Overview
Getting a denial notice from your insurance provider can be frustrating. In the case of life insurance, most companies do not raise an issue when someone requests for life insurance benefits. Your dilemma usually stems from the insurance carrier.
There is only one solution to ensure that you get the benefits you deserve: hire a lawyer. Denied claims are not the end of your appeal process. You can request for a reconsideration. If your insurance company refuses to cooperate, take the matters into your own hands by getting a lawyer to file for an appeal. Once the works are in motion, you will be in a legal fight to prove you deserve to receive the benefits.
How do I know that my claim is denied?
Insurance claim denials come in many forms. There are direct ones in the form of a life insurance denial letter. They can give you a lot of reasons, but the most common would be something such as the amount you’re requesting: it may be too much and you need to revisit some of the expenses that might not actually be covered.
There is another method of denial, in which the insurance company drags the process as much as possible. They will make excuses to prolong the process like changing adjusters, asking more documents, etc. This is to stall until the statute of limitations applies to the claim.
It is necessary for you as the requesting party to conduct regular follow ups on your application. Some insurance providers take their time until you are put in a very strict time limit. There is a specific deadline in which you can sue an insurance company for a denied life insurance claim and they are counting on the fact that you might not have enough time to prepare the documents to qualify for a hearing request.
I was denied health insurance, what do I do?
Whether you have had your prescription denied by insurance company or your insurance denied claim after surgery, do not panic. You can do any of the following:
- Coordinate with your insurance provider for answers. There is a contestability period for life insurance that applies to all and spans about 2 years. This means that your insurance company can contest the claim for the first two years of the policy if there has been misrepresentation. If they cannot give you a direct answer, you can try the other methods.
- If your company refuses to cooperate, escalate your concern to the regulator for your insurance company. Regulators are independent bodies that oversee the operations of individual private insurance companies. They ensure that they are conducting good business towards all their clients. Have the regulator conduct a review of your case.
- We recommend that you get a legal representative to sue your insurance provider. Most lawyers work on a favorable fee structure for clients. Consult with our lawyers at TSF Law and find out what you can do in order to get your insurance benefits.
Reasons for Denial of Life Insurance Coverage
There can be numerous reasons for denial of your life insurance. The most common (among many) reasons for life insurance claim denial is a non-covered charge. An insurance company will not honour the total amount of money you need for your claim. Some insurance companies dispute the amount because of various reasons that are, at times, minor. Also, some requests are thought to be not covered by your policy in the first place that is why it was denied.
Some denials are also caused by lacking documents and information. In such cases, a representative will contact you for more documents. However, some people fail to submit in time because they were not made properly aware of the deadline. Another variation to this is when the data in the forms do not match the supporting documents. It is very important that you provide accurate information because the insurance company can treat it as a dishonest request in bad faith.
Lastly, your reason for the claim may be due to an “unacceptable” behavior. The simplest example for this is in the case of health insurance. For instance, if a policy holder injures themselves in a fit of rage under the influence of alcohol. This is obviously not a good behavior and the accident only happened because of the person’s recklessness. These types of reasons are less likely to be approved.
How to avoid a denial?
One thing you can do is to be very vigilant with your policy. Upon signing up with an insurance company or your employer, review the written provisions. Make sure that you understand what they mean precisely. Most contracts are written by the carrier, so complex terminology is almost always used. In such cases, all you need to do is consult a legal counsel and have him explain the items to you. This way, you can get the legal aspects of the contract as well.
Another way is to make sure that when you submit a claim application, you have complied with the carrier’s rules and requirements. This means complete documents, accurate information, completely filled-out forms, and the like. Moreover, make sure that you are actually covered for your request. Review your contract first before proceeding any further.
Sometimes, insurance companies can find ways to make a denial sound legit. In such cases, prepare yourself to pursue them with a case. In order to get leverage, get your own attorney.
