You have been a great customer for your insurance company. You have dutifully paid your insurance company every month for years, based on the understanding that insurance will cover your expenses in the event of an accident or catastrophe. Now, after many years of paying for your policy, the worst has happened and it’s time to file a claim. Fortunately, you paid into your policy for this very reason: your insurer has you covered.
At least, that’s what you would rightfully expect.
Instead, you now find that your insurance company is refusing to cover your costs, despite the payments you have furnished for years. You don’t know what to do or where to turn — all you know is that you have ever-increasing bills which need to be paid, insurance coverage or not. When your insurer abandons your claims, do you have any legal recourse?
Fortunately, you do: an insurance dispute attorney from the Law Practice of Ken Kieklak is ready to assist you. At the Law Practice of Ken Kieklak, our skilled legal team has nearly 20 years of experience negotiating with insurance companies, and trying cases against them. We listen to and advocate aggressively for our clients, and we will deal with the large and notoriously stubborn insurance companies when your claims to coverage have gone ignored. You don’t have to fight your insurance company alone: enlist aggressive professional help from the Law Practice of Ken Kieklak today.
Insurance Dispute Q & A
Q: How can my insurance company refuse my claim?
Unfortunately, insurance companies deny claims every day, often without giving their customers a valid reason for doing so. Many of these claim denials are not contested by insurees, so the insurance companies frequently get away with these unethical and profit-oriented decisions to deny their clients the coverage which has been promised — and paid for.
This is not to say that all insurance companies or insurance agents have bad intentions. Often, the issue is simply that insurance companies are bombarded with thousands of claims every day. Some are fraudulent and some are not, but legitimate claims are frequently “swept under the rug” in the interest of deflecting insurance fraud.
Q: Can I appeal a rejection? Can I ask for a reconsideration?
If your health insurance policy was issued after March 23, 2010, the Affordable Care Act (ACA) requires your insurance company to:
- Explain why your claim was denied.
- Inform you of your right to appeal the denial.
If you would like to appeal a denial, you may ask for a reconsideration of the original rejected claim. This reconsideration may take the form of an internal review, or an external review. These reviews may be requested simultaneously.
Essentially, an internal review is a second review by the insurance company. An external review is a fresh review by an outside party.
Q: What are the most common reasons insurance companies deny claims?
Insurance companies deny claims for a variety of reasons. Some of these reasons are perfectly valid; others are not. Some of the most common reasons for insurance companies denying claims include:
- Material misrepresentation in the policy, excluding coverage for the particular claim.
- Failure by the insuree to pay policy premiums on time.
- The incident or injury falls outside of the scope of policy coverage.
- The treatment associated with your injury is not deemed medically necessary.
- The insurance company determines that the treatment is not effective, or is still in the experimental treatment stage.
Q: What types of insurance disputes can you help me manage?
At the Law Practice of Ken Kieklak, we have extensive experience handling various types of insurance disputes, including but not limited to disputes regarding:
- Automobile Insurance
- Medical Insurance
- Home or Renters Insurance
- Life Insurance
You have taken the time and effort to be a good insuree. You have made financial sacrifices with the understanding that your payments will act as a safety net in your time of need. If your insurance claim has been denied, an insurance attorney from the Law Practice of Ken Kieklak can assist. For a confidential case evaluation, call our law offices at (479) 316-0438, or contact us online.