Insurance Claims Disputes: Know Your Rights and How to Resolve Them

Insurance Claims Disputes: Know Your Rights and How to Resolve Them

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One very important aspect of Insurance is the insurance claims. For what will it profit the policyholder if he has bought insurance and cannot lay proper claims or enjoy the benefits his insurance covers? This is why this article has been prepared for you to know your rights and how to resolve them.

What is Insurance Claims?

In clear terms, insurance claims refer to the request action taken by an insurance holder to his insurer asking for payments based on the insurance policy agreements his insurance plan covers. The insurance company on the other hand reviews this claims, confirms its validity before approving payments to the insured. In a case whereby the policy do not cover the requested claims, requests are either declined or payments are made for more coverage.

If you feel as though you have been wrongly declined after laying claims, it is advised that you carefully go through all the insurance policies to see the limitations of coverage. After doing this, and you are convinced that your insurance provider has unfairly rejected your claims, you can now boldly engage in the stages of resolving the claims dispute.

Resolving  Claims Dispute

As earlier stated that it is important for the insured to know his or her rights and to know how to resolve disputes emanating from insurance claims. Being ignorant shouldn’t be an excuse. This aspect of the article explains how claims dispute can be resolved.

  1. Arbitration

Professionally, Arbitration is required as the first step in dealing with claims dispute. This step involves an amicable process between the two parties, that is, between the insurance provider and the insured. It will be advised to bring in a third party whose sole responsibility would be to ensure that the goal of the dialogue is reached. If the goal is reached, it will save the parties involved the hassles of court proceedings and money. This is why this option is preferred by smart policy providers who are bent on maximizing profits and keeping customers.

It should be noted that after this process of arbitration proposed by the insurer, the insured has the right to reject such offers that come out from arbitration. Although, it is usually a less stressful solution to claims dispute.

  1. Litigation

In a case whereby the insured rejects arbitration, the next step in dealing with insurance claims dispute is litigation. The litigation process involves employing a legal counsel who specializes in the area of claims disputes. After which, the case will be presented in court where the judge will give the final binding judgement.

Different Types of  Claims Disputes

  1. Home Insurance Claims Dispute

It is a well known fact that the home insurance coverage involves policies that cater to house accidents and damages. In a case whereby properties of tenants are lost, stolen or destroyed, the home insurance does not cover such, rather, the home content or property insurance does. This is the area where insurance claims cause disputes commonly.

  1. Health Policy Claims

The health insurance policy covers medical negligence, for instance, if the insured undergo surgery, either home or abroad, there are concrete proofs needed when laying claims. Most of the time, a valid evidence is required from a third party doctor which in most cases is always rejected or denied based on the Claims of irresponsibility by the staff of a healthcare provider.

  1. Natural Disaster Damages to Properties

The Insurer can rejects claims of natural disaster damaging properties or even the house. This is because there maybe a different insurance policy that covers such area.

  1. Legal Expenses Insurance Claims

This is commonly added to the general insurance policy. They help to cover legal charges and settlements and all kinds of litigation.

  1. Car Insurance Claims

This is a common claim that arises from damages done to a car. There are usually 3 parties involved. The first party who is the insured, the claimant who Claims that the first party was to blame for the accident and damages caused to his or her car and lastly, the third party who is the Insurance provider. A review is usually done by the third party and if the first party is truly guilty of the claim, the bills for repair or replacement is covered by the insurance policy.

How to Prevent Claims Dispute from Future Occurrences

The first step in preventing the future occurrences of claim disputes is to carefully read the policies of the insurance you are about to buy. Reading the policies thoroughly will reveal the limitations of coverage of the insurance. It is wise not to opt for insurance policies that don’t cover your expectations. Doing so is what brings about claims dispute in the future.

In a case whereby you are confused about the coverage of the insurance policy, it is advisable that you seek a legal counsel who will interpret the coverage to you and point out the limitations.

FAQ of Insurance Claims Disputes

The most commonly asked question is;

Why does insurance providers reject insurance claims?

Your insurance provider can reject Insurance Claims due to the following reasons:

  • Your insurance policy might not cover your claims
  • Suspicion of insurance fraud
  • Lack of convincing evidence to support your claims.

In addition to this, in a case whereby you have missed premium payments, your insurer can reject your claims. Therefore, try as much as possible not to miss your due payments so as to prevent rejection or even cancellation of your insurance policy.

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