One study found that insurers denied approximately 17% of in-network claims. Many people wondering why their insurance claim was denied don’t realize they have options after this point. They miss out on the opportunity to reverse the decision.

In this article, we answer questions like, ‘what if my insurance claim is denied,’ and, ‘what happens after my insurance claim is denied?’ Continue reading if you want the opportunity to reverse this decision.

What Is Insurance Claim Denial?

If you were in a car accident, experienced an injury, or experienced damage to your home, you’ve likely filed a claim with your insurance company. Your goal is to receive financial coverage in order to get the problem fixed.

However, there are instances where you don’t receive the coverage you want. This situation is an insurance claim denial.

Why Was My Insurance Claim Denied?

When you file a claim, a claims adjuster reviews it. They look at the details of the situation and compare it with your insurance plan to see what kind of coverage you’re eligible for.

There are a few possible answers to your questions of, ‘why was my insurance claim denied?’

Lapsed Policy

If you haven’t paid your monthly premiums or haven’t renewed your policy, then you’ve allowed your policy to lapse. This means that you don’t have any coverage for your claim and need to renew your policy.

Policy Exclusions

It’s important to review the fine details of your insurance policy for exclusions. There are certain circumstances that aren’t covered by your provider, which may be why your insurance claim was denied.

Not Enough Coverage

When you purchase insurance, you select a plan that has different types of coverage as well as different limits. If you select a plan that’s not comprehensive, you run the risk of not having enough coverage for your claim.

What Happens After My Insurance Claim is Denied?

You’re likely wondering, ‘what if my insurance claim is denied,’ or, ‘what happens after my insurance claim is denied.’ The answer depends on you. While you decide, be sure to keep up to date on the details of your claim.

Read Your Denial Letter

First, read your denial letter and try to understand why your insurance claim was denied. Whether or not the insurance claim was denied for a legitimate reason, you have the ability to fight it.

Appeal the Decision

If you decide to fight the decision, you need to file an appeal. We recommend working with an attorney to help you navigate the process and put more pressure on the insurance company.

In order to appeal the decision, have your attorney draft a formal appeal letter. The letter explains why you disagree with the decision and offers evidence as to why the decision is incorrect. A judge will then make a final decision.

Work With a Mediator

Another option is to work with a mediator and hire a third-party claims adjuster to review the case. The benefit of this is that the hired adjuster is looking out for your best interest instead of the interest of the insurance company.

In some cases, the insurance company may offer you a settlement. Be sure to avoid cashing any checks until the case is officially settled. This could appear as though you accepted the settlement, even if you didn’t mean to.

Your Insurance Claim Was Denied: Know What to Do

Use the above guide to know how to handle an insurance claim denial. Start by asking, ‘why was my insurance claim denied,’ so you can start the appeal process. In many cases, your insurance claim was denied justly, but you can still work to reverse the decision.

For more helpful guides and answers to your questions, visit our blog.