Anyone who has ever had to file an insurance claim knows that the process is almost always complicated. So what happens when insurance unfairly denies coverage for your claim?
While this sounds like a worst-case scenario, it happens with surprising frequency. In fact, the U.S. Department of Labor estimates that around 1 in 7 health claims made under employee health plans are denied. Unfortunately, not all of these denials are fair, and you could end up paying out of pocket for an injury that should be covered.
Don't give up if you find yourself with a denied insurance claim. There are a few different paths for contesting an insurance company decision.
Keep reading, and we’ll cover everything you need to know. And if you decide it’s time to speak with an attorney, fill out our contact form to schedule a free case evaluation today with the skilled attorneys at Morgan & Morgan.
Understanding the Duty of Your Insurance Provider
Before you ask how to contest an insurance company decision, you first need to understand the essential duties of a health insurance provider. This goes beyond your specific plan and coverage and gets to the heart of what an insurance provider actually provides.
Keep reading to learn more about the duties owed to you—the insured. And if you believe that your provider has fallen short in their duties, it may be time to call a lawyer.
Duty to Defend
If a claim from a third party is brought against you, the insurance provider has to defend you.
Duty to Indemnify
If you are found liable for losses in a claim brought against you by a third party, the insurance provider must pay them.
Duty to Handle Claims Quickly and Fairly
Essentially, the provider must act promptly to investigate the claim and make a fair decision.
Duty to Disclose Conflicts
The provider must inform you of any conflicts or problems that arise in filing your claim.
If you believe your insurance provider has not upheld its duties or acted in good faith, you need to call an attorney. It may be time to settle the matter in a legal setting.