Denial Letter

Denial Letter A denial letter in insurance is a letter from an insurance company to a policyholder or beneficiary informing them that their claim has been denied. The letter will typically explain the reason for the denial and the policyholder's right to appeal. The difference between a rejected claim and a denied claim is that; a claim rejection occurs before the claim is processed and most often results from incorrect data. Conversely, a claim denial applies to a claim that has been processed and found to be unpayable. This may be due to terms of the contract or for other reasons that emerge during processing. After the claim is filed, if the claim is denied, the claimant will receive a “denial letter.” This letter is very important because it will list what evidence the insurance company reviewed when making its decision, and who reviewed the evidence. Some common reasons include: -The claim is not covered by the policy. -The claim is not medically necessary. -The claim is fraudulent. -The policyholder has not paid their premiums. -The policyholder has violated the terms of the policy. The denial letter should state the reasons the claim was denied and what evidence the carrier needs to prove. The denial letter also gives important information for an appeal, including where and when the appeal must be received. What should be done if an insurance claim denial is received? You have the right to an appeal. You may ask your insurance company to conduct a full and fair review of its decision. If the case is urgent, your insurance company must speed up this process. #benewinsurance #insurtech #inclusiveinsurance #insurance #reinsurance #takaful