Denied for a ‘Technicality’? Don’t Let Your Insurance Company Hide Behind Fine Print

December 15, 2024

Details, details, details!!  If you have received an insurance claim denial, you are likely well aware that the reasoning behind their refusal to pay may not be based on something major.  Often, it’s the little things, the small issues we refer to as ‘technicalities.’

Unfortunately, even seemingly minor technicalities can result in an insurance claim denial, placing the financial burden of treatment or services on you.

These expenses can be financially devastating and, ultimately, life changing.

If you have received a denial letter from your insurance carrier due to a supposed technicality, it can be worthwhile to engage the assistance of an Oklahoma denied claims attorney to assist with your appeal. Insurance policy language is complex, as is insurance law.  Working with an experienced and reputable professional can have a very real impact on your settlement.

Understanding Your Insurance Policy

Everything having to do with insurance is complicated.  Policies are wordy, and the language can be technical; taking time to read and thoroughly understand your insurance policy is an important task to undertake.

Critical information that can be found in your insurance policy includes, but is not limited to:

• Details on premiums (amounts and how they should be paid)
• Deductible and out-of-pocket maximums
• Eligibility
• Covered v. non-covered benefits and their interpretation
• In-network v. out-of-network providers and coverage
• Excluded services
• Filing procedures for claims and appeals, including deadlines
• Contact information.

In short, your insurance policy documentation outlines the parameters of the services for which you have contracted. Make sure you understand it and keep it in a safe spot for reference in the future.

Common “Technicalities” Used to Deny Claims

Nobody submits an insurance claim expecting it to be denied. Yet, every day people throughout Oklahoma and across the country receive letters of denial from their insurance companies, covering health, automobile, property and disability.

In some cases, the denials are appropriate.  Other times, insurance companies leverage technicalities to deny reasonable claims.  Some examples of technicalities across various lines of insurance include:

• Late/unaccounted-for premium payments
• Failing to provide notification of a change of address
• Misspelled names
• Coding errors
• Missing diagnoses
• Misquoting policy exclusions
• False determinations of medical necessity
• Incorrectly requiring precertification
• Misclassifying damages
• Missing documentation.

While some technicalities can be resolved simply, others may require the assistance of an Oklahoma denied insurance claims attorney to appeal. If the denial is made in bad faith, you may be entitled to damages as well.

What to Do if Your Claim Is Denied

There are times in life to sit back and wait, and times to take action. When you receive a letter of denial from your insurance company, inaction is not an option. Simply doing nothing indicates that you accept their decision as final and are responsible for the expenses they refused to cover. In many cases these costs can be considerable and may impact both you and your family for years to come.

Many don’t realize that initial denials are not necessarily final decisions. In fact, as a policyholder you have the option to appeal their decision . . . and you should.  The steps you will want to take include:

• Reviewing your policy language for benefits and coverage
• Understanding the reason for the denial
• Identifying the deadline for submitting an appeal
• Contacting your insurance company, in writing, to confirm reasons for denial and details on the appeals process
• Gathering relevant documentation
• Drafting and submitting an appeal letter in accordance with guidelines shared by your insurance company
• Keeping copies of your submission
• Verifying your appeal was received, in writing.

While this list may seem straightforward, the process itself can be time consuming and complicated.  Many reach out to a reputable denied claims attorney for assistance in navigating the appeals process. These professionals can also represent you in cases where your insurance company’s actions were in bad faith.

Examples of Bad Faith Insurance Practices

Not all insurance denials are unfounded.  Policy coverages differ from person to person; reimbursement to which one person may be entitled may be very different from that of another policyholder, even if their claims are similar.

Your insurance company is required by law to act in good faith as they deal with their clients.

Unfortunately, as they continue to strive to enhance their profitability, insurers often act unethically and in bad faith.  Some examples of bad faith actions include:

• Delaying payment by requesting unnecessary information
• Intentionally underpaying valid claims
• Inappropriately investigating claims
• Leveraging biased experts
• Threatening clients for filing appeals
• Misrepresenting policy language and coverage.

If you believe your insurance company is acting in bad faith, contact an Oklahoma bad faith insurance lawyer as soon as possible.  This individual may be able to file suit on your behalf in pursuit not only of the settlement to which you were entitled, but for damages as well.

Don’t Take No For an Answer

Doug Terry and His Team Can Help You Address Your Denied Insurance Claims

Has your insurance claim been denied because of a technicality? If so, you are seeing firsthand how little things can make a big difference. Additionally, the cost of these little things can be considerable. Luckily, you have the right to appeal your insurance company’s decision, and the team at Doug Terry Law is here to help.

Unfortunately, the appeals process can be complicated; approaching it appropriately can make a tangible difference in the decision they make and the compensation you receive.  Doug Terry Law has decades of experience helping people address their insurance company denied claims, managing their appeals processes and representing them in court when bad faith comes into play.

They are well-aware of the impact that denials have on individuals; the stress can be overwhelming. As such, they have honed an approach to service that encompasses calm and empathetic communication as well as tenacious representation. Maximizing your settlement is their ultimate goal.

Finally, these professionals have an excellent reputation and understand the value of time.  They are ready to go to work for you immediately. Additionally, they offer all prospective clients a free consultation. Contact them at 405-463-6362 to schedule yours.