A step-by-step guide to handle your insurance claim denial

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By: tiarajoseph11
on 4th Dec,2013

The insurance company might have denied your claim even after you had paid the insurance premium on time.
A step-by-step guide to handle your insurance claim denial


If you have been denied an insurance claim, the first thing you should do is not give up. The insurance company might have denied your claim even after you had paid the insurance premium on time. In most cases, you are able to settle your claim if you follow certain steps. Here are the steps you need to follow if you’re denied an insurance compensation.


  1. Collect necessary documents – In order to make the claim again, you need the policy document along with the written document through which your insurance company has denied your claim. Usually, the letter “denied” is not written and only “$0” is written as the reimbursement amount.
  2. Know the reason behind the denial – In order to appeal for the claim, at first you need to understand the cause behind the denial. Knowing the reason will help you speak to the representative in order to appeal. In your claim denial letter, you’ll find a remark code along with the reason code. Just look in your insurance company’s website what the remark code means; usually, the company’s website contains the necessary details.
  3. Act quickly as otherwise it might be late – Usually there is a definite time period within which you need to resubmit your claim. Therefore, know the reasons behind the denied claim, talk to the claims adjuster and explain why you think your claim was denied by mistake. While talking to the adjuster, make sure you ask a date within which you will get the compensation. Do not forget to contact the person again if your claim doesn’t get resolved within that date.
  4. Follow the specific rules of your insurer – After the call, you need to follow up in writing.  Every insurer has specific rules to make an appeal. Usually, the insurer has a form which you need to complete. Most of the insurance companies have multiple levels of appeals and there is also grievance process if you are not happy with the outcome.
  5. Establish your claim with evidence – As already stated, you need to provide necessary documents for the required compensation. The content of your claim letter is really important in this matter. One of the best ways to do so is to use the insurer’s marketing materials; just quote from the marketing materials where it is stated that they will provide medical care for the beneficiaries, in case of a health insurance policy. And, in case of health insurance, you should also support your claim with the medical literature.  You should also read the policy documents carefully and make a note of the policy exclusions as well as the sections relevant to your claim.
  6. Keep documents for future reference - While trying to resolve your insurance claim, make sure you keep all the documents for future referral. Right from when you contact the claims adjuster till the last letter you send, you need to keep each and every document, at least until you get the required compensation. When you talk to the adjuster for the first time, ask his/her name; it will be easier for you to follow up later. Also remember to be patient throughout the process. If your claim is not resolved within the due date, you can contact your state’s insurance department in order to file an appeal. Usually, the dispute gets resolved with the intervention of your state insurance department, at the earliest.


While dealing with insurance claim denial, you should also contact your insurance agent as it is his/her responsibility to see that you get the required compensation. Therefore, do not hesitate to contact your insurance agent, explain the situation and ask him/her to help you get the required compensation.


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