You have paid your premiums and depended on your coverage, and when it comes time to file a claim, you expect your insurance company to have your back. But when they deny your claim, it can be emotionally and financially devastating. Suddenly you are faced with uncertainty about your future, your finances, and your next steps.
We have seen the toll this can take on individuals and families. Insurance companies are supposed to be there when you need them most, but all too often they put their bottom line ahead of the people they are meant to protect.
Our Los Angeles insurance lawyers understand the intricacies of insurance law and the importance of a personal commitment to our clients. Battling an insurance company can feel like taking on a Goliath – it’s our job to help you turn the tables.
We take pride in being people helping people, and we have helped countless clients in your situation, guiding them through the legal process and fighting to get them the compensation they deserve. We believe that no one should have to take on an insurance company alone, and we are here to provide the support, expertise, and dedication you need to make things right.
Contact our Los Angeles insurance attorneys at 818-886-2525 for a free consultation.
Steps to Take if Your Insurance Claim Is Denied
Receiving a denial of an insurance claim can be devastating, as you are counting on those benefits. However, a denial is not the end of the road—there are several steps you can take to challenge the decision.
First and foremost, do not panic. Take a deep breath and carefully review the denial letter. Insurance companies are required to provide a reason for denying your claim, and understanding their rationale is crucial. Look for any specific points or terms mentioned, as this will be the starting point for building your case. Be sure to meet any deadlines specified in your policy to avoid losing the right to appeal.
Once you understand why your claim was denied, gather all relevant documentation. This includes your insurance policy, correspondence with the insurance company, medical records, bills, and any other evidence that supports your claim. Having a complete and organized file will make it easier to present your case clearly and effectively.
Next, contact your insurance company in writing and request a copy of your “claim file.” A “claim file” is the complete collection of documents and records that an insurance company is required to maintain related to your insurance claim. When a claim for benefits is filed, the insurance company compiles all the information it uses to make decisions about the claim, including medical records, correspondence, internal notes, policy details, and other evidence it considers in approving or denying the claim. If your claim is governed by federal law, you are automatically entitled to a copy of the claim file.
If you intend to challenge the denial, the next step is to file an appeal. Make sure to file the appeal before the deadline listed on your denial letter and look to your policy for specific rules regarding your right to appeal. Submit a formal appeal letter, clearly outlining why you believe the denial was incorrect, and include all the supporting documentation you have gathered. Communicate with insurance companies only in writing. Again, be sure to meet any deadlines specified in your policy to avoid losing your right to appeal.
Throughout this process, make sure to continue to gather additional information as needed. This is important even after you have submitted your appeal, as you can continue to submit additional information until a decision is made.
Our experienced insurance lawyers can provide invaluable assistance, helping you understand your rights, build a strong case, and advocate on your behalf.
Why Do Insurance Claims Get Denied?
Often, you do everything right, yet your claim still gets denied. Here is why this might happen:
- Missing Information: One of the most common reasons for denial is missing information. Insurance companies require specific documents and details to process a claim. If you leave something out, even by mistake, your claim might be denied.
- Policy Exclusions: Every insurance policy has exclusions – specific conditions or situations that are not covered. For example, some health insurance policies do not cover certain treatments. If your claim falls into one of these exclusions, it can be denied. Insurance companies can deny claims based on pre-existing conditions if you file your claim within a certain amount of time of obtaining your coverage.
- Fraud or Misrepresentation: If the insurance company believes you have provided false information or misrepresented facts, they can deny your claim. This is why it is essential to be honest and accurate in all your communications.
- Biased Experts: Potentially the most common reason claims are denied is because insurance companies hire biased medical “experts” who review your claim in a biased manner and look for reasons to deny it.
Why Choose Kantor & Kantor?
Our team brings decades of experience in handling a wide range of insurance claims. Whether it is health insurance, long-term disability, life insurance, or long-term care, and long-term disability, we have seen it all.
We are intimately familiar with the tactics insurance companies use to avoid paying out claims, and we know how to counter those tactics. Our understanding of the insurance industry means that we can anticipate the challenges you might face and provide solutions that work in your favor.
What sets us apart is our approach to every case. We do not treat you as just another client; we see you as a person going through a challenging time. Our team takes the time to listen to your story, understand your concerns, and work to get you the results you deserve. With years of experience in insurance law, we have the knowledge and expertise to fight against even the most difficult insurance companies.
Insurance companies are often betting on the fact that individuals will give up after a denial or delay. But at Kantor & Kantor, we do not give up. We fight hard for our clients, whether it is negotiating a fair settlement or taking the case to court if necessary. We have the legal muscle and the resolve to see your case through, no matter how tough it gets.
We pride ourselves on our track record of success. We have helped countless clients successfully challenge denials, delays, and underpayments by insurance companies. Whether it is a straightforward claim or a complex dispute, our lawyers are equipped with the knowledge and skills to secure the best possible outcome for you.
How Kantor & Kantor Can Help
When you come to us for help, we will do everything we can to take the burden off your shoulders:
Case Evaluation
We start by listening—really listening—to your story. We know that every detail of your experience can shed light on the path to a solution. By understanding the specifics of your situation, we tailor our strategy to suit your unique needs. Our attorneys will keep you informed and involved at every step.
Expert Policy Analysis
Insurance policies are notoriously complex and deciphering them can be difficult. Our attorneys excel in translating insurance language into clear, actionable plans. We will explain your policy’s coverage in straightforward terms and identify the key issues that are affecting your claim.
Aggressive Advocacy
When it is time to face the insurance companies, we are tenacious. We will not be pushed around by big insurance firms, and we will stand up for your rights with unwavering determination. Our goal is to ensure that the insurance companies fulfill their obligations to you, and we are prepared to fight tirelessly to make sure they do so.
Results-Focused Strategy
At the end of the day, the result matters most. We are focused on achieving the best possible outcome for you, whether that is through a settlement or winning at trial. Our track record speaks for itself, and we pride ourselves on making a real difference in the lives of our clients.
Contact Our Los Angeles Insurance Lawyers Today
Insurance companies have the resources to drag out claims, but that does not mean you do not have options. With the right legal support, you can level the playing field and win.
Our team is here to help you push back and get the compensation you deserve. We have seen firsthand how a denied claim can put lives on hold, and we want to help you move forward.
You deserve peace of mind during the most difficult times, and our goal is to take some of that burden off your shoulders. We know the difference it can make to have someone in your corner who truly cares about the outcome of your case. We are people helping people, and we look forward to helping you.
When you are ready, we are here to listen. Whether your claim has been denied outright or underpaid, we will stand by your side and guide you through every step.
Contact our Los Angeles insurance lawyers at 818-886-2525 for a free consultation.
Attorney Glenn R. Kantor
Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]
