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Insurance offers people financial protection from the high cost of accidents, storms, sickness, the death of a loved one and other devastating life altering events. Unfortunately, the insurance claim process doesn’t always work the way it should. Perhaps your life insurance claim was denied when it should have been approved. Or maybe your homeowners insurance is offering a settlement amount that is far below the cost of repair. If you find yourself in such a dispute, you may want to consult with an experienced local attorney to better understand what rights you may or may not have.

What If My Life Insurance Claim is Denied?

For the great majority of life insurance claims, the insurer will honor a claim without any issues. However, there are some cases where a life insurance claim is denied by the insurer. Most life insurance claim denials happen due to the following reasons:

  • Material misrepresentations on the application (if you die within the first two years of the policy)
  • Employer misrepresented information about coverage to its employees
  • Policy owner failed to pay premiums on time
  • There was no designated beneficiary
  • Policy owner changed the beneficiary
  • Policy exclusions such as suicide

If your life insurance claim was denied, it is important to know your rights. Insurers are legally required to provide a valid reason for denying your claim, which must be thoroughly and arbitrarily reviewed in good faith. A local life insurance attorney will be able to assist in the process of appealing the insurance company’s decision. If your claim was denied due to false information on your application, an insurance lawyer will attempt to locate an incontestability provision in your policy. This clause says that the insurer may not, after the policy has been active for a certain period of time, refuse to pay benefits because the insured lied on their application.

Why Was My Homeowners Insurance Claim Denied?

If your property experienced significant damage from a disaster such as an earthquake or flood, the last thing you want to hear is that your homeowners insurance claim was denied. Unfortunately, there are several types of damage most homeowners assume are covered by their policy, when in fact they are not. When reviewing insurance policies, it’s just as important to understand what they don’t cover. These exclusions are especially prevalent in property and casualty policies. Some examples of what may not covered in standard policies include:

  • Mold
  • Sewer backup
  • Sinkholes
  • Flooding
  • Construction work damage
  • Termite infestation
  • Earthquakes
  • Trampoline Accidents
  • Pool Accidents
  • Stolen Cash
  • Stolen Jewelry
  • Dog Bites

Even if the property damage is covered by your homeowners insurance policy, the insurance company can still deny your claim for other reasons. Conditions such as rot, decay and leaks that last several weeks, months or even years indicate that you have not taken good care of your property. In these cases, they can assert that your lack of diligence are grounds to deny coverage. Another reason they may deny coverage is when you fail to minimize or mitigate further damages. If you do not take quick action to secure damaged property from rain, thieves or any other threat, the insurer may deny your claim, asserting that you did not take the proper preventative measures following a loss.

Review Policy Details Carefully

Read your homeowners insurance policy very carefully to see if all of your risks are covered. Even before you consult with an attorney, it’s a good idea to review your policy with an experienced insurance advisor. A professional advisor who specializes in homeowners insurance can help you understand what coverage entails and can help you find the best policy for your particular situation.

Ask If Your Claim Can Be Reviewed Again

If you recently filed a homeowners insurance claim and were not given proper coverage or were denied altogether, realize that you are not alone. Questions and discrepancies about how much damage was actually sustained are one of the more common reasons behind a disputed claim. If the settlement offer is lower than it should be, ask the insurance company to review your claim again based new evidence. The costs for replacement and repair can be significant, so even small discrepancies can equal hundred or thousands of dollars. You may also want to consider hiring an affordable independent appraiser to help support your argument. An expert appraiser will not only examine the extent of the damage, but will value the items that need to be replaced.

When You Should Consider Hiring an Attorney

If the denial or disputed settlement amount is off by more than a thousand dollars, you may want to consider hiring an attorney who specializes in these types of disputes. If you’re considering this route however, it’s important to first weigh your chances of success versus the potential cost. Many law firms offer a free consultation to learn more about your case and whether you have a valid claim. During this meeting, make sure you provide as much evidence as possible (in the form of photographs and videos) to show how much damage exists and how it happened. The more information you provide, the better the assessment a lawyer can make about the validity of your claim.

What If My Health Insurance Won’t Pay?

