What Can You Do If Your Insurance Claim Has Been Denied?

If you or a loved one are ever injured, chances are you expect to rely on your insurance to protect you and cover medical expenses, potential lost wages, or injury rehabilitation services. However, what happens if your insurance claim is denied? When your insurance claim has been denied, or if your benefits terminated before you are able to return to work, the consequences to you and your family can be devastating.

If your insurance claim has been denied there are three steps you can take immediately that will help you resolve the situation:


1 – Review Your Insurance Policy to Confirm Coverage, Exclusions, and Limitations

The first step after your insurance claim is denied is to read your insurance policy. Your insurance policy will list what is covered, and will also include any limitations or exclusions. If you speak with a Wirsig Matheos disability claim lawyer, they will also want to read your insurance policy to determine whether the facts in your case are covered. They will best be able to interpret the terms of the policy to confirm what conditions must be met or if there are any interpretation issues to address.

The policy should also include whether there is an internal appeals process that you need to follow to challenge the denial of your claim. Often these processes have strict time limits so be sure to check for time limits and don’t leave consulting a claims denial lawyer to the last minute.


2 – Speak to Your Insurance Company

If you’ve received a letter from your insurance company advising you on your benefits denial, and it is unclear why your claim was denied, don’t hesitate to call them to ask for a written explanation for the denial. The insurance company should be able to provide you with written reasons for the denial. Reasons could range from no proof of disability to failure to be under the regular and appropriate care of a physician. Knowing why your claim was denied will help you and your disability claim lawyer decide what steps to take next. Those actions may include steps to appeal your insurance company’s decision through an internal appeals process (if there is one) or taking steps to launch an external appeal.


3 – Speak to a Disability Claim Lawyer

Unfortunately, insurance companies do deny insurance benefits in circumstances where it is not appropriate to do so. There are disability claims that are commonly denied, but it’s important to remember that even in situations where the insurance company permits you to appeal the decision, it is still important to seek legal advice from a disability claim lawyer. You have a limited time within which to take legal action, depending on the facts of your case. Speaking with an experienced lawyer can make the difference between getting a settlement or losing your right to challenge the insurance company’s decision.

At Wirsig Matheos, we have over 60 years of combined legal experience dedicated to litigating insurance claims, including denials of short and long term disability benefits, life insurance and critical illness claims. If your claim has been denied, contact us and our lawyers can offer guidance on your options and how to resolve your situation efficiently.