Insurance Claim Denial
Insurance companies are not quick to advertise that good faith claims standards require them to investigate your insurance claim in a prompt and reasonable manner. Nor can they force you into an unwarranted insurance dispute grounded in unreasonable delay tactics and excessive demands.
The purpose of a legitimate insurance investigation is to pave the way for a fair and reasonable claim settlement. In the minority of situations where a claim denial is warranted, that insurance claim denial must be based on a solid and impartial investigation.
But unfortunately, dishonest insurance companies find ways to deny claim settlements rather than pay them. And these shady practices are based on the chance that by forcing you to wait, by forcing you to bow to their demands, you will eventually give up.
The more frequent unfair claim settlement schemes include unfair policy interpretations, unfounded coverage decisions, unreasonable demands for supporting information, and the most frequent of them all, the “ongoing investigation”.
These practices are conceived to generate extensive insurance claim delays, all without justification, all flawed. Following weeks and months of delays, you are at their mercy, not knowing whether your legitimate insurance claim will be honored or unfairly denied. And that’s the plan.
Your only chance is to accept the challenge of the insurance dispute. To do this, you must arm yourself with the knowledge to seize power from the insurance company.
You can begin with these basic insurance claim help tips.
Chances are your state has adopted the universal “Unfair Claims Settlement Practices Act”. These standards have been legislated into the laws of most all states, placing restrictions on insurance company unfair claims practices. For example:
• Insurance companies must promptly acknowledge and act upon your insurance claim. In some states, actions are required within a specified time period.
• Insurance companies must implement and follow stringent standards for the prompt investigation of all insurance claims.
• An insured person must be kept up to date on the progress of the insurance claim
• Insurance investigations are required to be both reasonable and timely.
• Insurance claim settlements must be fair and reasonable, and must meet reasonable expectations
• The insurance investigation cannot include unfair, unreasonable, and repeated demands for documents and supporting data as a requirement for settling your insurance claim.
Consistent violations of these regulations set the stage for an environment of unfair claims practices. You must learn how to recognize these tactics, and how to respond. Your goal is to achieve a fair claim settlement, even if that means you must rise to the obvious insurance dispute.
What should you do if you are the recipient of an unfair insurance claim denial? How can you protect your interests? Begin with the documentation.
• How were you notified of the claim denial? Denials must be sent to you in writing, they must be clear and precise, and they must specify the precise policy provisions that resulted in the claim denial.
• Insurance policies are contracts of adhesion, meaning the insurance company must interpret language to the benefit of the insured. Were the policy provisions fairly applied?
• Claim denials must be conducted in a reasonable and timely manner. Does the claim denial document support that such an investigation was conducted in regard to your claim?
• The insurance company must be prepared to defend its interpretation of the policy. Is that interpretation fair, impartial and relevant?
Here are some additional insurance claim help tips.
Study the “Unfair Claims Settlement Practices Act” for your state. Educate yourself on the laws and regulations that apply to unfair insurance practices. While these laws include penalties for unfair insurance practices, the authorities cannot intercede on your individual claim. Instead, take your knowledge of those laws to intervene on your own.
If the claim denial was issued by your insurance company, carefully study your policy. You must understand what your rights are according to that policy. And look specifically for appeals and review processes detailed in the policy. Some policy conditions require that you must meet these conditions before you can take further action, including the filing of a lawsuit.
An insurance denial must provide the specific conditions for that claim denial. An insurance company cannot ignore your claim, or place such obstacles in your way that you cannot possibly satisfy the unreasonable conditions. To the contrary, the company must resolve your insurance claim, and that resolution must be based on fairness and impartiality.
