Insurance disputes often arise after an individual or company files a claim with an insurance company and the insurance company denies the claim. In some cases, the insurance company can provide valid reasons for the denial, but in other cases the insured party may feel that the denial was unfounded. Types of insurance disputes and resolutions may vary depending on the state, type of insurance claim, disclaimers within insurance policies, and other factors.
Types of Insurance Denial Disputes
When an insurance company denies an insurance claim, the insurance company will provide a reason for the denial. If the policy holder feels that the reason for the denial was an error, the policy holder can file an appeal to have the claim readdressed. If the insurance company still does not approve the claim or the policy holder believes that the insurance company is acting unethically, an attorney may be able to provide advice about the next steps to take.
Insurance companies commonly cite similar reasons for denying insurance claims, including:
- Passages within the policy which exclude coverage for the claim, which may have been misunderstood
- Injuries, procedures, or incidents which are not covered by the specifics of the policy
- A lapse in coverage during the time period specified in the claim
- Incomplete or incorrect information within the claim
Unfair Claim Settlement Practices Act
Many states, including Florida, have adopted the Unfair Claim Settlement Practices Act to hold insurance companies accountable for unfair claims denials. If an insurance company attempts to intentionally mislead policy holders, commit fraud, or otherwise avoid honoring legitimate claims, it is considered to be a crime. This Act also prohibits insurance companies from paying less than was agreed upon for insurance claims.
Common Types of Insurance
There are different types of insurance that may warrant different types of insurance disputes. Insurance policies may cover very different types of claims, and the way that the claims are paid or denied may vary. Policy holders should carefully read all aspects of an insurance policy and make sure that coverage and claims are fully understood before purchasing an insurance policy of any kind.
Common types of insurance policies that may be purchased include:
- Health Insurance
- Automobile insurance
- Dental insurance
- Life insurance
- Professional liability insurance
- Homeowners insurance
Claims Denial Benefit
Insurance companies profit when customers pay for policies and claims are not honored. For this reason, unethical insurance companies will deny claims that are legitimate or provide inadequate compensation for claims and attempt to justify the denial. Many customers accept insurance denials without question, allowing unethical practice to continue.
Other Types of Insurance Disputes
Besides claims denials, many other types of insurance disputes may also arise, including:
- Disagreements over increases in premiums
- Disagreements over changing policy coverage
- Perceived misinformation from insurance company
- Misunderstanding in tax benefits or discounts from purchasing insurance
- Forged signatures or other misconduct
- Lapse in coverage without notification
Filing an Insurance Claim
Different types of insurance may vary greatly in the way that claims must be filed. Since errors in filing an insurance claim can be cited as a legitimate reason to deny a claim, policy holders should work carefully with the insurance company when filing a claim. Marking down dates and insurance company representative names when filing a claim may be helpful if any type of insurance dispute arises, including denial of the claim.
Resolving Insurance Disputes
Insurance disputes can sometimes be resolved by filing an appeal or speaking to an insurance representative. If the insurance dispute cannot be resolved in this way, it is often the best option to speak to an attorney. Insurance disputes are typically complex and require a well-rounded knowledge of legal and technical details that may be pertinent to properly resolving the dispute. An attorney will be able to review a case for legitimacy and provide advice for resolving the insurance dispute.
Sources:
“How can I protect myself from fraud in the Health Insurance Marketplace?” Healthcare.gov. USA.gov, n.d. Web. 28 Mar 2014. <https://www.healthcare.gov/how-can-i-protect-myself-from-fraud-in-the-health-insurance-marketplace/>
“Protecting Your Health Insurance Coverage.” U.S. Department of Health and Human Services. U.S. Department of Health and Human Services. Web. 28 Mar 2014. <http://www.cms.gov/Regulations-and-Guidance/Health-Insurance-Reform/HealthInsReformforConsume/downloads/protect.pdf>