Insurance Claim Appeals

What is an insurance claim appeal?

An insurance claim appeal is a formal request to have a denied, delayed, or underpaid insurance claim reviewed and reconsidered. Under US law, all insurance companies are required to have a formal internal appeals process, and external review is available in most states.

Types of insurance appeals

• Health insurance — denied treatments, out-of-network charges, pre-authorization denials
• Auto insurance — low settlement offers, denied collision or liability claims
• Homeowners insurance — disputed damage assessments, denied water or fire claims
• Life insurance — denied beneficiary claims, lapsed policy disputes
• Disability insurance — denied or terminated disability benefits

Steps to appeal an insurance claim

1. Request the denial in writing with the specific reason
2. Review your policy to confirm coverage
3. Gather medical records, repair estimates, photos, or expert opinions
4. File an internal appeal with your insurance company
5. If denied internally, request an external review through your state insurance commissioner

External review rights

Most states require insurers to offer external independent review for denied health insurance claims. The Affordable Care Act guarantees this right for most health plans.