Whether you’re maintaining a car or health policy, you should be aware of the pitfalls of insurance coverage. All too often, insurance companies deny holder claims. While a variety of plans are available—offered by dozens of insurance companies—claim denial is a common practice.
In many cases, a lawyer’s assistance is needed to re-secure a policyholder’s claim. If, however, the holder is considered to be “too risky,” a company may deny their claims outright. Maintaining comprehensive coverage is a tightrope walk. To receive the best-possible compensation, navigate the challenges of coverage and secure quality carrier policies, check out the most common claim denial excuses below.
Excuse One: The Holder Used an Out-of-Network Provider
If you’re holding medical coverage, and if you use a health provider who operates beyond your insurance company’s coverage network, you may be denied coverage. If your health insurance company is an exclusive provider organization, they may only aid those who strictly follow their standards. Acquiring medical assistance beyond an EPO or HMO network frequently voids one’s ability to adhere to an insurance company’s payment terms. So, watch out. If you’ve received non-emergency care outside of your network, your health plan may deny your claims. You might need to pay a bigger slice of the cost.
Excuse Two: The Holder is Liable
Liability is the most prevalent factor in claim denial. In car crashes, personal injury and damaged property cases, a policyholder holds a degree of responsibility. Spokane law serves to determine parties at fault. When this happens, following insurance coverage will be given to parties who weren’t negligent in the incident.
Your insurance company is legally required to offer compensation to insured parties who’re at fault, however. Car crashes still result in a driver’s insurance protection. That said, negligence can certainly exhaust a coverage plan’s monetary resources. For this reason, follow-up investigations are often used. An insurance carrier must, in the end, admit to some liability if they’ve contributed to damages, injuries or theft. In some cases, outright claim denial can still occur.
Excuse Three: The Holder has Non-Covered Charges
If your auto or health policy carries unpaid charges, you may be denied future claim coverage. Sometimes, policyholders undergo procedures which aren’t covered by their company’s policy—even if they think so. Some health plans don’t cover specific care categories, such as dental surgery and infertility treatments. Likewise, some auto coverage policies won’t assist intensive repair jobs. An outstanding balance can hinder one’s ability to receive full coverage when another accident occurs. Be sure to examine your policy’s outer limits, as a historical cost may result in future claim denial.
Excuse Four: The Holder Has Excess Damages
Business policyholders frequently obtain umbrella insurance coverage for this reason. If a health, car or business insurance policyholder experiences monetary damages which exceed their policy’s limits, they may be denied coverage. Insurance companies consider policyholders to be investments. If their holders accrue massive monetary damages, they may, indeed, deny coverage.
It’s important to understand your rights as a policyholder. Spokane law providers can assist you if a claim is denied. Similarly, legislation can protect you in the event of a wrongful claim denial. Insurance companies don’t deny claims often, but they do reserve the right to “cut off” a policyholder’s allotted coverage if any damages exceed their pre-specified coverage amounts. If your claim is denied, contact your insurance company immediately. Sometimes, a simple error is at play. If you feel your claim has been wrongfully denied, contact your legal representative immediately.
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