Tips to Get your Insurance Claim Approved: Part One

Thinker (Photo credit: paukrus)

By Kathleen Defever

Tip One: Think like the insurance company.

To get your insurance claim approved, the most important thing you can do is think like the insurance company. If you understand how and why your insurer acts the way it does, you can anticipate the reasons your claim may be denied or delayed – and avoid them.

First, you need to understand that your insurer is not motivated to pay you, no matter what they say. This is basic economics. You pay your insurance company a premium every month. They get to keep that premium money, unless you make a valid claim. If your insurer keeps your money, they get richer. This is common sense. Did you really believe all the warm and fuzzy commercials you see on the television about how your insurer “takes care of you like you are family”?

Of course there are laws meant to keep your insurer playing fair, but generally, these laws are enforced only if 1) the insurer steps significantly out of line and/or 2) someone with resources sues them. No, the government is not proactively monitoring them (at least not to the level that they would pay attention to your individual claim). More on that problem in a future blog.

The reality is that your insurer is a corporation like any other – working to make a profit. And to be fair, you better hope they do yield a profit, because the alternative is that they go out of business and you can kiss your claim goodbye.

So how do you think like an insurance company?

1) Be familiar with your policy.

Insurers stick to the language in your policy, because your policy is a contract between you and your insurer. Take a look at your policy – are there any exclusions or limitations? Look for those specific words  – exclusions, limitations. Read them carefully. Even if you read the exclusion and think to yourself, “Well, that obviously doesn’t apply to me,” don’t be so sure. Insurers try to apply these exclusions as often as possible, even when the link between the facts of your claim and the language of the exclusion is weak.

2) Use your imagination.

Pretend to be the claims representative analyzing your claim. Imagine that you are carefully looking for any weaknesses. Did you fail to submit all the paperwork and supporting documents they requested? Is there even a remote possibility that an exclusion applies to your claim?

Avoid Harmful Assumptions

Do not assume that your insurer wants to approve your claim and take care of you. Do not assume that your claim is simple and will be approved easily. These assumptions are the most common mistakes made during the claims process, and they lead to legitimate claims being denied and/or significantly delayed. So before you submit that application, take a long, hard look at the policy, the exclusions, and every word you wrote on your forms.

Remember: Once you submit your application, you can’t take it back.

You can’t un-ring the bell. If you submit an application with careless errors, you risk the denial of your benefits and a long delay before receiving your money. Many insurers are notoriously slow-moving when it comes to claims. If you are initially denied, your claim will be bumped to a different department (typically Appeals), and you will need to submit more information to a new representative.

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