Denied Claims Lawyer

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Denied Insurance Claim Lawyer In Arcadia

As an insured party, you have legal rights and protections during the processing and investigation of your insurance claim. If your claim has been denied or mishandled, seeking the counsel of a denied insurance claim lawyer in Arcadia can help safeguard your interests and protect your rights.

Injured workers denied benefits should maintain hope as the denial may be in error. Seeking legal advice from a competent denied life insurance claim lawyer in Arcadia experienced in handling workers’ compensation appeals can be beneficial. The legal team at Mohajer Law Firm offers a consultation to evaluate the case’s merit and can manage the entire appeals process if there are grounds for an appeal. With extensive knowledge of California’s workers’ compensation system, our denied claim lawyer works tirelessly to recover fair compensation for our clients. Contact us today to learn more about your legal options. 

What Happens If a Claim Is Denied?

If an insurance claim is denied, the insurance company has determined that the policy does not cover the damages or losses claimed or that the insured party has failed to meet the requirements or obligations under the policy.

When a claim is denied, the insurance company must provide a written explanation of the reasons for the denial. The explanation should include information about the policy provisions that were used to deny the claim and any other relevant information that was considered during the claims process.

You can appeal the decision if you disagree with denying your insurance claim. The appeals process may involve submitting additional information or evidence to support your claim and may require the assistance of a lawyer for a denied insurance claim in Arcadia. In some cases, the appeal may be resolved through negotiation or mediation, while in others, it may require litigation.

What Are the Common Reasons for a Claim Denial?

Many reasons can result in the denial of an insurance claim. Our lawyer for denied health insurance claims in Arcadia can help in these types of claim denials:
  • Policy Exclusions: Insurance policies often contain exclusions that restrict or deny coverage for certain losses and damages. If the claimed injuries or losses fall under an exclusion in the procedure, your claim might be denied.
  • Insufficient Coverage: Your claim may be denied if the policy doesn’t cover damages or losses claimed.
  • Late or Incomplete Filing: If a claim isn’t filed within the specified time frame or lacks vital information or documentation, it could be rejected.
  • Policy Lapses or Cancellation: If the policy has lapsed or been canceled due to non-payment of premiums or other reasons, your claim may be denied.
  • Fraud or Misrepresentation: If the insurance company finds an insured party made a fraudulent or intentionally misleading claim, their claim may be denied.
  • Lack of Evidence: If insufficient evidence is presented to support their assertion, the claim may also be denied.
  • Procedural Errors: If an insured party fails to adhere to the procedures or requirements outlined in their policy, their claim may be denied.

What Are Your Legal Rights When Filing An Insurance Claim?

When filing an insurance claim, individuals have the right to:

  • Receive a copy of their policy: They can obtain a copy and review it to understand what is and isn’t covered by their policy.
  • Receive Fair and Timely Payment: Insurance companies should investigate claims promptly, paying out those covered by policies fairly and on time.
  • Treat Customers with Respect and Honesty: Insurance companies must treat customers with dignity and fairness throughout the claims process.
  • Appeal a Claim Decision: If an insurance claim is denied or the payout amount is less than expected, individuals have the right to appeal the decision and have it reviewed by the insurer.
  • Contact State Insurance Regulators: Individuals can contact their state’s insurance regulators if they feel their insurer is not handling their claim fairly or appropriately.

Why Do You Need an Arcadia Denied Claim Lawyer?

Understanding the Law: Insurance laws can be complex and differ from state to state. Consulting our denied commercial insurance claim lawyer in Arcadia, CA specializing in this area of law will clarify your rights and responsibilities and those of your insurance company.

Negotiating with the insurance company: Insurance companies are in the business of making money, and one way they do that is by denying claims. A denied insurance claim attorney in Arcadia can negotiate on your behalf to increase the likelihood that you receive a fair settlement.

Gathering Evidence: You may need to assemble evidence, such as medical records or witness accounts, to prove your case. Our denied life insurance claim attorney in Arcadia can assist in identifying and gathering this crucial evidence so that it can be used in support of your assertion.

Representing You in Court: If your claim is denied, legal action may be necessary to recover damages. Our experienced denied car insurance claim lawyer can represent you in court and present your case, advocating on your behalf.

Call us today at (626) 569-5200 or fill out our contact form and have your case evaluated by our team of experts.

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Frequently Asked Questions (FAQs)

What is section 2695.7 of the California insurance code?
Section 2695.7 of the California Insurance Code requires insurers to promptly, reasonably, and equitably resolve claims in which liability has become apparent. It prohibits insurers from engaging in unfair claim settlement practices such as delaying or denying payment without an acceptable reason.
Can you bill a patient for a denied claim?
Healthcare providers typically can only bill patients for denied insurance claims if the patient has agreed in writing to assume financial responsibility for the services in question before the procedure.
Is there a difference between denied and rejected claims?

Yes, in the context of insurance claims, a “rejected” claim usually means that there was an error or omission on the form which prevented processing; on the other hand, a “denied” claim means the claim was reviewed and processed but ultimately determined not covered under the policy by the insurer. 

How do you resolve denied claims?

To resolve a denied insurance claim, one should review the explanation of benefits (EOB) or denial letter to understand why it was dismissed, provide any missing information, file an appeal with the insurer, and consider hiring a denied auto insurance claim lawyer or filing a complaint with your state insurance department if that doesn’t resolve things satisfactorily. 

What is the California Unfair Claims Practices Act?
The California Unfair Claims Practices Act is a set of laws prohibiting unfair methods of competition and deceptive acts or practices in the insurance business and setting standards for handling claims. If policyholders are injured due to an insurer’s violation of this Act, they have various remedies, including suing for damages and filing a complaint with the California Department of Insurance.