Insurance Denied Medical Treatment: What Now?

Insurance Denied Medical Treatment: What Now?

Many people struggle with debilitating pain and medical problems for years after they are in a car accident. Even if you do not, you may need immediate medical help right after the accident. When an insurance company tells you it will not pay for those medical needs, it is frustrating and worrisome. You just want to feel better, but an insurer is telling you they will not cover the costs. What do you do?

What you should never do is give up. With the help of the right personal injury attorneys, like our team at Siler & Ingber, LLP, we will help represent you as you obtain the financial compensation owed to you. We also help work as a buffer between you and the insurance company. This means you get the financial help you need for those medical needs, but you do not have to battle the insurer on your own.

Why Did Your Insurer Deny Your Claim?

When an insurer denies a claim for a medical treatment, they will provide a reason. Many potential reasons exist, but generally, the insurance company believes they should not have to pay for the treatment. For example, if you are involved in a car accident, you may receive medical treatment at a hospital. However, the pain lingers so you seek out care from another doctor or chiropractor a few days later. The insurer may state the two are not linked.

No matter what the reasoning is, it does not mean you should not get the care you need, nor that they will not pay the claim in the long term. You may need to appeal the decision. And, though a complex process, a personal injury attorney can help increase the likelihood they will continue to provide you with the coverage you need.

Common Causes for Denied Medical Treatment Claims After an Accident

You may have a different claim other than the ones listed below. Discuss your concerns with your attorney before you contact the insurer again.

No Treatment at the Time of Injury

Whenever you are in an accident, seek medical care. Not doing so tells the insurer you do not have any injuries and therefore do not need care. However, many times, injuries after a fall or car accident take time to become obvious. Sometimes, they can be severe, such as internal bleeding. Other times, they can be the result of inflammation or damage to muscles and tissues not immediately evident. Always seek care at the time of an accident.

You Have a Pre-existing Condition

If you had back pain prior to the accident, for example, this can be used as a way to void your claim for back pain later on. The key here is to show, within your medical records, that the accident caused the pain you have right now. It may be necessary to get this in documentation from your doctor, for example.

Your Medical Records Show No Injury

Sometimes, you will have medical records lacking details about what occurred or, you may claim one type of injury occurred, but the terms you use to describe it are different from what a doctor places on your medical file. Or, you may have failed to supply medical records to the insurer or missed a key filing date.

How to Appeal the Insurance Claim Denial

If you receive a denial of coverage, your first step is to contact a personal injury attorney in New York. This is important because the appeal process pits you against the insurer’s many attorneys. In some situations, an appeal will go before the court, and a judge will make the decision. Other times, the insurer will agree to settle your claim after receiving more information or clarity on what occurred and why it happened. However, you do not have unlimited numbers of appeals. For this reason, you need to speak with your doctor, gather all of your medical records and ensure they are detailed, and present your case in a thorough manner.

Insurers know the system well. It is their job to minimize the claims paid out for any incident. If you make a mistake, they will use it to limit your claim.

Schedule a Free Case Review for Your Injury Claim

You do not have to deal with insurers on your own. They work to reduce the number and amount per claim they must pay out. However, you are entitled to the compensation owed to you as well as the overall coverage for care you need. At Siler & Ingber, LLP, we can help you. With our 20 years of experience, over $50 million in claims settlements, and winning record, we can provide you with the guidance necessary in your case. Call our offices at 877-718-6079 or use our online contact form to book a free case review.

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