OK so you have made a claim against your insurance policy and your insurance company are disputing its validity.
There could be many reasons for this from a simple clerical error, processing oversight or a genuine mistake in the interpretation of your claim against the cover provided in your policy.
When faced with this situation, why not try employing the following 7 insurance claims tactics?
Tactic 1: Scrutinize Your Insurance Policy Very Carefully
Get your policy documents out and go over every clause with a fine tooth comb to ensure that you have correctly interpreted the cover you are entitled to.
Tactic 2: Obtain a Written Response from Your Insurance Company
Once you are sure of your facts and the validity of your claim against the terms laid out in your insurance policy, contact the insurance company and insist on a written explanation of the reasons they are disputing your claim.
Some insurance companies do not provide the reasons they have rejected a claim in writing. And also, this could very well be a legal requirement in your place of residence.
The simple act of doing this may well lead to your claim being reconsidered as a matter of routine.
After you have received the rationale for the claim rejection in writing, compare and contrast the facts provided against the details provided in your insurance policy. Be thorough and make sure that you identify anything that doesn’t make sense or is in conflict with the policy document.
Quite often, claims disputes arise from different interpretations of the policy documentation. That’s why a well written explanation of your case using details from the insurance policy is a vital course of action to take.
Tactic 3: Never Ever Assume That the First Rejection of Your Claim Is Final
Industry statistics reveal that less than 1% of policyholders question the decision made by the insurance company when they deny a claim! However, more than half of the people that do query the claim denial are successful with their effort to settle a claim in their favor. Fight back and you have a fair chance of getting a good result.
Other insurance industry statistics suggest that around 10 percent of denied claims are made unjustly. Therefore, if you are sure of your facts and you are confident that your claim is valid, you have a really good chance of success despite getting an initial rejection.
What’s more, a lot of people who challenge the insurance company over their claim usually end up with an improved pay out or having a rejection reversed.
Tactic 4: Do Not Accept Process Error as a Valid Reason to Deny Your Claim
Insurance companies have different claims submission and handling processes. Sometimes, insurance companies insist on claims being filed within a specific deadline after a loss has been incurred. Some insurance companies may try to refuse the claim if a claim form has been completed incorrectly or the claim has been made after the stated deadline in their process documentation.
Be aware however, that insurance providers are not normally allowed to reject a valid claim based on a “filing error” unless they can prove that the error precluded their investigation of the matter or the filing error penalized the company.
Please check the exact facts relating to this matter because different countries have different rules in this respect. So, a prudent course of action to take would be to check out the local legal issues applicable to insurance claims before and during any consideration of the application of the tactics outlined in this article.
Tactic 5: Enlist the Support of the Insurance Agent Who Sold You the Policy
Although using this tactic can be a bit “hit or miss” in terms of getting a favorable result, you will not know unless you try. Your insurance agent might be able to help or suggest other experts that can advise you about your claim. See Tactic Seven below.
Tactic 6: Persistence Is Your Best Friend
On a regular basis, say every few weeks, call the insurance company on the phone. Be persistent but always polite to progress your inquiry. Don’t be fobbed off with a junior admin person, always ask to be put through to their boss or supervisor.
Make sure that you keep a clear record of all your phone calls including the name of the persons you spoke with plus the time and date of each call. After each call, send the insurance company a “confirmation” letter which details the nature of your conversation and the issues covered in the conversation. Then ask the insurance company for a response in writing from them within 2 weeks. If no written response is forthcoming, call them again!
Make sure that you keep copies of all letters that you send to the insurance company and if possible send your correspondence by certified delivery that provides a “proof of delivery” receipt.
Tactic 7: Employ a Reputable Firm of Loss Assessors
No one can be an expert in everything. That’s why we have specialist professionals to help with all sorts of detailed issues we have no experience in. If you are not feeling well, you go and see a doctor. If you need legal advice, you see a lawyer right?
Well the same principle applies to insurance claims. Specialists in this field are called loss assessors or sometimes loss adjusters, claims adjusters or insurance adjusters. Insurance companies use them too to help assess the extent of their liability in the insurance claims process.
Most folks aren’t aware of the existence of such professionals or the fact that they can usually obtain a far better claims settlement than a private individual could.
The benefit of using a form of independent loss assessors is that they are experts in their field and they work in your interests, not the interest of your insurance company.
Loss assessors know their way around insurance contracts, polices and the tricky details of the claims process. If they are involved early in the claims process, they can maximize your claim payout. And even if you have had a claim rejected, a good loss assessor may still be in a position to facilitate a successful outcome for you.
Try these tactics and we’re sure they will be of some help even if we cannot guarantee that they will ensure that your claim will be settled in your favor. That all depends on the nature of your claim, whether there is demonstrable cover provision for it in your policy and how you pursue the claims process.
Hopefully, you have found some useful insights in this article. The most important thing to remember is that only one percent of people challenge a claim that has been rejected. However more than 50% of people that challenge their insurance company in such circumstances get a positive result!