Insurance policies are contracts and are therefore governed by contract law. If you have a dispute with the insurance company over the payment of a claim, your first recourse is the language in the contract itself. No insurance policy covers everything, and all policies contain certain exclusions and limitations. However, each state has an office of insurance regulation, and insurance companies must answer to regulators and honour their agreements or face stiff penalties under state law.
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Read your policy. If your condition or adverse event is specifically excluded from the policy, you have little chance of succeeding in your appeal.
Appeal to the company. As an insurance consumer, you have a number of possible layers of appeal, and it pays to use them all. If it is a medical insurance or disability claim, have your doctor write a letter to the plan's medical director, doctor to doctor, explaining the circumstances.
Contact the office of the insurance commissioner in the state where you live (see Resources). Write a letter stating the facts as best you can. Include supporting documentation from health care professionals, appraisers and other outside experts, as appropriate.
File a lawsuit. Litigation is expensive, so this option is a last resort. Many financial services companies require you to sign an agreement to arbitration rather than a court proceeding, as part of the original sale. However, if you have the facts and the law on your side, you may be able to convince a jury or reach a favourable settlement with the insurance company.
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