Appealing a Denied Insurance Claim

There are numerous reasons why you may seek an appeal after your personal injury claim has reached verdict. No insurance company is going to hand over the maximum amount of compensation to an injury victim without a fight, and many injury victims end up without enough compensation to stay afloat financially.

If your insurance claim has been denied altogether, there are several steps that you can take to position yourself for a successful appeal. First, read through your policy extensively in order to gain a firm grasp of what is covered under your insurance policy. It is important to seek help during this stage so that you can understand the fine print, and an experienced injury lawyer can help with this process.

Next, call the insurance company and ask for all of the information about what you need to appeal the claim. Keep careful documentation of who you talk to and record all pertinent information. Then, write a letter to the insurance company stating that you wish to appeal your denied claim. Copies of the bills from your provider, medical records, and records of the steps you have already taken should also be included with the letter.

Once these steps are completed, it may take weeks or even months for your appeal to be processed. During this time, be sure to call often to check the status of your appeal. Insurance companies have a three-level appeals process, and your appeal with first be reviewed by the company's appeals staff or medical director who is responsible for the denial. A second-level appeal will be reviewed by a director who was not involved in the original decision regarding the claim, and the third-level will involve an independent reviewer and a doctor who is board-certified in the same specialty as your doctor. During this process, it is beneficial to enlist the help of your doctor and a personal injury attorney who can help you in your appeal.

In cases where the insurance company continues to deny the claim past the third level, you can take the appeal to the state level. You will only have a limited time from the date of your procedure to file an appeal, and it is wise to seek the help of a Houston personal injury lawyer who has extensive experience in appellate court. The laws pertaining to appeals are very specific and detailed, and you must know how to proceed in these types of courts in order to be successful.

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