Denial of Insurance Claims

By SoftSettle Support

There may be delay in settling claims, ok the delay is delay but if the claims are denied it is truly unjustifiable. But the insurance companies have justifications. But we will find difficult to digest such arguments deemed to be the reasons for denial of claims.

We can assess the situation. Let me serve you with some hypothetical scenario.

A gentleman met with an accident. The accident is disastrous. He is seriously injured and left in a coma. When he wake nine days later, he has multiple broken bones, collapsed lungs, and are destined to spend the next few agonizing months under constant care. He regularly pays his insurance premiums. But unfortunately the insurance company denies his claim. They claim the driver who caused the crash acted negligently, and so the accident was not an “accident.” His hospital bills pile up, He is too injured to go back to work, and his insurance company has deserted him. The irony is that when the policy holder needs the insurer most, they do something like this.

So it is that. The policyholder is at fault. It is assessed and certified that the accident could have avoided.

Okay then the reasons steps up one by one. Then the claim is not covered by policy. Insurance policies are contract that define each party’s obligations. The insurer agrees to cover only certain claims as outlined in the contract.

Then again, the coverage has lapsed. If an accident occurs during gap in coverage, if the policy holder did not pay his insurance premium in correct date.

Then something most unfortunate. The policy holder’s doctor may use the wrong coder for a procedure causing the insurance company to believe that the procedure fails outside his policy coverage.

Then how can you overcome such awkward situations:

You have to read your policy carefully/ You should know exactly what is covered and how to appeal a denial by your insurance company.

Be very careful in filling the forms. Even if you make an honest mistake your insurance company may seize on that as a reason to retroactively deny your coverage.

If anytime your insurer rescinds your insurance by sending you refund for the premiums you paid, you never accept or cash them which might lead to make the court believe or may be interpreted as accepting their decision.

Talking to insurers or their representatives over telephones or directly is desperately a frustrating experience and you will fail to prove anything during litigation and it is better you insist the insurance company to put everything in writing. So that you can keep records of all bills and correspondence such as mails and other communications.

It is going to be  a mental test, sometimes even your persuasive attitude would not help you to not to abandon further attempts. Knocking at the doors and if it keeps on turning dear ear to you, never give up.

Soft Settle is there to support you. They can help you from your first knock at the door or even at your frustrated knock before you have decided to give up. As such Soft Settle with its mediation outfit ( Mediator Affair can resolve the issues and further if everything goes well,you can also negotiate with your insurance company to make a get through in settling your insurance claims. Soft Settle and Mediator Affair can put you in a safe resort and releasing all agonies against your insurer.