Insurance Claim Denied

Insurance Claim Denied – What Can You Do?
Insurance companies have an obligation to conduct insurance investigations for the primary purposes of making fair insurance claim settlements.  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.

If you have had your insurance claim denied, what actions can you take in the interests of your loss, your legitimate insurance claim? Here's some advice from an insurance expert.

• 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 a 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 denied?

Where do you go from here?  Get started with this claims advice. 

1. 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 policies require that these conditions must be met before any further action can be taken, including lawsuits.

2. 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 an insurance claim denied, that denial must be the result of a fair and reasonable insurance investigation.

3. 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 claim delay process 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 investigation.

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