Insurance Law Blog

blog image

Understanding the Repercussions of a Denied Insurance Claim and How an Attorney Can Help.

November 29, 20233 min read

10 Understanding the Repercussions of a Denied Insurance Claim and How an Attorney Can Help

Insurance claim denials can be a complicated and harrowing process for many, ranging from financial difficulties to emotional turmoil. However, many do not understand the repercussions that a denied insurance claim can have, as well as the steps that they can take to resolve it.

Through the help of an experienced insurance attorney, the claims process can become streamlined and potentially successful. The following is an in-depth look into why insurance companies deny claims, the most common issues, and the potential assistance that an insurance attorney can offer.

Why Do Insurance Companies Deny Claims?

It is important to understand why insurance companies deny claims. Every denial is different and based on a variety of variables. Generally, the most common reasons are:

• Inaccurate or Missing Information: Claim forms that are incomplete or inaccurate can often lead to a denial.

• Out-of-Network Care: Receiving care from an out-of-network provider will almost certainly result in a denial.

• Uncovered Service: If an insurance plan does not cover the service in question, the insurer will deny the claim.

• Policy Holder Violations: Carrying out a task or behavior that violates the contract such as coverage restrictions or pre-existing conditions will lead to a denial.

• Late Claims: If a claim is filed after the designated period, it will almost always be denied.

Common Issues

There are a few common, recurring issues that leave policyholders in a difficult situation – especially if they have not experienced a denied claim before.

Knowledge Gap: Many policyholders are unaware of their rights under their policy, making them vulnerable to disputes and denial. An experienced insurance lawyer can help to better educate a policyholder on their rights.

Agreement Issues: Disputes about what is agreed upon in the insurance policy can be difficult to resolve, even with the aid of an attorney. A lawyer can ensure that the policyholder’s view is clearly expressed.

Delay Tactics: In order to decrease their financial obligations, some insurers attempt to delay the claims process, regardless of the validity of the claim. Insurance attorneys can often expedite the process and ensure that care is provided in a timely manner.

Denial Problems: In some cases, insurance companies will simply deny a claim – despite it being valid. In these cases, an attorney can help to contest the denial and prove the validity of the claim.

How an Insurance Attorney Can Help

The aid of an experienced insurance attorney can often be essential for those experiencing a denied claim. Most attorneys will advise their clients on the best way to receive the care that they need.

In the case that a claim is denied, an attorney can review the policy in question and will advise their client on the best way to proceed. Depending on the situation, the attorney may help the policyholder to:

• Protocol Review: If the policyholder abided by all of the necessary process requirements, the attorney may send a letter of protest or demand letter to have the claim reviewed.

• Legal Representation: For cases that require more attention, an attorney may recommend taking legal action.

• Appeal: If a policyholder is not satisfied with the outcome of a denied claim, the attorney may represent them in the appeals process.

• Compliance Monitoring: In order to protect their client’s rights, the attorney may monitor the insurer’s compliance with applicable laws concerning claims and billing procedures.

Conclusion

Insurance claims denials can be both costly and emotionally draining. With the help of an experienced insurance attorney, policyholders can receive the care they need and peace of mind they deserve.

If you’re looking for a Florida insurance attorney, the attorneys at Fosky Law have years of experience dealing with insurance companies and lawsuits. Contact us today to find out how we can help you with your denied insurance claim.

Back to Blog