How to Appeal Insurance Company Decisions

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The entire purpose of having insurance is to protect you in the event an unforeseen circumstance damages your property or renders you unable to work. Since so much is riding on your insurance policy, it is important to know how to work with your insurance adjuster to get the settlement you deserve. If the claim is ultimately denied, it is also critical that you know how to appeal that decision. Many initial denials are ultimately overturned on appeal but how you approach the appeal process can make all the difference.

Things You'll Need

  • Insurance policy
  • Denial letter
  • Policy number
  • Claim documentation
  • Gather all of the information you can relating to your claim, from the initial claim form you filed to the denial letter your insurance company sent you. Also make sure you have a copy of your policy to review.

  • Go through the insurance policy section by section looking for information that can back up your claim. It is possible that the claim was denied in error and if you can point to a section in your policy that justifies the claim, you will be on much firmer footing.

  • Consider hiring an attorney or legal advocate to represent you during the claim appeal process. If the claim in question is less than $500 it may not make financial sense to hire an attorney but if the claim is for thousands of dollars, having an advocate on your side makes a great deal of sense.

  • Review the denial letter and make sure you understand the reasoning the insurance company used to deny your claim. Review your policy again looking for documentation you can use to substantiate the claim.

  • Complete the appeal form provided by the insurance company in its entirety. Do not submit the appeal form until it has been totally completed. If you are unsure how to fill out a particular section, check with your insurance agent or with your attorney or representative. Be sure that you provide complete documentation, along with your policy number, claim number and a phone number where you can be reached.

  • Follow up with the insurance company if you have not heard back from them in a week. Be sure to get the name of any representatives you speak to. Keep a log that includes the date and time you called, who you spoke to and the content of the conversation. It is also helpful to follow up in writing. Make sure you document what was said and submit the letter as part of your appeal.

References

  • Photo Credit Thinkstock/Comstock/Getty Images
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