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Can an Insurance Claims Lawyer Help Me Appeal a Denied Insurance Claim?

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When an individual’s insurance claim is denied, it can be a frustrating and often confusing experience. The process of appealing a denied insurance claim can be intricate and may require a clear understanding of insurance law and policy language. In such circumstances, consulting an insurance claims lawyer can be a critical step. These legal professionals specialize in analyzing the policy details, identifying grounds for appeal, and formulating a strategic approach to challenge the denial.

An insurance claims lawyer typically has expertise in navigating the complex appeal process. They employ their knowledge to scrutinize the reasons for denial and gather evidence that supports the policyholder’s case. The lawyer’s involvement can help ensure that the appeal is constructed professionally and presented cogently, increasing the chances of overturning the insurer’s decision.

Furthermore, these lawyers are adept at negotiating with insurance companies and advocating for their clients’ rights. If the appeal is not successful, an insurance claims lawyer in Fort Myers may also advise on the feasibility of taking further legal action. Through their guidance, policyholders gain the advantage of an informed ally committed to protecting their interests and securing a fair outcome.

Understanding Insurance Claim Denials

Common Reasons for Denial

  • Policy Exclusions: Most insurance policies have specific exclusions. If the claim falls under these exclusions, the insurance company will likely deny it.
  • Lapsed Policy: If premium payments are not up to date, an insurance policy may lapse, resulting in denied claims.
  • Insufficient Documentation: Insurance companies require adequate documentation to process claims. Claims may be denied if the documentation is incomplete or insufficient.
  • Filing Deadlines: Insurance policies often impose deadlines for filing claims. Failure to adhere to these can lead to denial.

The Appeals Process

After a claim is denied, policyholders have the right to an appeal. This process typically involves:

  1. Reviewing the Denial Letter: It is essential to understand the reasons for denial as outlined in the correspondence from the insurer.
  2. Gathering Documentation: This may include additional evidence or information to contest the denial.
  3. Submitting a Formal Appeal: This includes a written statement and any additional documents to support the appeal, directed to the insurer.

In Fort Myers, an insurance claim attorney can assist at various stages of the appeals process, ensuring that policyholders understand their rights and the available legal pathways to challenge a denied insurance claim.

How an Insurance Claims Lawyer Can Assist

When an insurance claim is denied, a specialized lawyer can provide crucial guidance and representation to challenge the decision. Their expertise is invaluable in understanding the intricacies of insurance law and advocating for your rightful compensation.

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Assessing Your Denied Claim

An insurance claim attorney will meticulously review the facts of your denied insurance claim to ascertain the validity of the insurer’s decision. They will scrutinize the policy details and the reasons provided for denial. This rigorous examination helps them determine if the denial was unjust and whether there are grounds for an appeal.

Navigating Legal Complexities

Insurance law can be a labyrinth of statutes, regulations, and case law that laypersons find challenging to navigate. A seasoned attorney in Fort Myers excels in interpreting these complexities and crafting a strategy to counter the denial. They can manage necessary paperwork, meet critical deadlines, and engage with insurance company lawyers on your behalf.

Representing Your Appeal

Should your case proceed to appeal, an insurance claims lawyer will serve as your advocate. They will present your argument, fortified with evidence, to the appropriate appeals board or court. They assert your position and seek to overturn the denial, aiming to secure the insurance benefits due to you. The lawyer’s presentation can include witness testimony, expert opinions, and other persuasive documentation.

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Why innovation in underwriting is so hard to achieve

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Why innovation in underwriting is so hard to achieve

I read Kevin Carr’s latest opinion piece on his recent underwriting experience with interest and immediately messaged him for two reasons.

First, to remind him he remains significantly older than me but also to point out that, much as I agreed with the premise of his writing, I found it a bit heavy on problem and light on solution.

That said, I had to concede I couldn’t really think where the next leap in underwriting evolution was likely to come from either.

