Discovering that your personal injury claim has been denied can be both shocking and dispiriting, especially given your payments toward premiums and expected assistance during difficult times. However, denial doesn’t have to mean the end; there are steps you can take to challenge their decision and potentially reverse it. Here is our guide on what steps should be taken if this situation arises; remember Precision PT can assist at no additional charge!
1. Understand Why Denial Occurs
Before taking action against an insurance provider for a denied claim, it’s essential to fully comprehend why. They must give an explanation as to their decision – some common causes could include:
Claim submission has not occurred on time There may be various reasons behind late claim submission; once identified, you can tailor your response more effectively.
2. Review Your Insurance Policy
Once you understand why your claim was denied, revisit your insurance policy to review all terms, conditions, and exclusions in depth to help determine if there’s room for contestation of its denial.
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3. Accumulate Extra Evidence
If the denial was due to insufficient documentation, collect more paperwork that may include medical records and bills, photographs of the accident scene, witness statements and police reports will all help strengthen your appeal. The more comprehensive your evidence is, the greater its weight in court.
4. File an Appeal
If the denial was unjust, you have the right to appeal the decision and file an appeal. Generally speaking, this process entails:
Written Notification: Notify the insurance company in writing of your intention to appeal their decision and include any supporting evidence or documentation in support of your case.
Internal Review: Your insurance company will conduct an internal review, wherein a claims adjuster not involved with the initial decision will evaluate your claim.
External Review: If the internal review upholds your denial, requesting an external review might help. In such a scenario, an independent third party will assess and either confirm or overturn the insurer’s decision to deny coverage.
5. Consider Filing a Bad Faith Claim
If your insurance company has denied your claim without adequate justification, and this constitutes bad faith behavior, then this may give rise to grounds for a claim in bad faith. Signs of such conduct could include things such as — refusing to pay claims without valid reasons; failing to conduct an appropriate investigation; unnecessarily delaying claim processing; and misrepresenting policy terms.
Filing a bad faith claim can be complex, so legal guidance may be advisable before filing one. Our team can consult you on options at no charge – feel free to call us today!
6. Contact Precision PT to review their services
Precision PT can assist with all aspects of personal injury claims and insurance denials, so if you feel confused or overwhelmed about where to turn for help or assistance during this challenging period, contact us for a free consult. Our team offers top guidance and support during this difficult time.
Conclusion
Although being denied personal injury compensation can be stressful and discouraging, remember that you do have options available to you. By understanding why it was denied, gathering more evidence, and seeking expert advice you can increase the chance of a positive result – don’t forget that Precision PT is here every step of the way for guidance and support if needed!
Have A Personal Injury?
Visit us at NO COST!
- Exam and Advanced Referrals
- Physical Assessment & Consultation
- Attorney referrals if needed
- Medical managed physical therapy and chiropractic visits
- We offer non-opioid mail order pharmaceuticals if needed
