wolterman conference room

A decade of friendly,



Home » Blog » General Interest » Everything to Know If Your Medical Insurance Claim Was Denied

Everything to Know If Your Medical Insurance Claim Was Denied

medical insurance claim

Over the past few years, a rapid increase is being observed in the trend of denied medical insurance claims. Many people are left dumbfounded when their claim is rejected by the insurance firm as they don’t have the appropriate legal knowledge.

As they don’t have much information about their claims and rights people tend to get frustrated and forgo their medical claim. However it is the job of every capable and qualified attorney at one of the best law firms in the country to make sure that their clients get their health insurance. Lawyers help their clients understand that they can’t be deprived of access to something they had paid for.

Possible Reasons for Denying a Medical Insurance Claim

There are several reasons why a medical insurance can be denied by the concerning firm, if the reasons below are levied for the rejection then the denial can be considered as a valid ground, otherwise it is deemed that the person has been deprived of a basic right.

  • The insurance firm doesn’t have sufficient information about your application required to process the claim.
  • You have exceeded the lifetime capacity of your insurance policy; therefore the insurance agency can no longer compensate your claims.
  • The services applied for aren’t covered by the plan you had signed for
  • The medical treatment you have received is not valid for disbursement by the insurance firm.
  • There’s a condition in the insurance contract that forbids you from receiving any further payments after a certain amount of approved claims.

Bad Faith Denial

Although there some valid reasons under which an insurance company could reject their client’s medical insurance claim but any reason apart from those can be called as a denial in bad faith. Some of these denials can be found if the insurer rejected the claim application by:

  • Fabricating evidence.
  • Refusing to accept any evidence provided by the client.
  • Not conducting any probe into the claim application.
  • Delaying the investigation for an unreasonable duration.
  • Other evident actions by the insurance agents that show ulterior motives.

For those who believe that their medical claim has been denied without any valid reason must not sleep on it. They should contact their nearest insurance claims attorney and seek their legal and expert guidance on the matter. The lawyers will help you through the process by analyzing your case and preparing a solid application for the trial and all following proceedings.

Having the services of an experienced attorney is almost a guarantee in itself that you will get your medical claims issued at the end of the proceedings. Most firms also offer an initial consultation free of charge so you can discuss your case without having to worry about incurring any expense especially if the lawyer deems your position weaker.