People Kev and my age saying “it’s probably AI” must sound like middle-aged people back in the 1990s suggesting “the internet” as the panacea to all life’s ills. Without context or insight, it’s meaningless rhetoric.

My roughly two decades in the life market have coincided with the digitisation of underwriting. When I was selling policies around the turn of the century, the paper application form was my only option.

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Even the biggest and most controversial disruptors, such as UnderwriteMe, haven’t sought to change the game so much as make the game slightly easier to play

We carried bundles of these chunky documents around with us (at least one for each insurer we might recommend) and, while each had additional pages designed to capture information on any diagnosed conditions, immediate acceptance rates were low and GP reports common due to the limitations of the data capture available.

The magic of the internet allowed insurers to turn these paper monstrosities into digital processes, which, as well as alleviating the strain on brokers’ arms, allowed underwriters to include unlimited reflexive questions in order to capture point of sale data on disclosures.

This innovation has led to an all-time high in terms of immediate decision making and a reduction in the need for GP reports but has necessitated ever more complex and expensive rules technology which underwriters must integrate, manage and update.

Arguably, change is just as hard now as it was in the pre-digital age, it’s just that IT change stacks have replaced printer ink costs as the major blocker.

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If real-time data sharing becomes a viable reality, insurers will be able to see far more about a customer than is currently available through a traditional application

When thinking about real innovation in the last 20 years, it’s hard to pinpoint anything which hasn’t, in reality, been an improvement or iteration of an existing process. Even the biggest and most controversial disruptors, such as UnderwriteMe, haven’t sought to change the game so much as make the game slightly easier to play.

I hear often about true personalisation being the key to revolution in underwriting. This means accessing the consumer data which exists in the ether through our NHS records, banking history and other financial activities, socioeconomic markers, television viewing habits, grocery purchases and exercise and health uploads. You name it, somewhere a company or organisation has consumer data on it.

By somehow pooling all this information, insurers could give accurate premiums with little or no further questions – a truly personalised and efficient underwriting process, which would mean no forms, digital or otherwise, and certainly no nurses popping round to Kev’s house to measure his particulars.

There are, however, significant hurdles to be cleared in order to reach this utopia, including: customer willingness to allow their data to be shared beyond the purpose for which they intended it (I don’t mind Netflix knowing what I watched on Saturday but I might not want to share it with the world), data protection laws and differing jurisdictions, and the infrastructure needed to integrate the myriad systems and software used by each data owner.

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In a market which has seen prices falling in real terms over recent years, perhaps this wouldn’t be a bad thing

There is also a wider, philosophical consideration. Currently insurers ask for a limited amount of information on which to make an underwriting decision. This means that, in the true spirit of pooled risk, they are taking the chance there is information about a customer to which they are not privy. Indeed, it may be information to which the customer themselves is oblivious.

If real-time data sharing becomes a viable reality, insurers will be able to see far more about a customer than is currently available through a traditional application. Can they remain “blind” to some aspects in order to continue to offer cover to as wide a cohort as possible?

Of course, underwriting could be less intrusive and quicker right now, it’s just that gathering less data would mean increased premiums commensurate with the higher risk taken by the insurer. In a market which has seen prices falling in real terms over recent years, perhaps this wouldn’t be a bad thing.

Phil Jeynes is director of corporate strategy at Reassured

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Tesco Bank down leaving customers unable to make credit card payments

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Tesco Bank down leaving customers unable to make credit card payments

HUNDREDS of Tesco Bank customers are currently locked out of their credit card accounts and unable to make payments due to a system outage.

Customers report being unable to log into the Tesco mobile banking app and online banking platform.

Hundreds have been complaining that Tesco Bank's services are down

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Hundreds have been complaining that Tesco Bank’s services are downCredit: PA:Press Association

According to DownDetector reports, over 590 users have encountered issues with the bank’s online services this morning.

