Valid insurance claims can be denied for several reasons. You may have suffered injury caused by a traffic accident, being on an employer or other business's premises, or injured working on a construction site. Whatever the cause, you may be entitled to compensation and damages. There are basic procedures to follow when submitting a valid claim, and the insurance company must also follow certain procedures when they receive a claim. Despite everything, insurance claim denial happens, but you also have options.
Insurance Claim Denial
There are some obvious and sensible steps to take if you receive written notification that your insurance claim has been denied. Your initial response may be anything from anger to disappointment, or deciding to just "throw in the towel." The best thing to do is to study the denial and decide what practical steps to take.
- - New York State has laws and standards in place that both you the claimant, and the insurance company must adhere to, so if your claim has been denied, the insurance company must give you a reason.
- - Even though the insurance company hires professionals to handle claims, everyone is human, and humans can make mistakes. It is also possible, but unlikely, that the insurance company is acting in bad faith, and just hoping that a denial will make your claim disappear.
- - Decide where you believe they are at fault in denying your claim.
- - Contact the insurance company in writing, keep a record of all communications, explaining why you believe they are "mistaken." Submit as much supporting documentation as possible. Highlight pertinent parts of the material you send. If they missed something and denied your claim, make it easy for the insurance company to see its own error.
- - If that fails to get your claim approved, consider appealing their decision to the New York State Insurance Commissioner.
- - Inform the insurance company that you are filing an appeal. Your goal is to have your claim approved. If the company made an honest mistake or even if they attempted to pressure you by incorrectly denying your claim, the threat of appealing to the Commissioner may be enough to get them to reopen your claim.
- - Decide if you should also file a lawsuit against the company for, for example, bad faith and/or violating New York's insurance code by not working to legal standards, or simple breach of contract.
If it is a Workers' Compensation Claim
If your workers' comp claim is denied, the company will issue a "notice of controversy" and file it with the Workers' Compensation Board for review. Either party may appeal the review decision, and it will go to a separate review panel for further consideration. If you disagree with the second review, you may decide to make an appeal to the Appellate Division of New York's Supreme Court.
Injury claims may run smoothly or they may not. If you, the claimant, are dissatisfied with how your valid claim is handled, you have options. The legal standards are complex, but we hope these basic guidelines will help you understand the steps. While you may decide to handle everything yourself, you may also choose to seek legal advice on what to do and how to do it. Simply click here to contact us so we can arrange a free, initial discussion.