Steps to take if an insurance company won’t pay you a claim

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Are you struggling to get your insurance company to pay your claim? Do not fret.

Each year, the National Association of Insurance Commissioners (NAIC) compiles a list of the most common complaints that consumers have with their insurance providers. The list is a compilation of records from state insurance departments, which are one of the primary tools that individuals can seek help from when they feel an insurance company isn’t treating them right.

Not surprisingly, the vast majority of complaints stem from issues regarding the handling of claims, which is the reason that people take out insurance in the first place. A 2019 NAIC study states that just over 18 percent of all complaints stemmed from unsatisfactory claim amounts offered by an insurance firm. Delays that policyholders experience when waiting to receive a claim were the next most frequent complaint and accounted for just over 17 percent of all complaints. The denial of a claim accounted for just over 14 percent of all complaints.

The key takeaway from this is that if you’ve been refused an insurance payout by an insurance company or one of its agents, you’re not the first.

The good news, however, is there are some steps you can take to fix things.

Keep reading to discover these steps.

1. Don’t take no for an answer

The fact that an insurance company tells you “no” doesn’t mean you should just accept rejection and walk away.

You have to try again. If you do, chances are you’re going to win your case. And if you don’t, you might reach a settlement agreement with them.

2. Ask for a written statement

Yes, they’ve said no the first time. And you’ve decided to try again. But before you do, ask for a written statement explaining why your claim was denied initially.

3. Compare their letter of explanation with your policy statement

Go back into the agreements you had when you first purchased the policy, and try and see whether the reasons they gave for not honoring your claim aligns with the policy statements in the agreement.

If in your heart, you feel the two statements don’t align, then there is a good chance you’re right.

4. Check whether the rejection was based on filing errors

There are lots of reasons why an insurance claim may be rejected. However, most of the time, these reasons are quite contestable.

For example, an insurance company might deny a policyholder their claim if the person has filled some certain information incorrectly at the point of application.

If your claim has been rejected based on this ground, you have a great chance of winning your case.

5. Speak to your insurance policy agent

I want to believe you purchased your insurance policy based on an agent’s recommendation. If so, then this agent has a responsibility to ensure your interests are protected at all times.

In order to ensure they wouldn’t lose you as a client, insurance policy agents go the extra mile to see that their clients get paid.

So, if you have a problem convincing an insurance company to honor your policy claim, simply reach out to your insurance policy agent.

6. Seek legal help

If, at this point, the company is still playing the wise-card, feel free to use any of these legal weapons.

  • Contact your state Department of Insurance: Depending on how seriously your state takes insurance matters, you should find a couple of these departments to table your matter. Once you inform them about the behavior of the insurance company, they’ll look to mediate your dispute.
  • Hire an attorney: The fastest way to make an insurance company take your case seriously is by hiring an insurance claim attorney. These professional lawyers have a healthy history of winning insurance cases for their clients. They will see to it that the insurer doesn’t rest until your claim is paid or a settlement is agreed.
  • A professional arbitrator: If you don’t fancy the idea of going to court because of the lengthy nature of court cases, you can resort to arbitration. Arbitration is a legal proceeding where you and the insurance company present information about your claim to a neutral referee, known as an arbitrator.

 Story by Uday Tank


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