It can be aggravating and taxing when an insurance company authorizes a claim but does not pay it. That's what happened to a Georgia couple recently following a burst pipe and a $13,500 bill. Nevertheless, there are particular actions you can take to solve the problem and claim the compensation you are due. Should your insurance approve a claim but then delay or deny payment, this guide describes the steps you can take.
Review Your Claim Approval and Policy
Review your insurance policy and the letter of claim approval before acting. Make sure you grasp the terms and conditions, which include any additional pertinent stipulations as well as payment schedules. This will enable you to verify whether there are any reasonable grounds for the delay and ensure that your insurance is obliged to pay the approved sum. Double-check to verify whether you have fulfilled all the criteria since insurance companies may occasionally need further paperwork before distributing money.
Ask Your Insurance Company
The first action is to get in touch with your insurer if they authorized your claim but have not paid it. To find out about the payment situation, phone or email your insurance agent. Record all of your contacts, including dates, hours, names of representatives, and specifics of your exchanges. Sometimes, especially if the delay results from administrative mistakes or oversight, a little follow-up will help to fix the problems.
Send A Formal Demand Letter
Think about filing a formal demand letter if calling your insurer doesn't fix the problem. This letter should seek quick payment, list the specifics of your authorized claim, and refer to pertinent areas of your policy. Set a reasonable payment deadline—e.g., 10–15 business days—and be polite but strong. To have evidence of receipt, make sure you send the letter by certified mail.
Notify Regulatory Authorities With Complaints
Should your insurer still refuse to pay, you can escalate the situation by complaining to the state insurance regulating authority. Most states establish a department of insurance specifically for consumer concerns. Send all pertinent records, including your insurance, claim approval, and notes of your contacts with the insurer. Regulatory agencies might look at your matter and might put pressure on the insurance company to follow its responsibilities.
Consider Legal Action
Should all else fail, you might have to see an attorney seasoned in insurance conflicts. Although legal action can be expensive and time-consuming, it could be required should your insurance company behave in bad faith. Sometimes, you can recover legal fees as well as damages for any financial losses resulting from the delay in addition to the accepted claim amount.
Investigate Alternative Dispute Resolution.
You might want to give mediation or arbitration some thought before filing a lawsuit. These alternatives are usually less expensive and faster than visiting court. A fair settlement can be attained by both sides with the assistance of an unbiased mediator or arbitrator. Review your insurance coverage; some may call for arbitration as the initial step before legal action.
Conclusion
Should your insurance claim be authorized but unpaid, you must act quickly and methodically. Review your policy first; next, get in touch with your insurance and submit a demand letter. Should it be required, escalate the matter by consulting legal counsel or filing a complaint with relevant regulatory authorities. These guidelines can help you raise your chances of receiving the pay you are due.