Medical Malpractice and Personal Injury Law Blog

Half of Insurance Claim Denials Are Overturned on Appeal

Posted by Briggs Bedigian | Jun 07, 2016 | 0 Comments

If you were injured due to another's negligence, there are a handful of things that you will have to deal with immediately. The first and foremost thing on your mind after such an accident is getting better. However, once things settle down even a little bit on your road to physical recovery, your mind starts to wonder about who will pay for your medical bills, and compensate you for the difficulties that you have been put through.

If you are insured, you probably feel like you can rest assured that someone else will handle the financial aspect of your injuries. By paying years of premiums, you should feel entitled to the insurance coverage that you were promised.

Unfortunately, insurance companies are in the business of accepting as many and as large premiums as possible, and then making as few and as small payments as possible. As a result, insurance companies have become very adept at finding a way to not provide the protection they said they would, when they convinced you to buy their insurance. If you get hurt and need your insurance company to step in and do their job, you may be in for a surprise when you file your claim and it gets denied.

An Insurance Claim Denial Is Not the End of the Story

Insurance companies want to hide the fact that you can do something about a denial to cover your insurance claim. They do this very well, and few people who file a claim and get denied ever take further action to fight for their cause. Instead, they simply pay the costs out of pocket and feel used by the insurance system.

Appealing Insurance Claim Denials Is Often Successful

This is incredibly unfortunate, because appealing insurance claim denials often works. In 2011, the U.S. Government Accountability Office published a report about insurance claims denials and people who appealed them. By analyzing the four states that tracked this data, the report found that, after an insurance claim was denied by a private insurer, between 39 and 59 percent of appeals were successful. The exorbitantly high rate of success on appeal shows how quickly and inaccurately insurance companies make their first response to an insurance claim, showcasing the need to appeal a denial.

The government report also investigated why so many claims were being wrongfully denied the first time. The study found that initial denials were often made for technical errors or eligibility issues, rather than substantive problems surrounding the claim itself.

Personal Injury Attorneys Fight for Your Well-Being

Personal injury attorneys like those at Gilman & Bedigian fight for you both in and out of court. If you or a loved one has been injured in an accident and need someone to legally represent you in Baltimore or Washington D.C., call our law office at (800) 529-6162 or contact us online.

About the Author

Briggs Bedigian

H. Briggs Bedigian (“Briggs”) is a founding partner of Gilman & Bedigian, LLC.  Prior to forming Gilman & Bedigian, LLC, Briggs was a partner at Wais, Vogelstein and Bedigian, LLC, where he was the head of the firm's litigation practice.  Briggs' legal practice is focused on representing clients involved in medical malpractice and catastrophic personal injury cases. 

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