Top 5 Reasons for an Insurance Claim Denial
If you are struggling to understand why you were denied your insurance claim, there are a few things you should know. First, it’s important that you understand that as a policy holder, you have a right to know why your insurance carrier refused your claim. They must also provide you with the steps to take to file a dispute. Here are some of the most common excuses insurance companies give after denying benefits:
- You billed for charges that your policy doesn’t cover
- If the claim was related to medical expenses, you may have obtained treatment that required pre-authorization from your carrier
- You made a mistake on your claim documents
- Not enough evidence was provided to support your claim
- The insurance company doesn’t believe you merit full (or any) compensation
These are just a few of the many reasons insurers give their policy holders after rejecting a claim. However, just because your insurance company doesn’t want to pay up, that doesn’t mean you need to accept their decision. Many times, carriers do not have a viable argument for denying benefits. They may fight tooth and nail with you simply because they don’t want to lose money or perhaps because they made a mistake when processing the claim. They may even be committing fraud.
No matter what kind of insurance policy you may have, you do not and should not have to back down. If your provider has no legitimate excuse for refusing to allocate compensation and acted in bad faith, you have the right to file an appeal and take legal action.
New Jersey Health Insurance Claims Denial
Health insurance is the most important kind of insurance for most individuals, especially those with underlying conditions who require constant treatment, yet it is also very expensive and confusing in the United States. Due to high costs and a maze of confusing rules, many health insurance claims are likely to cause problems that need to be sorted out with legal help or through an appeals process.
New Jersey Homeowners Insurance Claims Denial
When someone owns a home, there are a number of things that can happen such as property damage, lawsuits against the homeowner, theft, accidental fires, and other problems. A general homeowners insurance policy is required on properties that are mortgaged or financed to protect the lender’s investment in the mortgage. The total losses related to property damage can start to add up and become impossible to cover without assistance, which makes homeowners insurance a necessity for almost all property owners.
New Jersey Natural Disaster Insurance Claims Denial
Wildfires, snowstorms, hurricanes, hail, lightning, tornadoes and other kinds of severe weather destroy homes and businesses throughout the country every year. After you experience property damage due to this kind of weather, you will usually need to have an adjuster sent to review the damage and provide proof of repairs at a later time.
New Jersey Flood Insurance Claims Denial
Flood coverage needs to be purchased separately from a general homeowner’s insurance policy in government designated flood zones around the country. This is required for homes in certain flood zones, and a general homeowners policy absolutely does not cover flood damage.
New Jersey Auto Insurance Claims Denial
Coverage for cars and other types of motor vehicles is important because accidents happen on the roads every day. An insurance claim is the only remedy most drivers have to get their vehicle repaired without simply using their own money to pay for the damage. Unfortunately, some providers will still expect a driver to pay for everything after an accident even if they have been paying into a policy for years without incident.
New Jersey Life Insurance Claims Denial
As people begin to age, they are concerned about how their families will get financial help if they should suddenly die. Life insurance protects against this possibility by paying family members for expenses related to funeral and burial, along with an amount that is meant to temporarily replace the deceased person’s income. Even though this sounds like it would only be an important investment as people age and their risk of dying increases, it is usually cheaper to begin paying into a policy at a young age.
New Jersey Renter’s Insurance Claims Denial
When someone rents an apartment, condo, or home, they can get coverage that is very similar to homeowners insurance, but it is more focused on covering their personal property within the dwelling rather than the building itself. If your claim has been denied you need a renters insurance denial lawyer. Visit the New Jersey page on our site now to find an attorney to help you.
New Jersey Pet Insurance Claims Denial
When a pet has health problems and needs to visit a veterinarian’s office, the costs can quickly start to add up into the hundreds or thousands of dollars. There are many pet insurance providers who will cover the costs of important animal procedures and regular checkups for a smaller monthly fee. However, like health insurance there is often a confusing list of things that may or may nor be covered depending on your policy. To keep your pet protected when your pet insurance claim has been denied
New Jersey Boat Insurance
All kinds of watercraft can experience damage, and this can be devastating financially as vessels are expensive to buy and maintain. Boat insurance helps owners pay for any damage and protect their investment. This coverage functions in a similar way to auto insurance, but it must be paid separately.
