Improve Your Chances Of Getting Your Insurance Claim Approved

Charlotte Miller

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You pay your insurance premiums on time every month. You don’t even grumble too loudly when your rates are increased.

You accept the rate hike as a part of the overall increase in living that seems to happen every year. Unfortunately, your efforts at being an excellent client often go unnoticed and unrewarded, especially when it’s time to submit a claim.

Suddenly, you’re drowning in all sorts of red tape and claim denials, wondering if you’ll ever be approved. To help you avoid this mess, here are some tips on tackling insurance company resistance.

Plan for Eventual Problems

You may have a great relationship with your insurance agent that can even include meeting for an occasional beer or cup of coffee. If so, great! This type of relationship can help ensure your claim doesn’t languish for weeks in a pile.

Unfortunately, this also doesn’t guarantee your claim will automatically be approved. Insurance companies regularly receive hundreds, if not thousands of claims, and problems are bound to occur.

Insurance companies are also a business industry, especially if they’re for-profit organizations. This means the company’s goal is to take in money, not dole it out in the form of claim payments. Be prepared to encounter problems after filing a claim.

A good process to follow is saving all correspondence with the insurance company. Whether it’s emails and/or mailed letters and forms, save everything. You never know what you may need to hurry the approval process along.

Ask for Clarification

If your claim is denied, ask for specific reasons. Don’t accept a general answer; ask the insurance adjuster to point out the specific clause in your policy they’re citing for denial. Yes, insurance policies can be difficult to read, especially when you get into the clauses, but the adjuster shouldn’t have an issue citing a specific point.

Sometimes, the insurance company may struggle to provide a valid reason for the denial. Don’t accept this as fact. Keep pushing for the company to provide a clear and legitimate reason for the denial.

Gather Evidence

If you’ve ever dreamed of becoming a detective, now’s your chance. Sometimes, insurance companies need to be confronted with evidence before they consider processing your claim.

This doesn’t mean staking out the homes of insurance adjusters, instead, highlighting portions of your policy that apply to your claim. You can also do some research on similar claims and their approval rates.

You may also need to submit additional evidence supporting your claim. Sometimes, you’re submitting the same evidence twice, which can include copies of an accident report for auto insurance companies.

Thankfully, New York State makes it easy for drivers to get copies of their accident reports. You can request a copy online. If you’re dealing with health insurance, you may need to get copies of your medical files.

Something else to consider is reviewing the insurance company’s ethics codes. You can request a copy from your insurance agent. The ethics codes may contain provisions that can help support your case.

Stay Pleasant Before Expressing Frustration

Having your claim placed on hold or being denied is disappointing, stressful, and infuriating.

Expressing your frustration is easy, but it should be a last resort, so try to keep your phone calls and emails pleasant. You don’t want to be friendly, but try to stay courteous. Sometimes, expressing your frustration can set your case back instead of helping it move a little faster.

When being polite and pleasant isn’t working, it’s okay to express some frustration. However, don’t start yelling and cursing. This type of behavior will only make the situation worse.

Save Everything and Take Notes

Save all correspondence with the insurance company, which includes all written correspondence and emails. Take notes during any phone calls and write down the date and time. You also want to list the name of the person you’re talking to, along with their phone number and company position.

You may even want to take the step of sending your correspondence by registered/certified mail. This way, you have a record of everything you send to the insurance company. If you end up having to file a lawsuit, you may need to prove you responded to the insurance company’s communications on time.

While this is rarely an issue with correspondence to an auto insurer, it can be an issue with health care insurance. Be careful including personal information in emails and certified letters, since you don’t want to risk violating HIPAA rules.

Keep Communications Short and To the Point

You may be best friends with your insurance agent, but this doesn’t extend to the company. Don’t send long-winded letters and emails inquiring about the status of your claim. Leave out the irrelevant information, and don’t ask personal questions. Insurance companies are busy and don’t have time to read lengthy correspondence.

Along with inquiring about your claim, use your correspondence as a chance to remind the insurance company what you want them to do. In this instance, it’s to review your claim and hopefully issue a check. If you’re trying to figure out why a claim is denied, ask for specific reasons.

Don’t Be Afraid to Ask for a ‘Manager’

Asking for a manager, also known as going over someone’s head, is generally discouraged. However, there are times when it’s necessary. Getting information about your insurance claim is one of those times.

Don’t be afraid to ask to speak with someone higher up in the chain of command. The worst that will happen is a denial. The best is you may learn a little more about the status of your claim.

Don’t Give Up!

When it comes to pursuing insurance claims, be persistent and don’t give up. Sometimes, insurance companies hope you’ll accept defeat. Keep calling, writing, and sending emails. Even if your claim is denied multiple times, keep trying.

If the insurance company refuses to work with you, it may be time to consult with an attorney. Sometimes, the threat of legal ramifications is enough to get the ball rolling. Your attorney may also be able to work out a settlement that’s more than your original claim.