You have been paying your insurance premiums diligently, trusting that if something were to go wrong, your insurance company would have your back. Then, the unthinkable happens. You file a claim, expecting support during this tough time, only to be met with delays, denials, and endless red tape. Suddenly, the safety net you counted on feels more like a tightrope walk without a safety harness.
At Kantor & Kantor, we have seen the frustration, confusion, and stress that comes with battling an insurance company. Our San Diego insurance lawyers are people helping people, and we will champion your cause.
We know the tactics insurance companies use to avoid paying out benefits, and we are not afraid to confront them. Our mission is simple: to ensure you receive the benefits you have rightfully earned without unnecessary delays or denials.
Contact us today at 858-758-4231 to schedule a free consultation with our San Diego insurance lawyers.
Common Tactics Insurance Companies Use to Reduce Claims
When you are dealing with an insurance claim, it can often feel like the odds are stacked against you. Insurance companies, while seemingly supportive in their advertisements, can become formidable opponents when it is time to pay out a claim. Here are some common tactics to be aware of:
Denial of Claims
One of the most straightforward tactics is outright denial. Insurance companies often find small discrepancies or technicalities to justify not paying out a claim.
Requiring Unnecessary Documentation
Another common strategy is to ask for an overwhelming amount of documentation, some of which may not even be directly relevant to the claim. This can be exhausting and confusing, deterring many from pursuing their claims fully.
Misinterpreting the Insurance Policy
Sometimes, the language in insurance policies is used against policyholders. Insurers might interpret the wording in ways that minimize their responsibility to pay.
Surveillance and Privacy Invasion
Some insurers use surveillance to undermine your claim. They might watch you to see if your actions match your reported injuries.
Why Are Insurance Claims Denied?
Dealing with insurance claims can feel like a tug of war. 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 get denied.
- Pre-existing Conditions: Insurance companies often deny claims based on pre-existing conditions. They might argue that your illness or injury existed before your coverage started. This is a frequent issue with health and disability insurance claims.
- 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.
- Administrative Errors: Sometimes, claims get denied due to simple administrative errors. A typo, incorrect date, or misfiled document can lead to a denial.
- Failure to Meet Deadlines: Insurance companies have strict deadlines for filing claims and appeals. If you miss a deadline, even by a day, your claim can be denied.
- 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.
Steps to Take if Your Insurance Claim Is Denied
Receiving a denial on an insurance claim can be disheartening, especially when 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 your starting point for building your case.
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 and request a copy of your “claim file.” A “claim file” is a collection of documents and records that an insurance company maintains related to an ERISA 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 initial efforts to resolve the issue with the insurance company are unsuccessful, contact us before you file an appeal. Most insurance policies have an appeals process, and it is important to follow it meticulously. Submit a formal appeal letter, clearly outlining why you believe the denial was incorrect, and include all the supporting documentation you have gathered. Be sure to meet any deadlines specified in your policy to avoid losing your right to appeal.
Throughout this process, keep detailed records of all your interactions with the insurance company. Note the dates, times, and names of the representatives you speak with, as well as summaries of your conversations. This information can be invaluable if you need to escalate your claim further.
Our experienced insurance lawyers can provide invaluable assistance, helping you understand your rights, building a strong case, and advocating on your behalf.
Contact us today at 858-758-4231. We are people helping people, and we will fight for you.
Why Choose Kantor & Kantor?
When you are facing an insurance dispute, the support you choose can make a world of difference. Here is why we believe we are the best choice to help you through this difficult time:
- Proven Track Record: Our success is reflected in our history of satisfied clients and successful claim recoveries. We pride ourselves on fighting effectively and tirelessly for every client, ensuring they receive the benefits they are entitled to.
- Client-Centric Approach: Our firm’s philosophy is built around your needs and well-being. We make ourselves accessible, keep you informed, and ensure you feel supported throughout the process. Your peace of mind is as important to us as the outcome of your case.
- Tenacity and Compassion: We bring a unique combination of tenacity and compassion to the table. While we are relentless in our pursuit of your rights against insurance companies, we also understand the emotional and physical toll these disputes can take on individuals and families. We are here to shoulder the burden so you can focus on what matters most—your well-being.
- Expertise and Experience: Insurance law can be complex, and you need someone who knows the ins and outs of the system. Our San Diego life insurance lawyers have years of experience dealing with a wide variety of insurance claims. We have seen it all and know how to handle even the most challenging cases. Our understanding of insurance law allows us to anticipate the tactics used by insurance companies and effectively counter them.
- Fierce Advocacy: When you are up against a powerful insurance company, you need someone who will fight for your rights. We are not afraid to take on the big companies and hold them accountable. We fight aggressively on your behalf, using every tool at our disposal to ensure you get a fair outcome.
How We Can Help
We know that dealing with insurance issues can be one of the most stressful and confusing experiences. That is why we are here to take the burden off your shoulders. Our approach is all about making the process as smooth and supportive as possible for you. Here is how we can help:
We will Hear Your Story
The first step in handling your insurance case is listening to your story. We want to understand what you are going through, how the insurance company’s actions have affected you, and what you hope to achieve. This is not just about gathering facts—it is about connecting with you on a personal level and showing you that we genuinely care about your well-being.
We Will Review Your Policy Thoroughly
Insurance policies can be incredibly complex and filled with confusing legal jargon. We will carefully review your policy to understand what coverage you have and what benefits you are entitled to. Our goal is to uncover any potential avenues for your claim and ensure that we have a solid understanding of your rights under the policy.
We Will Gather Strong Evidence
To build a compelling case, we need strong evidence. We will help you gather all the necessary documentation, such as medical records, expert opinions, and any other relevant information. Our team knows what evidence is most persuasive and how to present it in the best possible light.
We Will Build a Strong Case
With the evidence in hand, we will craft a compelling case to present to the insurance company. Our team knows the tactics insurers use to delay or deny claims, and we are prepared to counter them with facts and a clear narrative. We will highlight the critical points and make a strong argument for why your claim should be approved.
We Will Negotiate on Your Behalf
Our experienced lawyers will handle all communications with the insurance company, advocating on your behalf. We aim to resolve your case through negotiation, securing the benefits you deserve without the need for prolonged disputes.
We Will Take Legal Action if Necessary
If the insurance company continues to deny your rightful claim, we are prepared to take legal action. Our team has extensive experience in insurance litigation and will represent you in court if needed. We are committed to fighting for your rights and ensuring that justice is served.
Contact Our San Diego Insurance Lawyers Today
Navigating the complexities of insurance claims can feel like an uphill battle, especially when you are already dealing with the stress of an illness, injury, or loss. At Kantor & Kantor, we are more than just lawyers – we are people helping people, and we genuinely care about your well-being.
We believe in building relationships based on trust, understanding, and mutual respect. When you reach out to us, you are not just another case file; you are a person who deserves to be heard and supported. We will take the time to listen to your story, understand your unique position, and develop a strategy tailored to your needs. Our goal is to relieve some of the burdens you are carrying and fight for the benefits you rightfully deserve.
Contact us today at 858-758-4231 to schedule a free consultation with our experienced insurance lawyers in San Diego.
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]
