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!