too late, that is also a reason it may be denied.
An insurance company may deny a claim because it states that it is not covered by the policy. It’s very important for consumers to review their insurance policy documents to understand their coverage. This includes information about what is covered, how and when to file a claim, how the insurance company will assess damage if applicable and what the process is for reimbursement.
Steps the consumer can take
When disputing a claim, consumers should note who they talked to, what the conversation was about and what the outcome was. In some situations, it may be simply a matter of resubmitting the claim with the correct information in order to have it paid.
Also, consumers have a right to make a complaint to the state insurance regulator. This agency can help consumers resolve an issue with an insurance company. Statistics indicate that accident, health insurance and automobile claims have the highest number of complaints.
If an individual’s claim was denied, an experienced attorney can provide representation and advice about next steps.