Unjustified Denial of Insurance Claim Must Be Challenged
You go on a trip presuming you have purchased the right health travel insurance. While on the trip, your spouse suffers a fall and gets medical treatment.
A few months later, when you are at home, you are in for a shock. You get an exorbitant bill from the hospital.
You have been hit by a denial of insurance claim.
Such a situation is not uncommon. They say around 3% to 4% of travel insurance claims are denied each year.
Lawyers in Toronto say claim denials are unjustified in some cases, but more often than not, individuals make silly errors that land them in trouble.
Here are some of the most common reasons for denial of insurance claim:
You did not get prior approval for treatment: Typically, when you buy travel insurance, you are provided with an assistance phone number in the event you need medical service. This facility allows the insurer to direct you to a pre-approved medical facility for treatment. The claim denial could be due to your failure to get pre-approval.
There were errors or missing information in your application form: Perhaps, you inadvertently failed to enter your birth date or your disclosure of your health condition was inadequate. Insurer always has riders on pre-existing health conditions. Remember, insurers are hawks. You cannot circumvent health issues.
Your claim for expenses was redundant: Insurers will be quick to display a clause that says you are not eligible for the treatment you underwent. Before you buy, be sure what you are purchasing. Read the fine print and if in doubt ask the insurance company rep.
You failed to get all the bills and documentation of your treatment: Before leaving the treatment facility, ensure you have all the bills and a copy of receipt of each and every service you were provided for.
Many people presume they are covered for an illness because they were the last time. Insurers are notorious for changing/ modifying clauses and getting tighter by the day with their qualifications. The only way to pre-empt a rude shock is by contacting your agent to get answer for your query.
Denial of insurance claim no doubt can have a serious impact on the claimant. Apart from the mental trauma, the blow to the individual's finances can be no less severe.
If need be, you can always seek legal advice. It may not be possible for you to fight the insurer on your own because insurers operate with solid legal backing. You will need proper representation to get your rightful claim.
Lawyers in Toronto will tell you that you can challenge the insurers decision, as the adjusters decision to void your claim may not always be a legally correct one. It is possible that the misrepresented facts were not within your knowledge or the queries in the insurance application were not clear enough to elicit an accurate answer.
Denial of insurance claim is a common happening everywhere. Some are justified and some are not. However, if you feel you have been unjustly denied a claim, fight for your rights.
A few months later, when you are at home, you are in for a shock. You get an exorbitant bill from the hospital.
You have been hit by a denial of insurance claim.
Such a situation is not uncommon. They say around 3% to 4% of travel insurance claims are denied each year.
Lawyers in Toronto say claim denials are unjustified in some cases, but more often than not, individuals make silly errors that land them in trouble.
Here are some of the most common reasons for denial of insurance claim:
You did not get prior approval for treatment: Typically, when you buy travel insurance, you are provided with an assistance phone number in the event you need medical service. This facility allows the insurer to direct you to a pre-approved medical facility for treatment. The claim denial could be due to your failure to get pre-approval.
There were errors or missing information in your application form: Perhaps, you inadvertently failed to enter your birth date or your disclosure of your health condition was inadequate. Insurer always has riders on pre-existing health conditions. Remember, insurers are hawks. You cannot circumvent health issues.
Your claim for expenses was redundant: Insurers will be quick to display a clause that says you are not eligible for the treatment you underwent. Before you buy, be sure what you are purchasing. Read the fine print and if in doubt ask the insurance company rep.
You failed to get all the bills and documentation of your treatment: Before leaving the treatment facility, ensure you have all the bills and a copy of receipt of each and every service you were provided for.
Many people presume they are covered for an illness because they were the last time. Insurers are notorious for changing/ modifying clauses and getting tighter by the day with their qualifications. The only way to pre-empt a rude shock is by contacting your agent to get answer for your query.
Denial of insurance claim no doubt can have a serious impact on the claimant. Apart from the mental trauma, the blow to the individual's finances can be no less severe.
If need be, you can always seek legal advice. It may not be possible for you to fight the insurer on your own because insurers operate with solid legal backing. You will need proper representation to get your rightful claim.
Lawyers in Toronto will tell you that you can challenge the insurers decision, as the adjusters decision to void your claim may not always be a legally correct one. It is possible that the misrepresented facts were not within your knowledge or the queries in the insurance application were not clear enough to elicit an accurate answer.
Denial of insurance claim is a common happening everywhere. Some are justified and some are not. However, if you feel you have been unjustly denied a claim, fight for your rights.
