Reasons why an Insurance Company Denies a Claim
Your claim may be denied by your insurance company if:
- They believe you overestimated the value of the claim.
- Insurance fraud is suspected.
- Your claim may also be rejected if there is insufficient evidence of the harm caused to back up your claim.
If you have fallen behind on your insurance payments, your insurance company may also cancel your policy.
Follow These Steps to Resolve Your Insurance Claim
If you have filed an insurance claim or an auto insurance claim but are dissatisfied with the outcome, there are several steps you can take to get a resolution.
- Inform your insurance representative of your dissatisfaction. If the agent or representative is unable to resolve your issue, obtain the name and phone number of the insurer’s claims department head. Your insurance company may also have a customer service department that can assist you.
- Prepare evidence to back up your claim. Send documents and a letter outlining your dissatisfaction, and make sure you have figures to back up your case. Include your claim number as well as your contact information.
- Examine your car insurance policy. Most companies provide either arbitration or appraisal services to help resolve disagreements and disputes. These options will be explained in your insurance policy.
- Contact the insurance department in your state. Explain the reasons for your disagreement to a department consumer services representative. While the department cannot resolve or otherwise handle every complaint, it will collect the information and notify you if your case is selected for individual review.
- Request that an arbitrator hear your case. An independent arbitrator with insurance experience can determine whether the settlement you were offered is fair. Your insurance company may recommend an arbitrator, or you can hire one through the American Arbitration Association.
- Speak with an attorney. Consult an attorney who specialises in auto insurance as a last resort. Each state’s bar association provides a free legal referral service that can provide you with names of qualified candidates. Depending on the type of case, attorneys work on an hourly or contingency basis, so make sure you’re comfortable with the attorney’s fee structure—and get it in writing. To stay up to date on the status of your claim, request copies of all correspondence from your attorney. Keep in mind that your attorney must obtain your permission before agreeing to any settlement.
After your claim has been resolved, take the time to re-evaluate your insurance coverage to ensure that you have adequate protection to cover you against any future damage or liability claims, and that you are satisfied with the insurance company you’ve chosen.
Arbitration
A neutral third party serves as a judge in arbitration and is responsible for resolving the dispute.
The arbitrator listens to both sides argue their cases and present relevant evidence before making a binding decision.
The parties can agree on almost any aspect of the arbitration process, including whether lawyers will be present and what evidence standards will be used.
Arbitrators make decisions that are usually confidential and cannot be challenged.
Appraisal
Appraisal is the Property valuation performed by a third party who has no interest in the property.
When insurance is covering something, whether it be a house or a wedding ring, it’s important to know how much the object is worth. If a $10,000 watch gets stolen and its owner’s insurance policy only provides $1,000 worth of coverage for watches, well… that’s a problem.
It’s easy to figure out the value of some things; a TV bought last week probably came with a receipt that tells you (and your insurer) exactly what its value is. When it comes to things like houses or antique figurine collections, the value can be a little harder to figure out. That’s where the appraisal process comes in.
When you request an appraisal, an expert will determine the value of the object in question. A professional appraiser has specialized knowledge and training that allows them to make a much more informed valuation than the average person.