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What If Your Insurance Claim is Denied?

Published: September 9, 2019 009 10:00 am

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medical claim denied | what to do if your insurance claim is deniedWhen you purchase an insurance policy, you trust that the company you are buying it from will uphold their side of the agreement. You pay your bill every month, and should the time come that something unfortunate happens, they’ll financially compensate you for your damages.  

Unfortunately, that isn’t always how things work out.  All too often, insurers will deny a seemingly valid claim for some reason or another. Remember, these companies are trying to make a profit. The more claims they have to pay out on, the less money they make in profit.

But there are things you can do if you find yourself in the middle of a dispute with your insurance company. Contact an experienced law firm that has a history of going up against the big insurance companies. They’ll be able to give you an idea as to what your legal options are, and most of the time, these initial consultations are completely free of charge and require no obligation. Learn more about what to do if your insurance claim is denied below.

Frequently Asked Questions About Insurance Disputes

Here are answers to some of the common questions people ask after having an insurance claim denied:

Q: Can my insurance company even deny my claim in the first place?

A: Yes, there are multiple conditions written into the fine print of any insurance policy that, in the right situation, the insurance company might attempt to use as a way to get out of paying a claim. If you feel like your claim is being denied unethically, it’s important to speak to an attorney and get their opinion. Just because your claim is denied, that doesn’t mean that you don’t have a fair right to compensation. Your attorney will be able to help you determine what to do next.

Q: How do I figure out whether the insurance company denied my claim with a valid cause?

A: The various reasons why a health insurance company might deny health insurance claims include: 

  • Pre-existing conditions, 
  • procedures not covered by plan benefits, 
  • experimental treatments, 
  • out-of-network provider or facility use, 
  • and treatments that are determined to be medically unnecessary. 

Sometimes these reasons are valid, but a health insurance claim can be overturned by an insurance company due to extenuating circumstances. An experienced insurance attorney can review your claim and advise you as to whether the denial is valid.

Q: Will my insurance company offer me a fair amount of money in a settlement?

A: The amount an insurer will offer in a settlement depends on the insurance company itself. Each company is different. But, since all companies have the same goal, making a healthy profit, it should come as no surprise that some companies look for ways to avoid paying out on a claim. If you are in doubt as to how fairly your claim was handled by the insurance company, you should contact a lawyer right away for a free consultation.

Q: What recourse do I have if I believe my health insurance claim was unrightfully denied?

A: You are entitled to appeal the insurance company’s decision regarding your insurance claim. First, you should contact the insurance company’s customer service department and ask politely for specific reasons for the denial, and request that the claim be reprocessed. If this does not yield satisfactory results, you may submit a formal written appeal to your insurance company. 

Colorado insurance companies are required to have formal appeal procedures. Check with your insurance company to find out their appeal requirements before proceeding. If the insurance company denies your appeal, you can file a complaint with the Colorado Division of Insurance or pursue a lawsuit against your insurance company.

Contact our Insurance Disputes Lawyers

Gold Law FirmAt the Gold Law Firm, we help guide our clients through the confusion brought upon by insurance companies and claim disputes. By working diligently with insurance companies, adjusters, accident reconstructionists, and medical experts, we fight to obtain the maximum compensation for all of our clients, regardless of their situation. If you are involved in an insurance dispute with your insurance company, you need an aggressive and compassionate legal team on your side. Contact the Gold Law Firm today for a free consultation at (303) 694-4653.

The Gold Law Firm serves the victims of personal injury and insurance disputes throughout the state of Colorado, including Denver, Akron, Brush, Byers, Fort Morgan, Greeley, Holyoke, Strasburg, Weldona, Wiggins, and Yuma.

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