Negotiating with Your Insurer After a Denial: Tactics that Work

July 19, 2024

Doing Things Right Makes a Tangible Difference

If you have received a letter of denial regarding your insurance claim, you are not alone. Health, automobile, and property insurance claims are denied every day in Oklahoma. Unfortunately, this likely provides little comfort. You need your claim to be honored to pay your bills. Without it, you may be forced to make difficult decisions, including assuming overwhelming debt to pay your expenses. In some situations, you won’t be able to repair your home or vehicle; in others, you cannot obtain the medical treatment you or your loved one needs.

Insurance claim denials are more than inconvenient; they can be life-changing.

Many who don’t realize that appeal options exist take their insurance company’s initial denial as final and assume the financial burden for their losses.  Recognizing that you can negotiate with your insurer is the first step toward impacting your compensation. Knowing the right steps to take and executing them correctly can positively affect the outcome of your appeal.

Perhaps the greatest issue with the appeals process is its intentional complexity. The requirements are strict, and the language is confusing.  Often, engaging the assistance of a denied claim attorney in Oklahoma can be valuable. These professionals know how to manage the appeals process to increase your chances of success.

Claims Denials Are Confusing

You Paid for Insurance Coverage, Not Denials

When you purchased your insurance, you did so with the hope that you would never need to use it, but with the belief that if you did, your insurance carrier would pay your covered claims in full and in a timely fashion. Sadly, this rarely happens. But why?

The reason is simple. Insurance companies’ primary goals are to maximize revenue while minimizing expenses. Every time they pay a claim, their expenses increase, an action that negatively impacts profitability. With this in mind, it makes sense that insurance companies deny, delay, and underpay claims. So many policyholders don’t realize they have the right to appeal or don’t have the patience to see the process through to the end and they accept their insurance companies’ first response. In short, these strategies work.

What to Do After an Insurance Claim Denial

It is not surprising that you are concerned that your insurance claim was denied.  The idea of being financially responsible for the totality of your expenses is overwhelming. Before you resign yourself to paying out of pocket, you should file an appeal.

Why Negotiation Matters

This is the first step in negotiations with your insurance company.  You want to begin a dialog to increase your chances of maximizing your settlement.  But, you want to negotiate wisely — the actual process can be challenging, and mistakes along the way can be costly.

Engaging a denied claims attorney to negotiate on your behalf can be beneficial. This professional not only understands Oklahoma insurance law but also knows how these companies operate. They know what to say and do to influence a positive agreement. If you don’t negotiate, you are accepting your insurance company’s word as final, a costly proposition.

Tips for Negotiating Skillfully

Know Your Policy

In all cases, knowledge is power, but this is especially true when appealing insurance claims. Luckily, a great deal of valuable information is available in your policy. Take the time to review it and recognize the extent of your coverage, your deductibles, and how to appropriately file an appeal.

You must understand why your claim was denied. In some cases, there is a simple fix. For example, if it was submitted incorrectly, you can refile it.  Other reasons for denial are more complicated, but these may be able to be refuted based on the language in your policy.

Gather Evidence

To successfully appeal, you must provide a great deal of information. Gathering evidence at the onset can help expedite the process.  The material you should have is dependent upon the type of insurance denial you are appealing. Health care, auto insurance, and property insurance all have specific documentation that you should amass.  Consider some of the things you would want to have on hand:

• Medical claims: letters of medical necessity, copies of bills, medical records
• Property claims: dates of damage, photographs, public adjuster quotes, contractor quotes
• Auto Claims: police reports, medical bills, witness statements, photos and video, repair estimates.

Keep in mind that other denials, including long-term care and life insurance, would require documentation unique to those situations.  A claims denial attorney in Oklahoma can help determine the best evidence for each.

Be Prepared with Facts and Figures

When negotiating with an insurance company, you want to come to the table with solid facts. This is why you need to have copies of your bills as well as estimates for repairs. If you are dealing with property damage, having more than one estimate is in your best interest.

Additionally, if you are fighting a medical claim denial, consider including published medical and scientific research that can be used as evidence.

Initiate Contact; Be Professional and Polite

It’s not surprising that you are angry and frustrated. That said, it is in your best interests to conduct all business with your insurance company professionally.

All interactions should be formal and polite — yelling will get you nowhere.

You also want to submit your appeal according to the process outlined in your policy. Never lose sight of the fact that this denial wasn’t personal . . . it’s just business.  You need to counteract their arguments and prove that your claim is covered.

Present Your Case Clearly and Concisely

Critical to effecting change is submitting your case clearly and concisely; in situations like this more is not better.  Draft an appeal letter that is short and to the point.  Make sure to attach all relevant documentation, including a copy of the policy and a copy of the denial letter. If possible, you want to refer directly to specific policy language.

You also should include copies of relevant documents as discussed in the gathered evidence section above.

Negotiate Strategically

Determining exactly what you should request in your appeal is important. Padding your expenses and asking for non-covered costs weakens your request.  The key is to negotiate strategically. That said, as a layperson, you likely don’t have the knowledge and experience to do this appropriately.  This is where engaging a seasoned Oklahoma insurance claims denial attorney works in your favor.

Document Everything

The most important advice to heed when negotiating is to document, document, document!  This refers to both your situation and your appeal.

For example, if you are ill, keep a record of your symptoms and their impact on your life. If you were in a car accident, track all damages and costs (like car rentals, repairs, and medical issues). In both cases, if you cannot work, it’s important to maintain accurate records.

Additionally, if possible, conduct all communication with your insurance company in writing. If you are required to submit your appeal via mail, make sure to send all correspondence return receipt requested.  Finally, if you do speak with a representative on the phone, immediately follow up with an email documenting your conversation. You don’t want to leave anything up for interpretation.

When Negotiation Fails

Sometimes, despite your best efforts or those of your legal counsel, an acceptable agreement cannot be reached.  In cases like this, your claims denial attorney in Oklahoma can take your case to court.

If your insurance company’s actions were in bad faith — meaning they stalled unreasonably, undervalued your losses, or imposed unreasonable requirements — you can sue them for their actions.

If you are successful you may be awarded the settlement to which you were entitled in addition to damages.

The Denied Claims Attorneys at Doug Terry Law Can Represent You

We Are Skillful Negotiators and Aggressive Litigators

As a layperson, you are at a disadvantage when appealing and negotiating your denied claim. Insurance companies recognize your naivete and work to convince you to accept less than the payment to which you may be entitled.

On the other hand, insurance companies tend to respond more positively, and in a more timely fashion, to attorneys. They realize that these professionals understand the legal landscape under which they operate and are not overwhelmed by the complex industry and legal terminology.

Doug Terry and his team are well-versed in Oklahoma insurance law and have a proven record of providing outstanding service. They understand the pressures you are facing and communicate compassionately and intentionally. As your denied claims attorney, they will manage the appeals process, taking responsibility for everything from reviewing your policy and crafting your appeals letter to negotiating and litigating if need be.

The firm was founded on the knowledge that every day insurance companies take advantage of unsuspecting individuals. Doug Terry Law is committed to providing our friends and neighbors in Oklahoma with the same quality counsel as that employed by their insurance companies. Working with us levels the playing field.

Reach out today at 405-463-6362 to schedule a free consultation.  As your denied claims attorney, we share your goals and will work hard to maximize your settlement as we minimize the stress associated with the insurance appeals process.