How to Resolve a Claim Dispute with Your Insurance Provider

How to Resolve a Claim Dispute with Your Insurance Provider
By Linda Rey

I love getting to know my clients and working with them to provide an insurance portfolio that meets all of their needs, but some clients are more difficult than others. I’m sure this is the case for anyone whose job has a customer service component. I refer to these more difficult clients as “accident prone.”

Some of my clients pay their premium when they should and go years without a claim. But then it seems like I hear from others every month.

When a client has a claim turned down or gets dropped by an insurance company, I often hear the same complaint: I pay my premium; I should receive the insurance benefit.

True, but the insurance companies are running a business. They try to figure out which claims are legitimate and covered by the insurance plan to avoid paying out for false or unnecessary claims.

I’m not saying you should never file a claim. It’s probably written into your contract to report any and all incidents. I want all my clients to receive the insurance benefits they deserve, based on the plans they pay for.

Sometimes all you need is a little bit of communication to solve a claim dispute or speed up a processing delay. We had a client who was told her claim was denied because of an oversight that needed to be reviewed with the underwriter. The client called us; we reviewed the file and discussed the case with the underwriter. Then the claims department reviewed the procedure and coverage and processed her claim.

Long story short, a good insurance agent can serve as an intermediary with the underwriter and help get your claims processed properly.

Here are some things you can do if you need to file a claim dispute:

Review your policy carefully to determine if your claim is indeed covered. The fine print can be tricky; you may need to review your plan with your insurance agent.
Keep track of all paperwork related to your policy and the incident requiring a claim. This may include police reports, medical charts, witness statements, damage estimates, and payment records. The more data you can provide to back up your claim, the more likely you are to receive payment.
Document all contact with the insurance company. Record dates and times of phone calls, as well as full names and extensions and outcomes of the phone calls. Save any emails or paper mail from the insurance company. Again, more proof will only help support your claim.
Keep calm. Problems with your insurance and claim disputes are never fun, but you’re more likely to get the outcome you desire if you stay calm, stay firm, and stay persistent.

Have you had to file a claim dispute? How did you deal with it? Did you receive the outcome you desired?

Linda Rey is a licensed insurance agent at Rey Insurance with a broad spectrum of expertise in life, accident, health, property and casualty insurance as well as retirement planning and college funding strategies.

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