Car accidents, medical accidents, slip and fall accidents, and workplace accidents all have one thing in common — insurance coverage should be in place to cover these unexpected tragedies. You trust that the at fault parties in these accidents have insurance to cover injuries or property damage.
After your accident, you file a claim with the insurance company and assume that your mounting financial losses can be recouped. But what happens if your valid claim is denied and you need monetary relief now? How can you handle a denied insurance claim?
Reasons an insurance claim is denied
At times, insurance claims are swiftly settled and paid without issue. However, more often than not, insurance companies are reluctant to pay out claims — a denial could even stem from a miniscule paperwork issue. A denied insurance claim can occur for a plethora of sometimes head-scratching and confusing reasons.
For example, a 2022 report from the Kaiser Family Foundation showed that a staggering average of 18% (and up to 80%) of federal, in-network health insurance claims were denied. On the other hand, in 2021, the auto insurance industry incurred almost $200 million in losses, ostensibly from claims.
Here are some of the reasons an insurance claim may be denied:
- Improper coding, clinical validation issues, and patient registration issues:
Paperwork errors could account for denied health insurance claims. If you’ve been hurt in an accident and are seeking just reimbursement, this could mean astronomical out-of-pocket costs for you in the interim.
- Lack of auto insurance coverage:
If the person at fault in your car accident has minimal insurance coverage and your claim exceeds this coverage, their insurer may deny your claim. Similarly, if you’re hit by an uninsured driver, you’ll have to use your own insurance for any initial coverage.
- Failure to file on time:
Most insurance companies have a 30-day time window for filed claims, starting with the day of your accident. If you wait too long to file, this could invalidate your claim.
- Failure to seek medical treatment:
If you file a personal injury claim as a result of a car, slip and fall, or workplace accident but haven’t received documented medical treatment or a professional diagnosis, your insurance claim could be denied.
- Lack of proof of liability:
If you haven’t filed a police report, or cannot prove you don’t hold liability for your accident, an insurance company might deny your claim.
If your claim is denied, you’ll receive a rejection letter from the insurance company. This is important for your legal records should you decide to appeal the denial or sue the insurer.
How to appeal a denied claim in Indiana
Most insurance companies will allow you to appeal a denied claim. However, the likelihood of a reversed decision is slim. If you haven’t already consulted a lawyer about your claim, you may want to do so quickly after your claim is denied.
In order to appeal a denied health insurance claim, you can ask the insurer for an internal review of your claim. If it’s still denied, you can request an external review. However, this process can take a long time — meanwhile, you’ll still be expected to pay the medical bills that are flooding your mailbox.
Many car insurance companies have an appeals process as well. In order to begin the appeals process, you’ll need evidence that your claim is valid. You’ll also need to write a detailed letter to the insurance company to explain why their decision should be reversed. Again, it may take awhile for the decision to be reversed.
Other tips for a denied insurance claim
Remember, if your claim appeal falls on deaf ears, it may be time to consult an insurance lawyer. There are also steps you can take to ensure you deal with the rejected claim in a way that will best serve you.
If your initial appeal has failed, here are some other tips to help you deal with a denied insurance claim:
- Keep all pertinent insurance documents:
Insurance documents often include blocks of industry language and fine print. Make sure you carefully review this information before you decide how to proceed. Your claim may have been denied in error, and the documents may help you prove that to the insurer or in a court of law.
- File a complaint with the Indiana Department of Insurance:
If you can prove that your claim was erroneously denied, the Indiana Department of Insurance may overturn the insurer’s decision. Your complaint will also remain on file should you choose to pursue legal action against the insurance company.
- Consult an Indiana insurance attorney:
If the insurance company won’t budge, an Indiana insurance lawyer can help you understand the viability of your claim. Even before you choose to file a lawsuit against an insurer, a lawyer can contact the company on your behalf, and may be able to get your claim reopened.
How an Indiana insurance attorney can help
You don’t have to feel defeated by giant insurance companies. After you’ve taken the necessary steps to file your insurance claim and an insurer rejects it, you may need someone to fight in your corner.
An Indiana insurance lawyer can help you receive the justice you’re owed. The right lawyer can do the following:
- Gather all documents and evidence pertaining to your denied claim
- Send a legal letter to the insurer on your behalf, defending your claim
- Present forensic experts to lend credibility to your claim
- Negotiate any settlement offers for you
- Represent you in any mediation or arbitration meetings with the insurer
Contact Yosha Law
If your insurance claim was denied in Indiana, Yosha Law can help handle your case. We’ve helped support numerous clients through the insurance claims process, and understand how stressful it can feel. After an accident, you need to be able to focus on your healing and you shouldn’t have to face the insurance giants alone.
At Yosha Law, we consider our clients as a part of our family. We will fight for your just compensation and help guide you through the legal process of your claim. Contact us today for a free consultation and together we can explore the merits of your case.