New Jersey Workers Compensation Insurance Claims Denial
Employers are required to pay into coverage that will give a worker their normal wages for any time missed if they are hurt at work. In most cases, as long as the injured person can prove that they were at work and engaged in their normal job duties, the claim should be paid without issue.
New Jersey Mortgage Insurance Claims Denial
Mortgages can be a large risk for the businesses that back and finance these large property loans. When someone invests in mortgage insurance, it will usually help them qualify for a loan because it takes some of the risk away from the lender. This type of coverage is usually bundled in with a monthly mortgage payment, and it will increase the payment cost slightly.
New Jersey How an Insurance Claim Denial Happens
The typical structure of a claim denial usually involves the insurance company sending out formal documentation that says they “reserve their right” to not pay the claimant. It is also common for simple errors to be made somewhere during the process that must be corrected so that the claim may be resubmitted to proceed.
There can be issues with the amount that the provider wishes to pay, or if they want to pay at all. Claim denials are common for policies with a high deductible or others that only cover certain types of damage or losses.
Regardless of what an insurance company says, people who pay for their services do have a right to contest their denials and get outside help from an attorney or neutral adjuster when necessary.
New Jersey Property Damage Insurance Claims Denial
After a weather event or accident, property owners need to document the damage to make a claim. Your insurance company has their own internal review process to go over whatever info you send them. This evidence may include pictures, videos, and summaries of damaged items and their value.
The property owner will go through the process to document their losses and send evidence of the damage to the provider. Problems usually start to occur when an independent adjuster views the damage and disagrees with the extent or value of the losses at the property. Some policies also have a very high deductible, in the thousands of dollars, which will cause the homeowner to cover all of the losses on their own if the provider believes that the value of the damage is not large enough.
There are a number of things that an insurance company does to protect against fraud as well. Unfortunately, because insurance fraud is a common problem, the protections against it are strong enough that they unfairly deny some legitimate claims at times as well.
A homeowner should contact their company after the initial denial and see if they need more information or simple errors need to be fixed. If either of these issues are present, it may be possible to get the denial reversed quickly and easily. The company will normally need some time to review the entire claim all over again once something has been changed.
If problems still persist, it may be possible to get a different adjuster to view the damage again or get legal help. Public adjusters may get involved in cases involving damage claims for several thousand dollars or above. When all else fails to resolve the claim, it is best to leave the matter to your attorney and file a formal complaint against the insurance provider if necessary.
New Jersey Health Insurance Claims Denial
Health insurance policies usually only cover very specific types of procedures or doctor’s visits. Many times, a claim denial starts when the covered person seeks some kind of treatment that is not actually included in their policy. For this reason, it is usually helpful to check with the insurance company before committing to a surgery or other health related event. Some health insurance companies even have a pre-authorization process which essentially allows you to file paperwork related to a procedure and find out in advance if they will cover it or not.
Because of the complexity of health insurance claims, there are many different reasons why the provider may refuse to pay a claim.
Health insurance generally does not cover non-essential procedures like cosmetic surgery. These kinds of procedures are almost always the responsibility of the person seeking treatment. If a procedure that is normally covered is considered too expensive, they may offer an alternative form of treatment that they believe is more appropriate and cost effective.
When a health insurance company issues a denial, it is normally important to review what they have said and either file an appeal or determine if they simply will not cover a certain type of procedure at all. The appeal process is regulated by the government, and it is meant to resolve claims in most cases. However, if the insurance company is not helpful or the issue remains unresolved, a neutral party can get involved. There is also the possibility of taking legal action against a health insurance provider.
If your insurance company denied your insurance claim contact an insurance claim denial lawyer in New Jersey using the USAttorneys.com Insurance Claim Denial Law Firm locator. Select New Jersey then your county to be directed to a claim denial lawyer near me or call 866-335-8999.