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Frequently asked questions about denied insurance claims

On Behalf of | Jan 29, 2024 | Denied Insurance Claims

Insurance serves an important purpose and provides a benefit in many areas of our lives. Car insurance, medical insurance or homeowners’ insurance are all designed to shield us from major expenses after an accident or disaster.

The insurance claims process usually involves several steps that must be completed correctly and within certain deadlines. But sometimes if you do everything correctly you find your claim denied, leaving you with many questions.

Why was my claim denied?

There are several reasons your claim may be denied. Some are relatively minor reasons that could have a simple solution, while other reasons are more complicated.

Some common reasons for denials include:

  • Failure to follow proper instructions
  • Lack of documentation
  • Missed deadlines

Before you submit your claim, you should review your insurance policy carefully and in detail. Missing a step in the process or not submitting complete or correct documentation can cause an otherwise valid claim to be denied.

Deadlines are extremely important. There might be different deadlines throughout the process and missing just one of them could result in a denial.

For example, there can be a deadline to file your claim and another deadline to submit documentation. If you file your claim in time but miss the documentation deadline, your claim could be denied.

What should I do if my claim was denied?

The first thing you should do if your claim is denied is review the denial letter in detail. The letter must clearly explain why the claim was denied so you understand your options.

If the letter does not have a written explanation that you understand, call your insurance company immediately and find out the reason.

Keep copies of every document you receive related to the denial. This includes any communications between you and the insurance company.

Communicate through email if possible. If you have a telephone conversation, write down the date and time of the conversation, the name of the person you spoke with and everything they told you.

Can I appeal the denial?

If the denial is because you forgot to submit a piece of paperwork or give certain information, the claim may be approved if you submit the paperwork or provide the missing information.

When the reasons are more complicated, you can usually appeal the denial. Each insurance company has their own specific internal appeals process.

Learn the rules for appealing and file an appeal as soon as you can. As with the claim submission process, the appeals process has requirements and deadlines. Missing one of these could cause your appeal to be denied before you even get to a hearing.

How can I avoid a denial in the future?

The best way to avoid another denial in the future is to remember to review the policy requirements before submitting your claim. Sometimes even if you do everything in the process correctly, your claim might be denied because it is outside your coverage limits.

Reviewing your policy to learn what is and is not covered can save you from submitting a claim for something not covered. You can instead explore other options to cover your losses.

Providing your insurance company with as much information as possible can also help you avoid a denial. Letters, photos, reports and other documentation are all important evidence that should be submitted.

Getting a denial letter can be frustrating and scary but remember that you have options and a right to appeal.