Tulsa Insurance Denial Attorneys
Representing Oklahoma policyholders in policy compensation claims
As an individual or business owner, you buy insurance to give you a sense of security, so that if you experience a loss, your policy coverage will promptly get you back on your feet. Unfortunately, sometimes insurance companies deny initial policyholder claims. When this happens, having an experienced insurance claim denial attorney can help you resolve the problem so you can receive the policy compensation you expect and deserve.
Biby Law Firm Injury and Accident Lawyers serve Oklahoma insurance policy claimants in many areas of insurance, including auto, homeowners, health, and business interruption. Our firm’s attorneys have decades of collective experience helping policyholders resolve insurance claim disputes. If you are having trouble with your insurance claim, contact us online to speak with one of our experienced Oklahoma insurance lawyers.
How often do insurance companies deny claims?
Because insurance policies differ, no single percentage figure exists to measure the frequency of insurance policy claim denials. Published studies and industry reports suggest that denial or non‑payment rates vary widely by insurance type, insurer, and claim circumstances, and there is no single authoritative national rate.
What are common reasons for policy claim denials?
When they refuse to pay out on policy claims, insurers usually issue a claim denial or close the claim without making any payment.
Claim denials
Claim denials can happen for many reasons. Common explanations that insurance carriers offer for denying claims include:
- Your policy does not cover the loss. Insurance policies often list explicit exclusions from coverage. For example, many homeowners’ policies exclude damage from earthquakes or floods, auto insurance policies usually exclude normal wear and tear expenses, and health insurance policies frequently exclude cosmetic or experimental treatments.
- Your coverage has lapsed. Many insurance policies have a grace period if you are behind in your policy premium payments, but if you fall too far behind, then your insurer may deny your claim for that reason.
- You made an error in your policy claim. Even a simple mistake, like putting down the wrong policy number, forgetting to sign your claim, or submitting your claim outside of your claim filing period, can be enough for the insurer to deny it. In a few cases, your insurer might even interpret missing or incorrect information as misrepresentation or fraud on your part and deny your claim for that reason.
- You did not provide enough supporting evidence. Depending on the kind of insurance you have, insurers usually want you to document your claim with additional evidence. This can include medical records of diagnosis, your doctor’s notes, repair estimates, or invoices. If the insurance company decides that your evidence is insufficient, this can trigger a claim denial.
- You have a pre-existing condition, or your claim is not medically necessary. For non‑ACA‑compliant plans (such as some short‑term or limited‑benefit policies), insurers may deny claims related to pre‑existing conditions; however, ACA‑compliant health plans generally may not deny claims on that basis.
- Your claim exceeds your policy coverage limits. This is not a strict claim denial, as the insurer covers your claim up to the policy limit, but it has the effect of being a partial claim denial for the amount over the policy limit that the insurer refuses to cover.
Claims closed without payment
A claim that is closed without payment is one in which the insurance company does not necessarily deny coverage under your policy, but for some other reason. Examples of these reasons include:
- Your claim did not meet your policy deductible.
- The insurance claim adjuster did not find any damage or harm.
- The claim was a duplicate claim or made in error.
- You withdrew your claim.
The good news is – in many cases, depending on the policy type and reason for non‑payment, you may have the right to request reconsideration or appeal.
What to do if your insurer denies your claim
Just because your insurance company refuses to pay on your insurance claim does not mean that you have no recourse. You may be able to appeal the decision. Here are some of the steps to take in the appeal process.
- Read the denial letter. When an insurer denies your claim, it will issue a denial letter that states the reason for the denial. It is important to understand these reasons before you take the next step.
- Check the reasons for the denial of your policy. Many claim denials are a matter of interpretation. If you believe that the wording of the denial letter leaves any doubt about the reasoning behind the denial, then this may give you an avenue for appeal. If you need more information or clarification on the meaning of the denial letter, you can request a more detailed explanation.
