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Car insurance is there to protect you from unforeseen financial distress due to an accident, theft, or damage. You purchase car insurance for the purpose of protecting your interests and avoiding huge financial or legal penalties because you would have to pay out-of-pocket expenses.
Filing a claim is the process by which you can get the funds owed you by the insurance company when you have an accident, property loss, or other issue involving your vehicle. Paying claims is how insurance helps you to move on with your life.
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When an Insurance Company Refuses to Pay a Claim
But what if an insurance company refuses to pay the claim?
What should you do then? When you depend on an insurance company paying their claim, and they refuse to do so, you will have to take action to get the funds that you need to pay the damages for your accident or other loss.
The very purpose of insurance is for it being there when you need it, in the form of an insurance claim payout.
When companies do not hold up their end of the bargain, you have a problem. In such cases, you may have to take assertive action to get the money due you.
However, you should first look into some factors before moving forward with your appeal.
What to Check Before Filing an Appeal
When an insurance company denies your claim, you should first do the following:
- Payment of premiums – The first thing you should check when you are looking into the failure of an insurer to pay your claim is whether you paid your premiums on time. If you failed to make even one payment and allowed the policy to lapse, your policy may not have been in effect at the time of the claim. In this case, the insurance company has no legal obligation to honor it.
- Policy status – Do some checking and see if your policy was in effect at the time of your accident or loss. Even if you paid your late insurance premium the day before but it was not recorded until after you had an accident, it’s possible you were not covered for the time in question.
- Deadline for filing claim – You need to know what the deadline is for filing a claim and see if you filed it on time. You must follow the rules set aside in your policy for the filing of claims and make sure that you honored this to be eligible for a payout.
- State insurance laws – Check your state insurance laws to see if they apply to your situation and be aware of what the insurance rules state about claims or other details within your state.
- Filing of proper paperwork – You must make sure that you file all of the appropriate paperwork for your claim to get money from the insurance company. Failure to file the proper documents can delay or even negate your claim if you miss the deadline.
- Check your coverage amounts and limits – It’s important to know that you were carrying the type of coverage that the accident involves, such as liability, comprehensive, or uninsured.
These rules may seem harsh but they are the law and you must always follow both your insurance regulations within your state and the paperwork filing requirement if you are seeking payment for a claim.
Failure to follow the regulations for these requirements will result in non-payment.
Writing the Appeal Letter
Once you have checked to make sure you’ve followed the rules and the insurance company still won’t pay your claim, you should write an appeal letter to refute the insurance company’s decision to refuse your claim.
Like the actual application process, you must make sure that you follow the guidelines for refuting denials of claims as well, including making sure that you have sent the appeals letter in plenty of time for the company to honor it.
When you send the letter, make sure it is directed to the particular customer service representative who deals with the denial of claims. Sending the letter to the wrong department can further delay the process.
Here is what you should include in your appeal letter:
- The policy number
- The claim number
- The date the request was made
- The date the application was denied
- The name of the agent who rejected the claim
Additionally, you should include any documentation connected with the incident along with photos, police reports, or other information. This inclusion of documents allows the claims department to know which incident it concerns immediately when they receive the letter.
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Purpose of the Appeals Letter
Remember the purpose of your appeals letter when writing it.
You are trying to present a case that you knew your insurance was current at the time of the accident, that you filed the paperwork promptly, and that you are deserving of the claim due to the circumstances of the accident.
You can present as evidence any documents that will further back up your claim and show that you have a legal right to the money.
This proof can include anything that you might present in courts such as police reports, eye witness accounts, or any other assets which may add to the strength of your claim.
Additional information that may be helpful might include statements from independent insurance adjusters or others who can verify that the amount you are asking for is not unreasonable and that the insurance company should pay the claim amount.
Your goal is to convince them that they promised to honor their claims in their policy and that, by law, they must live up to these promises.
When an Appeals Letter is Not Enough
Once you have sent your appeals letter and you still receive a denial, you may have to resort to speaking with an attorney regarding your claim. Lawyers may sometimes write a letter to the company reminding them of their obligation, and you may then get your claim.
Insurance companies are there to protect you from financial disaster. The most important way that you can avoid having to take an insurance company to task is to find the best insurance company in the first place.
It’s important to understand the policies of a company. Read about the company and check on their claims rate, how long it takes them to pay, and other factors.
By shopping and comparing companies and reading the fine print, you’ll find the best company for your needs. Shop and compare today by entering your zip code below.