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What to Do When Your Insurance Claim Gets Denied

Finding out your insurance claim was denied can be very frustrating. You pay your premiums on time so that in the off chance you need coverage, it will be there for you. If your insurance claim was recently denied, it is important you understand your rights. You do not have to accept a denial without a fight. The Colorado bad faith lawyers of Cannon Law can discuss your legal rights and options during a free consultation.

Review the Stated Reason for Denial

The first thing you need to do after a denial is to try to understand why your claim was denied.

Your insurance company should mail you a formal letter that explains why they have denied your claim. Carefully review the denial letter. Look for the specific reason(s) the insurance company has denied your claim. If it references particular policy language, read that entire section of your policy. If it discusses what you must do if you disagree with the decision, note this information.

Common reasons why insurance companies may deny claims include:

  • The policy lapsed or was not in effect at the time the claim arose
  • The claim arose during an elimination period
  • The type of loss is explicitly excluded from your coverage
  • Information in the insurance application was not accurate or complete
  • You had inadequate coverage
  • You went to an out-of-network provider
  • You did not have pre-authorization from your insurance that was required

Even if the insurance company lists a reason, this does not necessarily mean the denial is legitimate. This depends on a case-by-case basis.

Review Your Insurance Policy

Carefully review your insurance policy. You may have an explanation of benefits or summary of benefits and coverage. If you cannot locate this information, request it in writing from your insurance company.

Supplement Your Claim

If the denial is based on the insurance company not having sufficient information, you may be able to provide additional information to supplement your claim. Provide the missing information to your insurance company and ask it to formally approve your claim.

Contact Your Insurance Company

Many times, people represent just another claim file to adjusters. However, you may get a better response if you can humanize yourself to the insurance company. Reach out to the adjuster listed in the denial letter and explain your position. Ask what you need to do to get your claim approved.

File an Appeal

Most insurance companies will have policies in place that allow their insured to file an internal appeal if they disagree with a decision. Ask your insurance company about the process to file an appeal and the deadline. The process will vary by insurance company and the type of insurance, but the process usually involves the following:

  • Gathering evidence to support your claim and submitting it to the insurance company
  • Preparing an appeal letter that states your basis for the appeal and how the evidence you have submitted supports your position
  • Resubmitting the claim

An experienced insurance lawyer can assist you through this process and ensure that you fulfill all of the procedural requirements to effectuate your appeal. Your lawyer can also explain if the insurance company may be acting in bad faith and whether you may have a separate claim for that.

Contact Our Colorado Insurance Bad Faith Lawyers for Help

If you believe your insurance claim was denied in bad faith, reach out to Cannon Law for help. You can reach us at (970) 471-7170 or contact us online for your free and confidential consultation.