- Know your appeal deadline. Ordinarily, your insurance company will give you a limited amount of time to appeal the denial. If you miss this deadline, then you may lose your right to appeal.
- Take care of any readily correctable errors. Many times, a claim denial is based on minor errors or a lack of information that you can provide. Before you begin the formal appeal process, fix as many of these lesser errors as possible; sometimes this alone can solve the issue.
- Submit a formal appeal. If fixing the immediate issues in step four does not resolve the claim denial, then the last step is to prepare a formal appeal letter. Your appeal will usually include an appeal letter and supporting documentation. You will need to precisely follow the insurer’s instructions; failing to do so can result in rejection of your appeal.
Once you submit your appeal, the insurer will review it. During this period, the insurer may ask you for additional information. If it does, respond as quickly as possible to minimize any delays in processing the appeal.
How Biby Law Firm helps Oklahoma individuals and businesses with claim disputes
The appeal steps above may seem simple, but they often are not as easy as they may seem on the surface. A Biby Law Firm attorney can help you to navigate the denial appeal process in the following key ways.
Helping analyze the denial against your policy provisions
Successful appeals of claim denials start with a careful analysis of your policy terms, conditions, and exclusions against the insurance company’s stated reasons for rejecting your claim. A Biby Law Firm attorney can review your policy and compare it to the contents of the denial letter to look for ambiguous or misapplied exclusions, or procedural errors by the insurer, or if the insurer referred to the correct policy provisions in justifying the denial.
Gathering supporting evidence to back your appeal
An insurance company will not simply take your word for it when you disagree with its refusal to pay out on your claim. You will need to support your argument with compelling evidence. A Biby Law Firm insurance claim attorney can help you to identify the relevant documentation you need and to organize it in a way that effectively supports your appeal and answers the questions you can expect the insurer to ask.
Writing an effective appeal letter
The appeal letter is the heart of your argument for why the insurer should reconsider its claim denial decision. It needs to be carefully written to address the insurance company’s concerns and state the reasons for the denial and weave the supporting evidence you provide into a consistent and coherent narrative. Our attorneys at Biby Law Firm are experienced in crafting appeal letters that insurance carriers can understand and take seriously.
Complying with appeal deadlines and procedures
Even the most persuasive appeal letter will make little difference if you do not submit it on time or if your appeal package is missing important information that the insurance company requires you to provide. Your Biby Law Firm attorney can make sure that your appeal meets all the insurer’s specific requirements so that it does not get dismissed based on a technicality.
Representing you in further actions or litigation
You can present a strong appeal to a claim denial, and still, the insurer may decline to pay your claim. Sometimes the insurance company may offer valid reasons for this; other times, such a continued refusal may support a potential bad faith claim if the insurer unreasonably withheld payment after failing to conduct a proper investigation, and lacked a legitimate basis for the denial under Oklahoma law. If your insurance company rejects your appeal without conducting a proper follow-up investigation, or ignores your evidence, or starts offering up new reasons to deny your claim, a Biby Law Firm claims lawyer can determine whether you have recourse to an external review of your appeal, or to file a complaint with the Oklahoma Insurance Department, or if necessary, take action in a civil lawsuit in which you may be able to recover damages beyond the policy benefits you are claiming.
Empathetic assistance for Tulsa insurance claim denials
At Biby Law Firm, we understand how frustrating it can be when you need to count on your insurance policy to recover from an injury or property loss, and your insurer turns its back on you. Our legal team has the experience and tenacity to help you get the insurance compensation that you need. To schedule a free consultation with an experienced Tulsa insurance claim denial lawyer, contact us. We handle insurance claim denials on a contingency fee basis.
Biby Law Firm serves all of Oklahoma, including the communities of Tulsa, Broken Arrow, Bixby, Claremore, Jenks, Sand Springs, Sapulpa, Wagoner, Owasso, Muskogee, and the surrounding areas.