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More than 50% of the reported problems related to difficulties with mobile banking, while 35% of users experienced trouble accessing Internet banking.

Others claim they’ve been unable to use their credit card for online payments.

Frustrated customers have taken to social media to express their concerns.

One person posted on X (formerly Twitter): “I cannot log on to mobile app or internet banking.

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“When trying to get on to internet banking, I get a message saying that Tesco is having difficulty sending a one-time code to my phone.”

Another said: “Are they down? I’ve been trying to pay Tesco bank bill online for the past two days with no luck.”

One customer who says their card payments have been declined said: “I’m constantly getting ‘This service is not available’ when trying to make a credit card payment online.”

However, another added: “I’ve made card payments online since the website and app went down but even telephone banking can’t access accounts.”

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The Sun has contacted Tesco Bank for comment.

Switch bank accounts for free perks

Tesco Bank provides a variety of personal banking and insurance products, including personal loans, credit cards, car insurance, and pet insurance, to over five million customers.

In February, Barclays agreed to purchase Tesco’s retail banking division, which included the acquisition of nearly 3,000 employees.

While Barclays will run these services, they will continue under the Tesco Bank name.

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Plus, Tesco Bank will retain some of its banking activities, including insurance, ATMs, travel money and gift cards.

The sale still needs to be approved by regulators and it is expected to be completed before the end of 2024.

Tesco Bank stopped offering mortgages through its bank in 2019 after seven years.

It’s 23,000 mortgage loans were sold to Lloyds Banking Group, which Halifax is part of, for around £3.8billion.

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Tesco Bank also offered current accounts, which were closed to all customers in November 2021.

How can I check if my bank is down?

THERE are a few different ways to find out if your bank is experiencing an outage.

Senior consumer reporter Olivia Marshall explains how you can check.

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If you’re trying to send money to someone, or you just want to check if you have enough cash for a coffee, finding your online banking is down can be a real pain.

Most banks have a dedicated news page on their website to show service problems, including internet banking, mobile apps, ATMs, debit cards and credit cards.

You can also check on any future work they have planned and what it might mean for you.

Plus, you can check websites such as Down Detector, which will tell you whether other people are experiencing problems with a particular company online.

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Can I claim compensation for the outage?

Banks don’t have to pay out compensation to customers if there has been a drop in service, unlike how telecoms companies have to.

But if you have incurred costs as a result of service issues, it’s likely you could get your money back.

For example, if a bill payment didn’t go through as a result of an outage and you’ve been charged a fee for missing it, you should be able to claim that money back.

If your credit rating has been affected by a service outage, because you got a late payment fee after being unable to make a transaction, for example, you should also keep a record of this.

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If you spoke to anyone to try and resolve the problem, make a note of their name and when you spoke to them, as well as roughly what you discussed and what they advised you to do.

You can find out more details about how to complain on the bank’s website.

It is worth gathering evidence of your problems so you can make a formal complaint to the bank directly.

What happens if my bank refuses to compensate me?

If you’re unhappy with how the bank dealt with your problem, you can contact the free Financial Ombudsman Service (FOS).

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It is an independent body that will consider the evidence you present and make a fair decision about the action a bank should take.

The FOS can usually get involved 15 days after you’ve raised concerns with the bank.

In the case of an IT system outage at a bank, the FOS says any compensation depends on your circumstances and whether you lost out as a result.

If it thinks you did, it has the power to tell the bank to reimburse any fees, charges, or fines you were hit with, for example, if you were unable to make a payment on a credit card bill or to your mortgage provider.

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It could also tell a bank to pay you for any money you didn’t receive, such as interest, if you weren’t able to pay money in.

If your credit score was affected, it may tell the bank to correct your credit file.

The FOS might also tell the bank to reimburse you for any extra costs you had to make, such as phone calls or trips to your local branch, as well as a payment for any inconvenience it caused.

Do you have a money problem that needs sorting? Get in touch by emailing money-sm@news.co.uk.

