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Fight Big Business: Appealing Denied Insurance Claims

Posted By Jim On 03/06/2006 @ 5:26 pm In Insurance | No Comments

For those of us new to the insurance game (I only “recently” had to get homeowners), it’s tough whenever the insurer denies your claim or offers you a pathetic settlement offer, so articles like this one are particularly helpful in educating me on what to expect and how to counter-attack. That, of course, assumes that my insurance company will try to swindle me and since I’ve never had to file a claim, I have no idea how friendly they can be when the money starts flowing the other way. That being said, knowing is half the battle. (Yo Joe!)

Apparently two terms you have to know are Estoppel and Contracts of adhesion. The Webster’s Dictionary definition for Estoppel is “a legal bar to alleging or denying a fact because of one’s own previous actions or words to the contrary.” In layman’s terms, you need to ask the insurance agent the specific provision in your policy that the agent is using when they give you a low-ball offer or flat out denying you. Estoppel just means that once they say Section A.4-3.1 is the reason they denied your claim, they can’t change their mind (after you bring some proof that perhaps the provision doesn’t apply) and claim that Section B.5-11.3 is the reason you were denied.

Contracts of adhesion are those contracts in which you accept without much say in how the wording is constructed. When you subscribe to a magazine, that’s a contract of adhesion. When you sign up for insurance, that’s also a adhesion contract and it’s enforceable. The onus is on the writer of the contract, the insurance company, to be unambiguous and if they are in any way ambiguous, you will win.

The articles goes on to talk about paperwork and the importance of keeping good records because an insurance company may argue that something you claim was a pre-existing condition. You’ll need good paperwork and even photos to prove that it didn’t exist before the event.

via CNN Money [3].


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[3] CNN Money: http://money.cnn.com/2006/02/06/pf/fightback3_money_0603/index.htm

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