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Dawson and Rosenthal
Dawson and Rosenthal

What to do after your insurance claim is denied

Having your insurance claim rejected can be shocking. You expect your insurance company to be there for you when you need it, so when it is not, it is natural to want to fight back to get the insurer to live up to its promises.

But most people have never been in this situation before. What do you do to appeal a denied insurance claim apparently made in bad faith?

1. Review your policy.

Generally, the first step is to review your insurance policy, especially the Summary of Benefits and Coverage, which your insurer should have provided you. Looking over your policy gives you an idea whether or not the insurance company wrongfully denied your claim.

2. Ask for a review.

After reviewing your policy, if you suspect the denial was wrongful, the next step is to ask the company to conduct an informal reconsideration. Sometimes, the insurer changes its mind at this stage and the matter is settled.

3. Appeal.

However, this does not always work. If the company won’t reconsider, or reviews the claim and still denies it, your next step is to request a formal internal appeal. This is a more involved process, but still within the insurance company itself.

If this appeal is also unsuccessful, it may be necessary to further appeal, possibly to court. Your best bet for getting your claim paid is to hire an attorney experienced in bad faith insurance denial cases to represent you.

Time can be of the essence, especially when health care is involved, so contacting an attorney as soon as possible is a good idea.