If you’ve recently been in an accident, needed medical care, or experienced any kind of damaging event, the last thing you need is an unfair claim denial from your insurer. Fortunately, an insurance company’s “no” isn’t always final. With some extra effort, you may be able to get a better resolution from your insurance company.
How Insurance Coverage Disputes Usually Resolve
Insurance disputes can be resolved in different ways depending on the case, although most ultimately settle out of court. You will likely go through a negotiation process such as mediation or arbitration.
Your lawyer may also recommend going to litigation to push the insurance company toward settling or making a better offer. Companies generally prefer to avoid the costs of a full trial and the uncertainty of leaving the decision to a jury.
9 Steps to Resolve Your Insurance Coverage Disputes
1. Start keeping a record of your insurance-related communications.
Having a record of every phone call, email, and letter to and from your insurance company will help you gather evidence if your case continues down the road.
2. Get a written explanation of your claim denial.
Like most states, Washington requires insurance companies to provide a written explanation of claim denials. If they do not, that is likely an illegal practice, and having a record of your communications will help your case.
3. Check your policy.
Some disputes come from insurance companies failing to implement their own policies. If you’ve checked your policy, and you think the policy language implies the insurance company should have provided more coverage, you may be right.
In other cases, insurance companies insist they deny claims because of a reduction in coverage. Under the law, companies must notify you about a reduction in your insurance plan coverage or any other plan changes at least 60 days before the change takes place. You have a good chance of winning your claim if you can determine that you were never notified of the reduction in coverage.
4. Ask your insurance agent or group policy administrator to help.
When you purchased your insurance, you may have worked with an insurance agent or a group policy administrator. If so, that person has a duty to ensure that the coverage protects your insurance. They may be able to advocate for you with the insurance company. Allow the insurance agent 30 days to solve the problem, or let them know if you need it resolved urgently.
5. Do research.
Sometimes you can support your claim with research. For instance, if you think your insurance company didn’t give you a large enough payment for a medical claim, you can research what other medical providers charge for similar care in your area. You have a better chance of challenging the payment amount if local doctors typically charge more than the amount the insurance company gave you.
6. Contact the insurance company directly.
If your insurance agent doesn’t resolve your claim issue within a month or so, call the insurance company directly. Make sure to keep a record of the call, including the date and time, what you discussed, and the name and position of everyone you spoke to.
7. Go up the corporate ladder and make written complaints.
If the first person you talk to at your insurance company doesn’t help, be persistent and go up the corporate ladder. You can also make written complaints to whoever denied the claim and their supervisor. If that doesn’t work, try mailing the customer service department and the company president.
Your written complaint will be most effective if it includes all of the following:
- A brief description of the problem.
- An explanation of how the claim denial has affected you and any other involved parties negatively.
- Your policy number.
- A copy of any relevant forms, bills, or supporting documents you think could be helpful.
Send the letters by registered mail and keep a copy of the letter. Please note that Washington State (and most other states) view failing to respond promptly to letters as an unfair insurance practice.
8. File a complaint with the Washington State Office of the Insurance Commissioner.
The Office of the Insurance Commissioner can often help people in Washington State with insurance claim disputes. Among other things, they can review the insurance company’s response to make sure they followed state laws and your policy, then tell the company to fix the problem if they did not.
However, the Office of the Insurance Commissioner cannot resolve every case. They can’t require your provider to adjust their charges, respond to complaints, comply with state insurance laws, make liability decisions, or give you legal advice. If your dispute still isn’t resolved, you need to talk to a lawyer.
9. Get a lawyer.
An insurance lawyer can advocate for you during mediation, arbitration, or in court. They can also help you do more intensive research to back up your claim, including looking for nuances in the laws that may help you.
If you’re looking for an insurance lawyer in western Washington, the Anderson Hunter Law Firm is here to help. Contact us today to schedule a consultation with an experienced insurance lawyer.