Denied Insurance Claims: How to Mitigate your Risk

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Denied Insurance Claims: How to Mitigate your Risk

Risk is everywhere – which is why insurance exists.

Difficult times can be frustrating. Whether it’s a car collision, a diagnosed terminal illness or a flooded house, insurance is there to help you get back up and return to normal life. Getting a plan will provide you with peace of mind no matter what kind of risks you undergo.

How can I make my denied insurance claim work for me?

Insurance providers offer plans to businesses and individuals. When you buy insurance, you contribute money called a premium. This money is pooled with other funds to serve as a security deposit in case one of the members need financial assistance. Depending on the company, you will be required to pay a certain number of premiums. Once you complete the target number, you can then claim your benefits whenever a calamity or incident happens.

An insurance policy is very useful. Moreover, the statistics for denied insurance claims in Canada remains very low. In the year 2014 alone, insurers had to pay a total of $83.5 billion to Canadian policy holders and their beneficiaries. This number is multiple times as much as the 2013 figure for natural catastrophe payout of $3.2 billion.

General Insurance Plans in Canada

There are several insurance types you should be aware of:

• Disability Income Insurance aims to cover lost income. They normally amount to a certain percentage of a person’s normal earnings and is paid periodically. This type is closely tied up with benefits from Worker’s Compensation and Employment Insurance, as well as from the Canada/Quebec Pension Plans. It is crucial that you understand the framework of your policy for this particular type so you know what to do when you get your disability insurance claim denied.
• Long-term Care Insurance provides financial aid to people who lost the ability to care for themselves. This may be caused by a terminal disease, a chronic illness or a physical disability. The financial coverage for this plan may include hospital bills, medication and salaries for care personnel. By the end of 2014, it has been recorded that 348,000 Canadians were covered up to 75% through cluster arrangements.
• Auto/Home/Business Insurance is a specialized plan aimed to cover damage costs caused by unforeseen events in relation to the policy coverage. For example, if you get involved in a car accident and accidentally injure the other driver, your insurance may cover the medical bills the patient is entitled to. A similar situation can also happen to your house or your business, so insurance is needed to help you financially to fix the damages.

Insurance Claims and How to File Them

Claims refer to financial aid requests filed to your provider. Filing claims are relatively easy, but the process may vary among different providers. Moreover, there will also be variations between different insurance plans. Take health insurance claims , for example. You want to get money to pay for the hospital fees incurred during your operation. A provider may require you to pay the bills beforehand and hand them the receipt for reimbursement. Another provider might request for a billing request direct from the hospital. It is very important that you know the procedures of your insurance provider for your particular policy.

Once you know the requirements, be sure to comply. Completely fill out the forms clearly and as accurately as possible. If the insurer finds any discrepancy in your application, your claim might be denied and this will prolong the process.Essentially, you have one year from the date you incurred the expenses to file a claim. This is possibly the maximum period although other filing periods may vary for other companies. Once your application is approved, the company will issue a cheque or deposit the money into your bank account along with a voucher detailing the amount sent.

The most convenient way to file a claim is by hiring the services of lawyers for insurance claims. They will take care of all the documentary requirements, as well as follow-up.

What do I do if my insurance claim is denied?

Claims can be denied by an insurance company because of numerous reasons, such as:

• Material Misrepresentation. This happens when you fail to present all the details in your claim accurately. One of the common versions of this incident is when you fail to update the company of your current home address. This might seem insignificant, but it can cost you the entire insurance if the company finds a loophole.
• Non-covered Charges. If you file a claim for an expense that is clearly not covered by your policy, the application will surely be denied.
• Claims related to unacceptable behavior. There are companies that lay weight on why you have run into a car accident. If this is because of DUI or any similar reckless behavior, the company can deny you from getting a claim. In these cases, you should consider lawyers for car insurance claims.
• Document Mix-ups. This happens often for health insurance cases. Make sure that your doctor sends the bill to the right insurance company. If you have two policies, make sure that there is no double charge. This can happen when both policies cover the same incident and one of them is automatically initiated with or without your authorization.

The first thing you need to do is examine whether any of the above reasons apply. If you still believe that your claim is valid, initiate contact with your insurance company. If they fail to resolve the issue, you can contact any of the governing bodies listed below for assistance.

There is also the option of hiring a lawyer to settle the dispute. We pride ourselves in providing personalized service, including extensive interviews and preparation for all clients and their witnesses. We believe that preparation is key to effectively, and successfully representing our clients.

Our experienced attorneys are available 24/7 to offer injury victims a free consultation . If you have been seriously injured and would like to speak to an attorney, we will make arrangements to travel to meet you. Call us today at (905) 940-5554 .

Significant Organizations in Canada

OmbudService for Life and Health Insurance (OLHI) – is an independent service for complaints resolution and information dissemination available throughout the country. They cater to Canadian life and health insurance policy holders, as well as disability, travel, and many more. Matters concerning investment products like segregated funds and annuities can be discussed.

Office of the Superintendent of Financial Institutions (OSFI) – is another independent agency that aims to maintain the safety and soundness of Canada’s financial system. They examine all financial insurance providers for legitimacy and capacity. This ensures that Canadians have access to reliable insurance services in the country.

General Insurance OmbudService (GIO) – is a national independent dispute resolution service that caters to all insurance types from home, automobile or business insurance. They act as an intermediary between the complainant and the concerned party to resolve issues in a more standardized manner in the least possible time.

Insurance Bureau of Canada (IBC) – is a national association governing the private insurance sector. Apart from providing support to its members, they also provide resolution services to complaints related to any of its members. They host several information including helpful tips on what to do if health insurance claim is denied.