Denied Claims and Rejected Claims are terms often used interchangeably. We’ll look at what they mean and, more importantly, the consequences of each. It is common for insurance companies to deny or reject coverage of your claims. Understanding these terms’ differences will help you maximize your benefits as a policyholder.

Understanding Denied & Rejected Claims

The difference between a denied and a rejected claim is that the denial implies that an applicant was not eligible to submit a claim, while the rejection implies that an applicant has failed to meet the criteria of completing their application. If you receive a denial or rejection, it usually means it wasn’t something you were allowed to do in the first place. These two claims differ because denials indicate that your information was incorrect or incomplete, while rejections indicate flaws in your application.

Rejected claims often result in a denial of coverage of specific property damage. The denial process involves the insurance company’s decision. The insurer decides whether a claim is paid, and the decision may be based on evidence submitted by the policyholder or a third party.

The insurance company may provide specific reasons for not paying a rejected claim.  However, when it comes to denied claims, they seldom explain why their insurance company has not paid them.

What to do if your Claim is Rejected or Denied

The insurance company will first send a letter informing you why the claim was denied. The letter may be very formal, stating that the company has decided to deny your claim. They may also state that the claim was denied because the policy terms are different from those in your policy form contract. For instance, the policyholder was mistaken about the amount of coverage, the limits stated in the policy, or other reasons.

Here are some guidelines to follow after your claim is rejected or denied:

  • Don’t respond to them yet. Before responding to the letter, ensure you have read their reasons for rejecting your claim. Read it carefully and note their reasons for rejecting or denying your claims.
  • Discuss the matter with a denied claims specialist in Pompano Beach if your claim is denied or rejected. The specialist will help draft a response that details all of the reasons why the company is wrong and all of the reasons why you are right.
  • Contact a public adjuster Pompano Beach and request an appeal be filed on your behalf. The adjuster may require a brief written explanation regarding the denial or rejection of your claim. In the appeal, the insurer should provide you with records or additional information about why they have denied or rejected your claim.
  • Keep track of all correspondence with the insurance company throughout this process since an appeal does not guarantee that you will receive your claim payment.

In general, rejected claims are paid according to the requirements stated in your insurance contract. Denied claims are not paid if they exceed a predetermined amount.  If a claim exceeds the state limit, you can request a public adjuster in Pompano Beach to file an appeal and request a review of the denial.

A denied claims specialist in Pompano Beach, FL can help you reopen denied or rejected claims. Find out more by contacting Xpert Public Adjusters at 954-675-4785 or visiting their contact page.