People need to choose automobile insurance companies with care. Every person should know what is in his or her claim and exactly what the insurance company is going to pay in the event a claim needs filing. Be aware of any exclusions in the insurance policy. This is just part of the puzzle of finding the right insurance company.
Rates, value and time in business needs exploring. A person can find it a challenging task if the insurance company denies a claim; claims can be denied for various reasons. One big reason is a medical necessity; in some instances, winning a medical claim can be difficult. The insured will have to get their medical team involved through a documentation process. Doctors will have to write letters to the independent agent and explain why the insured should be covered. It may be necessary to get your health plan involved, and the insured may have to pursue a meeting.
Get with the insurance company and request a written statement about exactly why the claim was denied. Make sure that the claim did not cross a fine gray line in the policy. Also confirm that coverage is available for what was claimed. The first thing an insured person can do when a claim is denied is to contact the agent. If any mistakes are seen in the claim, notify the insurance agent at once. If the agent discovers that an error was made, the insurance company can reopen the initial claim.
Keep good notes and document times and dates of contact to the insurance company and who was spoken to and what was said. You can always request to see the claim form to review. In addition, the adjuster will write out a report for the insurance denial, and this can be requested for review by the insured.
If none of these steps is effective, the insured can take the case for appeal. A denial can also be appealed with the state insurance commissioner. This will prompt negotiations with hopefully a resolution. All medical information and documentation gathered through the months will have to be submitted.
As a last step, if the insured feels that the claim was wrongfully denied and is still not having any results with the insurance company, the insured can seek an attorney who is well versed in insurance denial cases. The insured can sue the insurance company for denial, a breach of contract and insurance violation. This attorney will tell the insured if they in fact, have a lawsuit case against the insurance company.