Reversing Insurance Claim Denials Part 2: Credibly Analyze Claim Denial Letters

 

 

In Part 2 of this series on businesses and legal strategies that can be employed to reverse insurance claim denials, we address strategies for responding to insurance claim denial letters.  In this video Mark Miller explains that the next step in dealing with a denied business insurance claim is to credibly analyze the insurance carrier’s denial letter, taking apart, and responding to, each and every argument raised. 

When responding, there is one additional strategic step that policyholders should take.  Watch the video to learn about more about the process, and best practices for reversing a claim.

For a transcript of the video please see below.

Reversing Insurance Claim Denials Part 2: Credibly Analyze Claim Denial Letters

Point number two is you have to credibly analyze their basis for denial. By that, I mean it’s like you can’t just talk, “Oh, we think this.” Or, “We think that.” Or, “This should be covered because we bought a policy and covers should be provided.” You can’t talk those abstract things. You have to credibly, purposefully take apart their letter and prove them wrong.

You do this by writing a letter in response. You got to look at with very close scrutiny, look at every single argument, look at the cases they cited. Many times, those cases will be cited incorrectly. Many times, there will be cases that are not cited that are more important than the ones that they cited and the cases that are not cited give the answer you need which is it’s covered.

Go to the effort of reading through their letter, analyzing it, putting together a response. When you put together that response, do one thing in addition to making it credible and that is close out the story. I say producing these documents, I don’t care if they respond to the 12, 10, 5 pages of requests they gave you. We’re providing these documents. “We’ve complied with all of your requests. Please immediately let us know if this is covered.”

What you have to do is you got to try to give them the documents they request to the extent they’re relevant. A lot of times, they’ll be privileged and you can’t get them anyways, but the point of the matter is close out the letter with, “It’s on your back now. We’ve given you everything. We’ve responded. You need to now start paying for this.” That’s sort of a strategy. Credibly analyze the letter, their letter, send your letter in response to their letter and do that every time they send you a letter. Do these same steps. Send the response and close it out, okay?

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