Trouble with Your Insurance Claim?

Reasons for Denial and Cancellation

As a faithful policyholder, you expect your insurance company to cover your claims as long as you pay your premiums each month. In some cases a claim is properly denied but there are also many instances where the denial is questionable. The insurance company is a commercial enterprise that has to answer to a higher chain of command. They are going to do everything in their power to watch out for their own and either minimize, delay or deny your claim so they don't have to pay you. That is why you should consult with the experts at Gianelli & Morris to determine if you should challenge the decision of your insurer. We will pursue compensation and we will fight to protect your best interests by maximizing your claim and getting it to you in a timely manner.

Some examples of valid reasons for denial would include:

  • You waited too long to file
  • You provided two services in one day
  • You changed your insurance plan
  • You lost your coverage
  • You out-of-network benefits are different from in-network benefits
  • You have a deductible you haven't reached
  • You were late to pay your COBRA
  • You didn't get a referral from your physician
  • That procedure isn't covered

Your insurance company may decide to go further and cancel your insurance coverage if you fail to make your payments on time, ignore their calls and lie on your claims. They may also end your contract if your driver's license is suspended or revoked at any time during your insurance policy period. Lastly, if you end your own life by committing suicide within the first two years of your policy, then under the contestability clause your insurance company will not pay out any money to your beneficiaries. It is also important to remember that if there is any change of risk that would affect your insurance coverage, you must report it to them. For example, if you were to buy a speedy sports car and you fail to report it to your insurance, then your policy may be cancelled by default.

How can you resolve your denial?

While you can an appeal to the insurance company and request resolution of your problem, this does not always work. There are certain steps you can take however, that can make the appeal process easier. Always keep detailed records, keep your paperwork in order and remember your argument. It help to remember how the phone conversations went and to take detailed notes. You can also go to your doctor and have them investigate the claim. If they feel that you are being treated unfairly then they can write a letter of medical necessity will which only help your case. Following up with the insurance company is always helpful, periodically check in and to see the status of your appeal.

Insurance Claim Denial Attorney in Los Angeles

The appeal process may take week or even months and it can be very strenuous, especially if your insurance company fails to cooperate. In this case, the best thing that you can do is contact Gianelli & Morris if you think that you may be a victim of unfair claim denial or policy cancellation. We can help you mediate with the insurance companies and resolve your dispute in an amicable fashion, or we can take your matter to trial and formulate a compelling case on your behalf. Having the professional advice of someone who has worked through insurance cases before will prove beneficial as you wade through paperwork and legal jargon. We know the law and can make sure your rights are not violated. If your insurance is actin in bad faith of failed to properly investigate your claim, contact our Los Angeles office today!