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Plus, you can join our Sun Money Chats and Tips Facebook group to share your tips and stories

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Manchester developer Shenton Group completes £5.3m bridging loan

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Manchester developer Shenton Group completes £5.3m bridging loan

The loan with a 24-month term has refinanced the developer’s existing debt and provides funding for acquisitions.

The post Manchester developer Shenton Group completes £5.3m bridging loan appeared first on Property Week.

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Carlos Rodón delivers as Yankees take ALCS Game 1.

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Carlos Rodón delivers supreme outing as Yankees take ALCS Game 1 from Guardians.

The New York Yankees took the lead in the American League Championship Series on Monday, securing a 5-2 win over the Cleveland Guardians in the Bronx with a strategy they know well. Carlos Rodón delivered six impressive innings as the starting pitcher. The Yankees capitalized on their opportunities, drawing six walks during a stretch of nine batters in the third and fourth innings.

They also saw home runs from two of their star hitters, Juan Soto and Giancarlo Stanton, while Clay Holmes and Luke Weaver provided excellent relief, closing out the game for the save. After a rough outing on the mound, where reliever Joey Cantillo set a postseason record with four wild pitches, the Guardians will look to their ace, Tanner Bibee, and a refreshed bullpen for Game 2 on Tuesday. However, they will be up against the Yankees’ top starter, Gerrit Cole, who performed impressively in Kansas City last week during the division series.

Flawless

Rodón admired Gerrit Cole’s composed performance against the Kansas City Royals in Game 4 of the American League Division Series and aimed to emulate that steadiness in Game 1 of the ALCS. He focused on managing his emotions better than he did in Game 2 of the ALDS, and on Monday, he executed flawlessly as a focused, strike-throwing machine. Rodón’s performance against the Guardians was outstanding, allowing only three hits and one run—a solo homer by shortstop Brayan Rocchio in the sixth inning.

He recorded nine strikeouts and achieved 25 swings-and-misses, the highest for a Yankees pitcher in the postseason since the pitch-tracking era began in 2008. The Yankees had considered starting either Rodón or Clarke Schmidt for Game 1 but ultimately opted for Rodón, believing his pitching style would be effective against the Guardians, despite their strong performance against left-handed pitchers during the regular season.

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Rodón’s performance was significant, showcasing exactly why the Yankees invested $162 million in him two offseasons back.

 

Brayan Rocchio Home Run

Rodón’s only hiccup of the evening occurred when Brayan Rocchio hit a home run to start the sixth inning. However, he didn’t let it rattle him. There was no sign of confusion as he watched Rocchio’s shot clear the left-field fence. He quickly bounced back, retiring the next three batters and capped off his performance by giving a nod to Aaron Judge, who made a spectacular catch on a line drive from José Ramírez for the final out of the sixth. Rodón successfully faced the Guardians slugger three times without allowing a hit. “I think he was very mindful of how his last outing went and how emotions got the better of him early on,” Yankees pitching coach Matt Blake noted. “That was something he focused on throughout the game. You could see him trying to maintain his composure each inning and just keep getting those outs.”

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The Yankees are just three victories away from reaching the World Series for the first time since 2009, boasting a 4-1 record in this postseason. The only loss came from Rodón. He started strong in Game 2 of the Division Series against Kansas City, dominating the first three innings without allowing a run and celebrating as if it were a quick sprint rather than the marathon that is a successful October campaign. However, he faltered in the fourth inning, surrendering all four runs and unable to finish the inning. With ace Gerrit Cole securing the win in Kansas City and Rodón set to pitch Game 1 in the ALCS, he cannot afford to repeat that performance.

