Dealing with Delayed or Denied Insurance Claims: Your Rights and Options

There are times when an insurer will not pay a claim as quickly as it should. Whether it’s a prior authorization requirement or a medical bill, you may struggle with delayed insurance claims.

Some people are even forced to pay out of pocket. Then you’re made to wait for months on end for reimbursement, which can be frustrating.

If your insurance company refuses to pay a claim, you have the right to appeal the decision and have it reviewed by a third party. With the help of your attorney, ask the insurer to reconsider the decision. You can also ask them to tell you why they denied your claim, and then find out how you can dispute their decision. 

Your Rights and Options When Dealing With Delayed or Denied Insurance

Filing for an insurance claim should be a simple process in Florida or anywhere else, right? But like many things in life, this process can get very complicated. That’s especially if you’re dealing with an expensive claim.

If an insurance company denies your claim, that’s not to mean that you’ll not get your compensation.

When dealing with denied insurance claims in Florida, it’s important that you hire the services of a Florida public adjuster. Someone that can negotiate on your behalf and together with an attorney, make sure that you finally get compensated. You must also know your rights and options since insurers are likely to take advantage and employ tactics to delay your claim.

Let’s discuss some of your rights and options that you must know about when dealing with delayed or denied insurance claims.

1. Know Your Insurance Policy and Rights

A thorough review of an insurance policy will provide you with good insights into what’s expected in case you need to make a claim. You will be able to find out:

  • Details on what’s covered
  • What needs to be done to file a claim
  • How quickly a claim must be submitted
  • The process of estimating damage reimbursement amounts

It’s important to have an attorney when the insurer interviews you to get details on an accident. The attorney must also be present when you’re giving information about the value of the possessions in the case of property and casualty insurance.

It’s equally important that you know your rights in case of a dispute. These rights should be detailed in a policy or a discussion with your agent, the insurance provider, or the state regulator. 

2. Review all the Notifications About the Claim

This may sound obvious but it’s one of the most crucial steps when processing a claim. You must carefully review remittance advice and explanation of benefits, and other notifications whenever you receive them.

The notifications must show whether your claim was paid in full, delayed, or partially paid. It must also indicate in case the claim was denied. Follow the carrier’s instructions for resubmitting the claim if it was determined to be “unclean” or contested. You must also follow up on any missing or corrected information.

In case the claim is partially paid or denied, the notification must specify the reason why. It must also outline the specific procedures and documentation that’s required to resubmit the claim or file an appeal.

It’s important that you call the carrier for more information in case the notification is not clear. Apart from eliciting a stated reason for denying a claim, you may realize that the claim was incorrectly adjudicated. That may have been due to an administrative error on the part of the payer.

You may also find out that your submission procedures don’t match the company’s requirements. In such a case, you may make simple adjustments to your procedure, hence streamlining future claim submissions. 

3. Take Advantage of the State Regulations

Always keep in mind that taking your insurer to court should only come as a last resort. That’s considering that such a lawsuit can tie up a claim for many years and seriously delay the needed funds for medical treatment.

You must first try and work directly with your insurance agent. Alternatively, you can work directly with the insurance provider in a calm and patient manner. Be sure to document the entire process while at it.

But if they end up proving difficult to work with, then you can go ahead and utilize the services of a state insurance regulator. That will help to move the process of a delayed insurance claim forward.

4. Be Persistent

Having difficulties getting an insurance company to honor its claim obligation can be a frustrating and time-consuming process.

Majority of these cases should actually be straightforward. That’s considering that the claims are largely handled correctly and ethically.

Unfortunately, challenges always crop up and you must stay on top of the insurer with frequent follow-ups. You must also do a thorough documentation of the entire process to succeed in getting a fair compensation. 

5. Get to Understand the Appeals Process

You must get familiar with the insurer’s appeals process when you submit an appeal. That’s because knowing your carrier’s policy places you in a better position to respond to their actions.

You must also be up to date with regards to the current information on claims adjudication and the appeal processes of every carrier. Usually, carriers will have this information on their websites. And if necessary, you can provide hard copies of the information. 

6. Keep Your Records

The work that you did before an accident is very important when it comes to claims. When it comes to insuring the items in your home, it pays to keep receipts and a record of your possessions. That’s especially important for the more expensive assets.

For better documentation of the possessions in your home, you can choose to take a tour of your home and record all the contents with a video camera. Then keep the video in a safe place outside your home. Such a place can be your office or a safe deposit box.

When it comes to disputing a claim, have a very detailed record of who you talked to. Make sure that you can prove when it happened and what was discussed. Remember that shady insurance companies can go out of their way to make the claims process a nightmare. As such, it would help your case to have a piece of evidence that proves their elusiveness. 


There are studies that exist to rate how reputable individual insurance providers are. Thus, it would be a good idea to do your due diligence and carry out a background check on your insurer. You can also refer to your findings when looking for a new insurance provider.

Note that a lot of insurance claims are handled in a right and timely manner. However, it helps to be aware of your rights, possible challenges, and how to handle them. That’s in case the insurance claim process fails to go as smoothly as it should.

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Filing for an insurance claim should be a simple process but that’s not always the case. The process to claim your insurance settlement can get so complicated that youér forced to file a lawsuit. But do you understand your rights and options in case your insurance claim gets denied? We find that out in this article.

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