How to Dispute an Insurance Claim That Did Not Pay Out

An insurance claim denial is frustrating, especially when you had expected the insurer to pay the expenses related to the claim. Instead, you have to come up with the money. Claim denials occur with various insurance products, including homeowners, auto, life and medical policies. You must act quickly to dispute a denied claim, as state laws set limits on how long after a denial you can challenge the insurer's decision.

Things You'll Need

• Original insurance policy
• Claim dispute forms

Instructions

1. Gather evidence of the claim. Include photos of damage, damage reports, doctor's reports for medical insurance, certified copy of a death certificate for life insurance cases and the original insurance policy.

2. Obtain a documented second opinion that supports the dispute. Check insurance paperwork for a clause to invoke an independent appraisal. Follow any procedures to start an independent appraisal if such a clause exists in the policy. Get an independent evaluation of damage from a licensed professional for home and auto claim disputes. Obtain a letter from the attending doctor or dentist stating the need for the procedure or service for health insurance claims.

3. Review the claim dispute procedures. Check all the paperwork from the insurer regarding the policy and the policy itself.

4. Contact the insurer directly, and request claim dispute forms and instructions. Complete the claim dispute forms. Attach copies of supporting evidence. Return the forms to the insurer using certified mail, return receipt requested. Keep the receipt in a safe place.

5. Contact the state insurance department. File a complaint against the insurer. Supply details and copies of all evidence, the policy and correspondence from the insurer.

6. Hire legal representation. Visit the official website of the state bar association to find a list of attorneys experienced in insurance law. Provide evidence, the original policy and all letters from the insurer about the claim when you meet with the attorney.

Tips & Warnings

• You may have to complete a mediation with the insurer about the claim before you can pursue legal action.

• Keep a list of all dates and times you spoke to the insurer about the claim, along with the information received and the representative's name.

• Do not sign any settlement check if you do not agree with the decision. Doing so may void your right to dispute the claim denial further.

References

• Alliance of Claims Assistance Professionals: Top Ten Ways to Avoid Problems with Your Medical Claims
• "The Wall Street Journal"; Taking Gripes Over Insurance to the Top Brass; Anna Wilde Mathews; August 2009
• Bloomberg: Accidental Death Becomes Suicide When Insurers Dodge Payouts; David Evans; March 2011