Guardians Pitching Hell

The Guardians faced a tough time on the mound during the third inning. It all started with a home run, followed by a walk, and then a short pause for trainers to check on Cobb. After a strikeout, there was another walk, a flyout, and yet another walk. A pitching change occurred, leading to a wild pitch that allowed a run to score, followed by another wild pitch that brought in another run. The inning concluded with a strikeout. In total, the Yankees scored three runs on just one hit, while their hitters mostly just had to stand there. Cobb left the game after 2 2/3 innings, having thrown 65 pitches.

Cantillo struggled during his warmup, with his first pitch sailing to the backstop, and he lacked control in a situation where precision was crucial. Out of 21 pitches, only seven found the strike zone. The rookie faced four batters, walked three of them, and threw four wild pitches—matching the total he had in 38 2/3 innings during the regular season.

The Guardians relied heavily on their bullpen to narrowly defeat the Detroit Tigers in five games during the ALDS, showcasing the best ERA in the league, which was over half a run better than any other team’s bullpen. However, to compete in a seven-game series against the Yankees, they will need their starting pitchers to step up. A small positive from the Game 1 defeat is that Pedro Avila, who was added to the ALCS roster after being a supportive presence during the ALDS, managed to pitch 2 2/3 innings in relief of Cantillo. This performance allowed manager Stephen Vogt to avoid using his top four relievers: Cade Smith, Tim Herrin, Hunter Gaddis, and Emmanuel Clase.

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Yankees Execute Their Game Plan Perfectly

Whatever strategy the Yankees had in mind for Game 1, it likely couldn’t have unfolded any better than it did. They witnessed what might have been Rodón’s finest outing in a Yankees uniform. They put early pressure on Cobb, forcing him out of the game after just 2 2/3 innings, and managed to avoid facing Cade Smith and Emmanuel Clase, the top arms in the Guardians’ formidable bullpen. The team’s star hitters also made significant contributions.

Soto kicked off the scoring with a solo home run in the third inning against Cobb, a pitcher he had historically performed well against. Aaron Judge added a sacrifice fly and crossed home plate himself. Stanton hit a solo homer in the seventh, pushing their lead to 5-1. Even Anthony Rizzo made his mark with a single in his first at-bat and a walk, showing that the two fractured fingers on his right hand, which sidelined him during the ALDS, weren’t a hindrance. While two of the Yankees’ runs came from wild pitches, they effectively positioned themselves to take advantage of Cleveland’s errors.

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Advisers play ‘pivotal role’ in later-life planning

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Advisers play ‘pivotal role' in later-life planning

People who have sought financial advice are more likely to have taken action to prepare for later life and the transition of wealth, research by Canada Life has revealed.

The insurance provider has published a report focused on the 100-year life. It examines what living longer means practically, financially and emotionally.

It found that, while overall 15% have sought professional advice on inheritance and intergenerational wealth planning, those who have consulted a financial adviser are much more likely to have discussed their intentions with family members.

Two-thirds of those who use an IFA have discussed their intentions, compared with 44% who do not have an IFA.

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Meanwhile, 62% of those who use an IFA have written a will, compared with 32% of those who do not.

And 28% of those who use an IFA have established power of attorney, compared with 11% who do not.


Propensity to have written a will and established a PoA by use of IFA
Source: Canada Life

“Those who use an IFA are more prepared for all later-life eventualities than those who do not, including funding their long-term care, financing their retirement and making sure their loved ones are looked after once they die,” Canada Life said, in its report.

“These figures highlight the notable benefits of using professional advice. Expert guidance is often a starting point for wider discussions with those closest to us.

“Our research suggests many more people could benefit from doing this to prepare for later life and facilitate the transfer of wealth.”

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The report also suggested that, overall, people who use an independent financial adviser are more likely to feel satisfied and in control of their lives than those who do not.

Canada Life reported that 75% of respondents who use an IFA are satisfied with their lives, compared with 61% of those who do not use an IFA.

Almost six in 10 (58%) who use an IFA feel in control, compared to just over two-fifths (44%) of those who do not use an IFA.

