One of the most argued actions today is the issue of insurance claim denial. You have paid thousands of dollars for coverage – health, auto, home, business, personal liability. But when something goes wrong, your insurance claim payment is denied. The company, citing some technicality or fine print, refuses to pay the claim.
The Reality of Insurance Claim Denial
The insurance claims process can be a long hard-fought road. Appealing claims requires a mountain of paperwork, verification, grit, and determination. Once companies deny a claim, it becomes a matter of business practice to stick with the denial. Most have an army of analysts and attorneys to fight for them. Once your claim has been denied, and your appeal as well, you will need an attorney versed in insurance appeals to fight on further. Remember, there are no guarantees that you will win the case, and the cost of litigation can be significant. Some attorney fees are based on whether the appeal goes in your favor.
Insurance Claims Most Commonly Denied/Appealed
- Small Business Claims
- Acts of God
- Customer Injury
- Product Liability
- Commercial Vehicle/Auto
- Personal Life Insurance
- Pet Insurance
Steps in Appealing a Case
- Write a response letter to your insurance company that lists your reasons for believing they should not have denied your claim.
- Gather detailed records and receipts to support your letter.
- Consult with an insurance regulator in your state to discuss your case and get advice on proceeding.
- Hire a lawyer and take your insurer to court.
Insurance Company 2-Step Appeal Process
Your policy should indicate how to appeal a denial, and there are typically two levels of appeal:
- A first-level internal appeal administered by the insurance company and
- A second-level external review administered by an independent third party.
When Health Insurance Claims are Denied
As the most commonly appealed denial of claims (250,000 each year), health insurance appeals come immediately to mind. Every day customers are appealing claim denials they consider unfair. Because the coverage under policies in the U.S. differs substantially, appeals can be difficult to construct.
Can Health Insurance Companies be Sued?
As of now, no. If you want to sue your health insurance company in federal court because they denied your claim or because they are not paying your medical bills in a timely fashion, chances are you can’t. Most companies have written into contracts mandatory arbitration clauses which prevent customers from a further appeal. However, some legislators have suggested changing the law to allow for suits from private individuals in federal court.
If you are one of the 250,000 who wants to appeal an insurance claim denial, Hunker Appeals is here to help. Our specialized attorneys will sort out the legalities of your case and advise you of the feasibility of winning the case. As appeal specialists, we keep abreast of every law pertaining to insurance appeals and provide the best chance of getting you what you deserve—what you paid for!
Residents living in Fort Lauderdale, Boca Raton, Weston, Miami, West Palm Beach, or other surrounding Florida communities, don’t wait. The appeals process has time limits.
Call or email Hunker Appeals now to set up a consultation.
Hunker Appeals, 110 Southeast 6th Street, Suite 2330, Fort Lauderdale, FL 33301 877-841-8808.
Email: [email protected]