If you find yourself filing a claim with your insurance provider, the process can be difficult. Filing a claim is even more frustrating if your insurer refuses to pay the claim. There are a few tactics to assist you in this process that involve persistence, patience, and following the internal and external appeal process.
Keep Accurate Records and Files
You submitted a claim to your insurance provider and it denied the claim. The National Association of Insurance Commissioners recommends that before you take any action, you locate a copy of your insurance policy and review its contents to understand your rights and obligations. The policy may confuse you; if so, contact your state Department of Insurance for clarification.
If you still believe you are entitled to recovery on your claim, contact your insurance provider. Have a list of questions that relate to why your insurer denied your claim and the internal process to appeal its denial. Keep a record of this conversation, noting the date, time, and person with whom you spoke. Maintain these records for future calls and use. Do not overlook the importance of maintaining accurate records of your conversations with your insurer.
Remain Persistent with Your Claim
If your first call is unsuccessful, do not lose your temper. Remaining calm is crucial to effectively communicating your reasons for having your claim paid. Ask to speak with a supervisor for additional clarification of why your insurer will not pay your claim. If the supervisor also refuses to pay the claim, submit a letter to your insurer stating the reasons why your insurance policy covers your claim. Cite language from your insurance policy in your letter. Provide as many details about your claim and provide specific evidence (i.e. medical records in the case of health insurance) to support your reasons for coverage. Keep a record of this letter with your previous phone call notations.
Internal and External Appeals
After submitting your letter, the insurer will provide you with the next steps of the internal appeal process. If completing the internal appeal process with your insurer does not yield positive results, contact an independent organization to assist you. Most states provide means to seek external appeals of insurance claim denials. These external appeals are referred to as "grievances," and according to Insure.com, most states provide specific guidelines for filing grievances with an independent review board. Contact your state's Department of Insurance for guidance through an external appeals process.
