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Your insurance company refused to pay your claim: now what?

On Behalf of | Jun 9, 2015 | Insurance Law

Having insurance is essential for people all across Florida. Whether it is auto, life or health insurance, these policies can help you cover some significant expenses. However, as helpful as it can be to have insurance, it’s not always easy to get the payments you believe you deserve.

Insurance companies are just like any other business: they want to make a profit. This can be quite difficult if they just pay out every claim that is submitted. Because of this, companies are motivated to deny claims or delay paying them. Sometimes this is justified, but sometimes it is not. If you feel like your claim was wrongfully denied or delayed, you need to understand what you can do to seek a satisfactory resolution.

To begin with, you will need to know why your claim was denied. As this article notes, there are five common reasons an insurance company may refuse to pay:

  1. Typos
  2. Charges do not fall under those specified in a policy
  3. There was no referral or pre-authorization
  4. Billing was sent to the wrong company
  5. Services were provided by an out-of-network party

In some cases, fixing the situation can be fairly simple. If, for example, the bill was sent to the wrong company or there was a typo on the claim, resolving the issue may be as simple as re-sending the claim or fixing a spelling error.

However, if a claim was denied because there is a dispute regarding the services provided, the provider of the service or the lack of referral, addressing the situation can be much more complicated. You may need to scrutinize the details of your policy, seek the support of your doctor to backup your claim or challenge the decision of the company.

Whether the solution is simple or complicated, the fact is that challenging a denied claim can require extensive legal knowledge and having experience going up against an insurance company. Rather than try to do this alone, you may want to strongly consider having an attorney by your side should you choose to dispute a denied claim in order to have it paid.