Insurance Companies Denying Claims Because Of Unclear Or Incorrect Terminology

Denying liability either completely or partially.

Insurance companies denying claims because of unclear or incorrect terminology. Many times these claims can be appealed and sent back to the payer for processing but this process can be time consuming and. In a perfect world whoever handled my claim at the insurance company would have brought it to a supervisor or medical professional to determine the correct course of action. The terms in any official document can be difficult to understand. He was injured because the other driver failed to follow basic traffic laws.

But once the insurance company sent out this letter denying all liability. The insurance company may deny a claim because an allegedly injured person did not seek immediate treatment or make an immediate complaint. These insurance claim terms jargon and definitions are in layman terms and from the. When you pay premiums for insurance coverage you probably expect that your claims will be paid automatically.

But in the case of your insurance policy the wording is deliberately confusing. Without medical records the insurance company may claim that there was no injury at all. Here are the most common ways insurance companies are denying their customers claims. While this one may seem obvious it s one of the most common reasons car insurance companies reject accident claims.

They filed a claim with the defendant s insurance carrier and the case was underway. As mentioned above several states have no fault insurance laws which means drivers cannot file a personal injury claim against the responsible driver. This type of error can usually be cleared up quickly with a single phone call. Even if a collision is the fault of its insured an insurance company may simply deny liability on the claim.

These claims may violate the terms of the payer patient contract or they may just contain some sort of vital error that was only caught after processing. Your provider s billing staff may have entered an incorrect code when your claim was filed with the insurance carrier or your claim may have inadvertently been sent to the wrong insurance company. Payers will include an explanation for why a claim is denied when they send the denied claim back to the biller. You were driving under the influence of drugs or alcohol.

Doe was injured in the accident he contacted another law firm and they agreed to represent him. With incomplete records they may also deny the claim. Denied claims on the other hand are claims that the payer has processed and deemed unpayable. In some cases a simple error could be why your claim was denied.

Limited or no medical records. This tactic allows the provider who wrote it plenty of wiggle room when you file a claim.