Can You Fight A Claim Denial?

One secret that unscrupulous insurance companies want to keep from you is that when you file a valid insurance claim, the insurance investigation must be both reasonable and prompt.  Simply stated, the insurance company cannot force you into an insurance dispute with unreasonable demands or excessive delays.
 
Insurance companies have an obligation to conduct claims investigations for the primary purposes of making fair claim payments.  In certain circumstances, the insurance company might be compelled to make a decision in favor of a claim denial.  However, the denial must be issued for cause, and it must be the result of a legitimate insurance investigation.

Unfortunately, not all insurance companies are interested in legitimate investigations, and, instead, develop tactics to engage in disreputable practices.  Why?  To delay your claim, to make you desperate, to set you up for an inevitable claim denial, or to force you into an unwanted insurance dispute.

Some of the more common unfair claim settlement tactics include flawed and unfair policy interpretations, unjustified coverage decisions, unreasonable requests for supporting documents, and ever-popular "ongoing investigation".

All of these unfair claims practices are designed to extend and delay your insurance claim for extensive periods of time.  After weeks and months of delays, there no explanations, no justifications, and you have no idea if your valid insurance claim will be resolved fairly or unjustly denied.

You need help.  Insurance claim help.  Where do you turn?

You can begin with a simple search for your state's "Unfair Claims Settlement Practices Act".  These are standards which have been adopted into the laws of most all states.  These regulations place the following burdens on insurance companies.

• Insurance claims must be promptly acknowledged and acted upon.  Some states   additionally require that actions must be taken within a defined period of time.

• Insurance companies are required to implement and apply strict standards for prompt investigations of all insurance claims.

• Insureds must be kept abreast of the progress of the insurance investigation, and the insurance claim.

• All claim investigations must be conducted in a manner which is reasonable and timely

• Insurance claim settlements must be reasonable, and must not fall below reasonable expectations

• The insurance company cannot use unreasonable and repetitive demands for documents and information as a means to delay your claim

A violation of any of these standards presents a likely environment for unfair claims practices.

You have no choice but to act.  You must do everything you can to reach a fair claim settlement even if that means getting involved in an extended insurance dispute.

And, if you have been notified of a claim denial?  What actions can you take in the interests of your loss, your legitimate insurance claim?

• Has your claim really been denied?  All claim denials must be made in writing, must be defined clearly, and must reference the exact policy provisions that triggered the claim denial.

• Policy provisions must be interpreted to the benefit of the insured.  Were they misinterpreted for the purposes of the claim denial?

• Is there supporting evidence that the insurance company conducted a reasonable and timely insurance investigation to support the claim denial?

• The insurance company has the burden to defend its interpretation of the policy language.  Is that interpretation both relevant and clear in terms of the claim denial?

Where do you go from here?  Consider these initial insurance claim help tips.

Find the "Unfair Claims Settlement Practices Act" that applies in your state.  Look for the laws and procedures in place for the investigation of unfair claims practices.  Understand, however, that while state laws usually incorporate penalties for unfair insurance practices, authorities are not in a position to get involved directly in your insurance claim.  Unfortunately, that intervention is your responsibility.

If your claim denial came from your insurance company in a first party claim, by all means carefully review your policy.  Understand your rights under that policy, and look specifically for appeals or review processes.  This is extremely important because some policy require that these conditions must be met before any further action can be taken, including lawsuits.

Every claim denial must be issued in writing with no exception.  An insurance company cannot act by ignoring your claim, or by hoping that you will give up and go away.  They must resolve all claims.  And in the case of a claim denial, that denial must be the result of a fair and reasonable insurance investigation.

In every case, denied insurance claims must be denied with specificity, in writing.  The company cannot simply choose to ignore your insurance claim or to place you in such lengthy delays that you finally give up.  If they decide to deny your claim, they must notify you.  And, that notification must be timely, following a legitimate, reasonable insurance investigation.

A veteran of the insurance industry, former insurance investigator Jane Pytel 's e-book Power To Profit enlightens readers to refuse to accept that the insurance company holds the power.  Now is the time for you to discover how you can protect yourself from an unfair insurance dispute. Join those who have already benefited from Jane's unique insurance claim help tactics.

© Jane Pytel 2010