How Do You Appeal an Insurance Denial Under Connecticut Law?

If you’ve been relying on an expected insurance payment, a denied claim may come as a bit of a shock. An East Hartford, CT insurance dispute attorney can help you appeal the decision and put together a compelling case that is based on Connecticut law. Below, we outline how an insurance appeal usually works and what to expect from the process.

Tackle the Reason for the Denial

Your first instinct may be to send in more supporting evidence, but if that’s not the reason for the denial, the insurer won’t change its decision. The denial letter should contain clear reasons why your claim has been denied. The precise reasons will depend on your individual circumstances and the type of claim but may include:

• Exclusions or policy limitations
• Time-barred claims
• No insurance policy in force
• Qualifying conditions not met
• Errors in the paperwork
• Lack of supporting evidence
• Bad-faith denial

Checking the letter to understand the reason for the denial should always be the first step. This might require cross-referencing to the policy terms and conditions. Once you understand the insurer’s position, you will be able to mount an effective appeal.

Follow the Internal Appeals Process

Many insurers will outline their internal appeals process, and this should always be your first step. In most cases, you will need to send a letter outlining why the denial is incorrect. This letter should directly address the reason your claim has been denied, together with any additional evidence that may help.

You can also ask for a more detailed explanation for the denial, and for sight of any supporting evidence they used. This will allow you to appeal more effectively at the next stage, if they refuse to reverse their decision.

Request Mediation or Arbitration

Depending on the type of claim, there are various rights in Connecticut that can help if your insurance claim is denied. This includes the right to ask for mediation or arbitration, or to request a third-party review of your claim.

Mediation helps you and your insurer reach an agreement that you both find acceptable. Arbitration is a type of review that issues a judgment that your insurer must comply with. An insurance dispute lawyer can help you decide which option is the more appropriate and how to prepare your case.

Issue a Lawsuit

If you have no success overturning an insurance denial by other means, you can take your insurer to court. The Connecticut Unfair Insurance Practices Act (CUIPA) is often cited as the basis for a claim, as this sets out standards that insurers must adhere to.

Talk to an Insurance Dispute Attorney in East Hartford, CT

An experienced insurance dispute lawyer can assist you with any claim that’s been denied. You can appoint a legal professional at any step of the process, but early intervention is usually beneficial. This can prevent disputes from escalating and allows the most effective arguments to be put to your insurer at the first opportunity. It also helps ensure you are treated fairly and that your rights under Connecticut law aren’t violated.

It’s entirely possible to successfully appeal against an insurance claim that’s been denied. For trusted, professional help, contact our team here at Adler Law Group, LLC Attorneys at Law in East Hartford, CT to schedule a consultation.

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