The research found that 54% of the UK population have used professional advice, which includes IFAs, bank or building society advisers, solicitors, accountants, mortgage brokers, insurance brokers or stockbrokers.

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Under a quarter (23%) have used an IFA.

The propensity to use professional advice, and an IFA specifically, closely correlates with age. Those 55 years and over are more likely to use both than the under-55 age groups.

In addition, 52% of those under 35 can see the benefit of accessing professional financial advice – higher than for any other age group.

However, 42% do not know where to turn for advice, suggesting a need for better access to information and reassurance.

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Britain’s £400MILLION ‘NEWEST town’ unveiled – with 20,000 homes, 2 schools & shopping parade

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Britain’s £400MILLION ‘NEWEST town’ unveiled - with 20,000 homes, 2 schools & shopping parade

BRITAIN’S “newest town” costing £400million has been unveiled and will ultimately include 20,000 homes, schools and a shopping parade.

The Barking Riverside project in East London, has already seen 2,700 homes built and will occupy a 443-acre brownfield site that once was the location of Barking power station.

How the new town is expected to look, situated on the north side of the River Thames

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How the new town is expected to look, situated on the north side of the River ThamesCredit: Llifschutz Davidson Sandilands
It's hoped that up to 50,000 people will eventually live in the new development

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It’s hoped that up to 50,000 people will eventually live in the new developmentCredit: Llifschutz Davidson Sandilands

It is hoped that it will eventually house a 50,000 strong community on the north bank of the River Thames.

So far, more than £400million has been pumped into the project so far, with 2,700 homes created and permission has been granted to build up to 10,800.

Under new plans, that figure would almost double, gaining benefit from improved transport links, including a new overground station and a pier.

Matthew Carpen, managing director of Barking Riverside Ltd said: “We have much more we wish to deliver, with the investment to date setting the foundation for the significant growth that is now proposed.

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“We look forward to delivering our new masterplan for 20,000 homes, together with the amenities and services needed to support and attract a vibrant and growing population.”

Under the scheme, more than a third of the 13,046 new homes would be earmarked as affordable housing, offered at a minimum of 20 per cent below market value.

The extended plans include two new parks – Ripple Park, covering roughly 50 acres, and River Park, a 19-acre site – along with two primary schools and improved cycling and walking routes.

Mr Carpen added: “As well as meeting the need for housing, with much of this being affordable, the new masterplan aims to maximise public benefit – both for the growing community here and the whole of east London.”

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There are already five schools and several nurseries and various play areas and shops.

Fiona Fletcher-Smith the CEO of housing association L&Q said: “The UK is in the grips of a housing and affordability crisis, which is getting worse.

Trolls say I should be ashamed because I live in a council house – they judge & assume I’m on benefits but I don’t care

“That has to change, and projects like Barking Riverside are part of the solution.

“We believe Barking Riverside could be a blueprint for brownfield development across the country.

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“None of this would be possible without partnerships, from L&Q and the mayor of London to the many others contributing to the success of this place.

“Delivering the proposed new homes and infrastructure will be a wonderful next step at this exciting new neighbourhood.”

The extended plans also have the backing of London mayor Sadiq Khan.

He said: “Barking Riverside is a prime example of a new town in London, a pioneering partnership delivering thousands of new homes for Londoners.

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“It’s an inspiring model of how to fix our housing crisis, with new public transport connections, schools, green spaces and a town centre making this a blueprint for how the next generation of English new towns could work.

“I’m determined to do everything in my power to continue boosting homebuilding across London, as part of my plan to build a fairer, more prosperous city for all Londoners.”

Barking and Dagenham council will decide on the plan early next year.

More than a third of the 13,046 new homes would be affordable housing

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More than a third of the 13,046 new homes would be affordable housingCredit: Llifschutz Davidson Sandilands
London mayor Sadiq Khan has given his backing to the plans

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London mayor Sadiq Khan has given his backing to the plansCredit: EPA

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