What do you do if your insurance claim is denied?

What do you do if your insurance claim is denied – Insurance is that risk management tool you must have in your arsenal to overcome any uncertain financial provocations. When you purchase insurance, then you back yourself up against sudden unexpected financial losses like an accident.

If something bad happens to you, the insurance company pays you or someone you nominate as your nominee.

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How to settle if your insurance claim is denied

If you do not have any car or health insurance and an accident occurs, I pray it never happens to you with God’s grace but who sees the future! Then what? You have to pay for all applicable expenses.

Auto, health, homeowners, and life are known as the most popular types of personal insurance.

A report by LIMRA shows that 54% of Americans covered themselves with any of these types of insurance.

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What do you understand about insurance claim denial?

Denial of an insurance claim simply refers to a situation when an insurance company refuses to pay the claim amount due to some inconvenience(s) that occurred as per the terms mentioned in the agreement. 

It generally implies that you are short on the money you need to repair your car and also need to pay for your medical bills if you were injured.

Your first reaction is possibly bafflement.

Why was my insurance claim denied?

Claims which are on documented damage are mostly valid, and relying on the testimony of witnesses present to the crash or cause of loss, the claim will typically be approved without incident.

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But some cases are known to be a bit murky, and there can be several reasons an insurance claim can be denied. Some common reasons are mentioned below;

  • Suppose you break the law or terms in the agreement during your claimable accident. Like, while auditing, if the surveyor finds you were drunk or at the time of the accident you don’t have a driving license or something like that, then it’s most likely that your application gets rejected. 
  • Delay in reporting the accident can also become the reason for the rejection of your claim. It is very important to note that you must report within 48 hours of the mishap.
  • If you take services from outside of the enlisted partners of your insurer, then there are high chances that your insurer will refuse to pay you off for the losses.
  • Claim worth more than that of your coverage. Another scenario could be that you do not have the necessary coverage.
  • If you are high on drugs or mentally disrupted, the insurance company may reject your application.

Several other reasons by which your car insurance company can deny an insurance claim

There are several other reasons why a car insurance company may deny a claim,

  • One of the most common reasons is that the driver or the policyholder doesn’t have all the required credentials. 
  • When an accident is caused by the mistake of the driver, then the insurance companies may reject the insurance claim. Like
  • Absence of grounds to have made the decision based on the evidence provided. In this case, your claim may have been incorrectly denied.

What do you do if your insurance claim is denied?

When you come to know your insurance is denied, it adds fuel to the fire in these traumatic circumstances.

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I kind of knew that as well. But the thing is, approving a denied claim is just like squeezing water from a rock. But still, we jotted down below some approaches that can help,- 

Report the claim immediately

To avoid rejection, you have to report your claim immediately, just after the car accidents have taken place.

It decreases the chance of rejection of claims by insurance companies. But what if you didn’t? Then also you can share proof of the mishap, such as video footage of the traffic, images, medical documents, and so on. 

Make sure you choose the right company.

To avoid claim rejection, you have to resist any type of documenting with another driver’s insurer.

Because it is the other driver’s fault, not yours, and this strategy is known as subrogation.

Also, while choosing your insurer, make sure you go through all the data and info as per your checklist.

Get detailed estimates

The more information you have, the higher the result you will typically have with your claim.

A method you can do is to have your repair shop give you an itemized, detailed estimate of repairs.

Do not give rise to the blunder of going just anywhere for your repair measures.

Receive estimates based on original factory (OEM) parts

You possess the right to have your car returned after repairs in the same condition it was before the accident.

For some insurers, you need a certain rider on your policy to request original equipment manufacturer (OEM) parts.

This may cost a few more dollars in buying certain riders, but it is a nice idea to invest in this coverage.

How to challenge an insurance claims denial?

You can write an Ombudsman of your area to object to your insurer.

The complaint can be about hold in claim settlement, premium dispute, misrepresentation of terms and conditions, and other Affordable Care Insurance Act issues.

Also, you can take action from acts like McCarran Ferguson or take assistance from a regulatory body like NAIC.

What are the ways to challenge an insurance claim denial?

There are two ways to challenge claim denial:

Internal appeal: If a claim is denied or your insurance coverage canceled, then you have the right to an internal appeal.

You may ask your car insurance company to conduct an entire and satisfactory survey of its decision. 

External review: Democratic rights in the US gives you the exposure to take your plea to an independent third party for review.

This is called an external review. In this approach, the insurance company no longer gets the final say over whether to pay a claim and is shifted to the third party. And this should consider as a final strew. 


Now, with the help of this article, you can know the reasons for the denial of your claim by the insurance company, what precautions you have taken to avoid denial, and how to challenge the denial.

And also, do You know the immediate steps to take if your insurance entity refuses to pay you off. 

Make sure you leave any excuses from your end so that your claim can process effortlessly. This is how you will be able to avail the insurance benefits offered by your insurance plan.

And for better assistance, you may contact an industry expert or comment down below. We’ll definitely get back.  

Frequently asked questions

What are the most popular citations of insurance claims?

Incorrect demographic information, procedural or diagnosis codes.
Medical necessity requirements not met.
Non-covered procedure.
Payer processing errors.

How do I write an insurance appeal letter?

Things to Include in Your Appeal Letter

Patient name, policy number, and name of the policyholder.
You have to provide valid contact data for the patient and the policyholder.
Date of the rejection letter, specifics on what was denied, and illustrated reason for denial.
Medical providers and doctors and contact information.

Name the three types of US health insurance?

The several types of US health insurance include:ย 

Health maintenance organizations (HMOs)ย 
Exclusive provider organizations (EPOs)
ย Point-of-service (POS) plans.

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