If your insurance company denied your health insurance claim, you may feel like your financial security is at stake. However, many of these issues can be easily addressed, either through the appeal process or by making corrections to the medical documents submitted. If the appeal is unsuccessful and the insurance company still refuses to accept your valid claim however, it may be time to seek the advice of an insurance lawyer.

Reasons Your Health Insurance Claim Was Denied

Many insurance claim denials arise from questions about whether treatment was medically necessary. Determination of medical necessity may lie with an administrator, physician review board or some other committee of your health insurance provider. In many cases, the insurer or plan administrator may not have extensively reviewed your medical records before denying your request. Other common reasons for denied claims include getting treatment without the required referral or pre-authorization, using an out-of-network provider or typographical errors. When you challenging the denial, an experienced attorney can collect the necessary records and present expert opinions to demonstrate information most helpful to your claim.

How to Appeal an Insurance Company’s Decision

If your health insurance company refuses to pay your claim, you have the right to request an appeal. The law allows you to receive a full, fair and honest review, both from the insurer and from an independent third party. The first step of the appeal process involves a review by the insurance company called an ‘internal review’. During this process, your claim will get a second look by insurance company employees who weren’t involved in the original decision. After they have completed their internal review, they will notify you of their decision. If you are still not satisfied with the result, you have the right to ask for an external appeal. During this phase, an independent third party will conduct their own review. If the insurance company still refuses to honor your claim even though it’s valid, you may need to file a lawsuit as a last resort. A local insurance attorney can show you how to appeal a denial and can represent you in court during litigation.

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What If My Disability Insurance Claim is Denied?

In addition to health benefits, your employer may provide disability insurance. This provides payments of at least a portion of your average wages if you become unable to work due to an injury or illness. If your claim has been denied, you have the right to appeal. An affordable lawyer who handles disability insurance can help answer important questions such as whether your disability is covered, how to properly submit an appeal and how to challenge the denial in court.

In What Other Cases May an Insurance Attorney Represent Me?

You may need an insurance lawyer for reasons other than recovering losses or collecting on life insurance. Those who provide professional services such as engineering, medicine, accounting or law may need an attorney when their insurance provider refuses to provide a defense or cover a judgment rendered against them.

You may also be seeking legal counsel as a plaintiff in a bad faith insurance claim. These lawsuits arise from the failure of insurance companies to properly investigate claims or apply insurance policies in a reasonable manner. Insurance agents and brokers may also face liability if they fail to procure the proper amount and types of insurance in accordance with what you choose.

Where Can I Find a Top Rated Insurance Lawyer?

If you’re having an issue with your insurance company, it can be quite a challenging task to face them on your own. Whether the claim involves life insurance, car insurance or health insurance, you’re probably better off hiring an attorney. Here are some helpful tips on how to find the best one:

Find a Lawyer Who Specializes in Handling Issues Like Yours

Insurance matters draw upon principles of contract law, consumer rights and business practices. As a result, you”ll want to hire an experienced lawyer who specializes in these fields. If your matter involves a health insurance claim for example, your lawyer should have experience dealing with healthcare and review of administrative decisions.

Find Online Listings and Read Reviews of Local Attorneys

When looking for a great legal representation near you, recommendations from family and friends are usually a good place to start. You can also search online listings and browse through websites that list the best attorneys in your local area. Read reviews of affordable lawyers who handle consumer, contract and commercial law matters in addition to insurance law. Examine the ratings given by past clients and pay attention to law firms they recommend.

Understand How Much It Will Cost, Ask Questions

Most attorneys will offer a free consultation to better understand your case. Use this as an opportunity to ask questions and learn about all of your options. Ask the lawyer how much their services cost and how they want to be paid. For many insurance lawsuits, the lawyer will charge a contingency fee, where they earn a percentage of whatever is collected or recovered from the insurer. If you lose your case, you pay virtually nothing except for the cost of materials, phone calls, etc. If you prevail in the lawsuit however, the court can award you with a reasonable settlement amount. It’s important to understand how much this amount may be, so you can determine how much the lawyer may ultimately receive.

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