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Sorry. Your insurance claim has been denied.....

I make myself available to my Clients and their families for as long as they live. Sometimes one of them will call me with an insurance problem because they know that I worked in insurance at one point in my business career. Here's a little help in working with insurance companies.

I made the following comment in someone's blog, but it really deserves a wider audience via a blog of its own.

First, recognize the fact that insurance companies don't make money by paying claims, so their first line of defense is quite often just to deny the claim outright. Their thinking is that you'll accept their decision and go on your merry little way.

If they deny your claim for whatever reason, ask them to reconsider. The second time around your claim will actually get "processed," meaning that you'll probably get more action than just a computer-generated letter.

If they deny your claim because of "pre-existing conditions," understand that that phrase is standard denial language. Call them on it with this little tidbit that has worked for me and my Clients 100% of the time:

Dear Mr. Insurance Company:

You had the opportunity to inspect the [roof/waterheater/whatever] prior to issuing a policy and accepting my premium payments. Because you did not do that, the fact that you issued a policy and accepted my premium payments mean that you warranted that the [roof/waterheater/whatever] was in insurable condition. Please forward to me at [address] either a check for [repair/replacement] of the [roof/waterheater/whatever] or a refund of all my premium payments from [date of coverage commencement to current date]. Thank you.

Sincerely,

Modify as necessary.

Now send it by overnight mail to the insurance company and a copy, also by overnight mail, to the insurance commissioner in your state. Make sure that the copy you send to the insurance company notes that a copy has been sent to the insurance commissioner.

Insurance is regulated in all 50 states, so while you might not have an "insurance commissioner," there is some Top Dog somewhere who is in charge of your state's insurance industry.

Even if your policy excludes pre-existing conditions, if the insurance company didn't send anyone out to look at everything, they can be taken to task. Once they understand that they have a serious and knowledgeable Client on their hands, it's far less expensive to just send you a check and be done with it.

Every time I do that for one of my Clients, it's amazing that two days later a check arrives in their mailboxes, also by overnight delivery.

My greatest success so far was a check for $11,950 for plumbing problems. All she had to pay was her $50 deductible, which had been deducted from the $12,000 plumber's invoice.

Comment balloon 1 commentTim Maitski • August 26 2008 12:46PM

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