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In Denial

What do you do when your insurance company refuses to pay a claim?

Do insurance companies routinely deny valid claims just to avoid paying for them? Such a scenario might make good dramatic fiction, but it's not the case in the real world, says David W. Henry, an attorney with Allen, Dyer, Doppelt, Milbrath & Gilchrist PA in Orlando, Florida. "Carriers look to get the right answer," Henry says. Even so, claims adjusters are human, some claims and insurance policies are complex, and mistakes happen.

So what should you do when you think you have coverage and your claim is denied? Henry, whose practice focuses on insurance litigation, says to start with a written explanation from the insurer. "Insurance companies normally provide this automatically," he says, "but if they don't, insist on it." You can also ask that a supervisor review the claim decision.

Take the denial letter to your insurance agent and see whether he agrees with the carrier's decision. "Sometimes, a knowledgeable agent will know if the claims adjuster has made a mistake," says Henry. If the agent agrees with the denial, and you are satisfied with his explanation, the case is closed. If he doesn't, he may contact the carrier on your behalf, or you may decide to consult an attorney.

If it turns out your claim was denied because you didn't have the coverage you thought you did, you may need to review your policy and examine your relationship with your agent.


Jacquelyn Lynn is a freelance business writer in Orlando, Florida.

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This article was originally published in the May 2003 print edition of Entrepreneur with the headline: In Denial.

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