Insurance companies are built to make money, just like other businesses. The less they have to pay out to policyholders, the higher their profit. It’s not unheard of for an insurance company to find excuses to deny a claim or pay a policyholder a lower amount than is fair.
If you think your insurance company is not paying out as much as it should be, especially after reviewing your policy, you may be right. Here are some tips to help you get the money you are owed as a policyholder.
Tips for Dealing with Insurance Companies
- Keep a record of all phone calls to your insurance company.
Whenever you call your insurance company, make a record of the call date and time and the names and positions of everyone you spoke with. You may also want to save phone bills that list the calls.
It’s also a good idea to quickly follow up on each call in writing. A written letter that states what you understood from the conversation and requests a response within 30 days could help speed up your case.
- Don’t assume that “no” is final.
Many insurance claims are unjustly denied the first time the person applies. However, these denials do not have to be final. If you think your claim was denied unjustly, you should question your insurance company.
Policyholders who contest their cases often have a good chance of winning or at least receiving a higher settlement.
- Ask for a written explanation of your claim denial.
In most states, insurance companies are required by law to provide a written explanation of claim denials. If your insurance company does not provide a written explanation, that may be considered an illegal practice.
- Double check your policy to find out if your claim was legitimately denied.
It’s not unheard of for insurance companies to interpret policy clauses differently from how their policyholders interpret them, and sometimes even ignore those clauses. If you think the insurance company’s decision is unfair based on their policy, you may be right.
- If your claim was denied because of a reduction in coverage, check whether you were notified.
Your insurance company may insist they denied your claim because of a reduction in coverage. If you can determine that you were never notified about the reduction in coverage, you have a good chance of winning your claim. Failure to notify a policyholder of a reduction in coverage violates the law.
- Know that a filing error is not grounds for refusal.
While you should always follow the instructions for filing a claim, failing to fill out a form correctly or missing a deadline (even if you’re several months late!) is not grounds to refuse a claim. An insurance company cannot refuse to pay an otherwise valid claim unless it can show the error prevented it from making an adequate investigation or otherwise caused harm.
- Ask your group policy administrator or insurance agent for help.
The insurance agent or group policy administrator who helped you purchase your insurance may be able to help you. They have a duty to ensure the coverage protects your interests.
- Do research to support your claim.
The more research you have to support your claim, the better. For medical claims, it’s a good idea to find out what other medical providers in your area charge for the same type of care. If other local doctors charge more than what your insurance company gave you, you may want to challenge the payment.
- Contact the insurance company if the problem isn’t resolved within a month.
If your group policy administrator or insurance agent doesn’t solve the problem within 30 days, call the insurance company directly. Again, make sure you are keeping a record of all insurance claim-related phone calls, including the names and positions of everyone you speak with.
- Keep going up the corporate ladder.
If the problem still isn’t resolved, keep going up the corporate ladder. Be persistent, but stay polite with everyone you talk to to get the best chance of having the problem resolved.
- Make a written complaint if your phone calls don’t get results.
If your phone calls aren’t working, make written complaints. Start by sending a written complaint to the person who denied the claim, then try that person’s supervisor. Try sending the letters by registered mail, and keep a copy of each letter.
Each written complaint should include a brief description of the problem, an explanation of the negative effects caused by your claim denial, your policy number, a copy of every relevant form, bills, and any other supporting documents you think could help. Be sure to stay polite — avoid rude statements. Request a response within a specific amount of time, such as three weeks.
- Write a follow up letter with your original letter attached.
If sending written complaints to the person who denied the claim and their supervisor didn’t work, try mailing the insurance company’s customer service department and the company president. Attach your original letter to this letter.
Failing to promptly respond to letters about claims is considered an unfair insurance practice in most states.
- Get your state’s Department of Insurance to help.
Your state’s Department of Insurance may be able to help you for free. Depending on the state you live in, the state may be able to mediate your dispute.
- Hire an insurance lawyer.
An insurance lawyer can give you a better chance of success with your claim. They can help you argue your case, do more intensive research to back up your claim, and bring the situation to court if needed.
The Anderson Hunter Law Firm defends individuals with a variety of types of insurance claims, including auto accidents, personal injuries, accidents that occurred while operating equipment, and many other common types of claims. Reach out to us today for legal representation and assistance with your insurance claim.
My Insurance Company Still Won’t Pay. Now What?
If you’ve tried the steps above, and your insurance company still won’t pay, you can get help from the National Association of Insurance Commissioners (NAIC). The NAIC is a federal agency that handles customer complaints in the insurance industry.
For complex cases, we recommend seeking out an insurance lawyer who specializes in complaints like yours.
Should I Hire an Insurance Lawyer?
If you believe your insurance company is treating you unfairly, or if you are planning to file a large claim, we recommend hiring an insurance lawyer. Disputes are more common when there’s more at stake for both you and the insurance company.
Here are a few signs you could benefit from an insurance attorney’s help:
- Your claim is complex and/or expensive
- You and the insurance adjuster didn’t agree early on
- Fault is hard to establish for your claim
A lawyer can help you present your claim more effectively and give you a higher chance of success. Insurance companies are less likely to try to deny a valid claim when there’s an attorney involved.