The Process of Appealing a Denied Claim in Louisiana

Posted in Car Insurance Claims on January 21, 2023

What Can You Do if Your Claim is Denied?

In Louisiana, the process for processing claims begins with the initial filing of a claim with the Louisiana Department of Insurance. This claim will typically include information about the incident or injury that gave rise to the claim, as well as any supporting documentation, such as medical records or police reports. Once the claim is received, it is reviewed by a claims adjuster to determine if it is valid and if any benefits or compensation are due. If the claim is denied, the claimant will be notified in writing and provided with an explanation for the denial. If the claim is approved, the claimants will receive a settlement offer or award.

So, what happens if your claim is denied? The first step is to review the reason for the denial and file an insurance complaint. The insurance company is required to provide a written explanation for the denial, including any specific policy language or regulations that apply. If the denial is based on a technicality, such as a missed deadline for filing the claim, the claimant can refile their claim and ask the insurance company to reconsider their claim. If the denial is not resolved through reconsideration, the claimants can file an appeal with the Louisiana Department of Insurance. This process involves providing additional evidence and documentation to support the claim.

Furthermore, if the first appeal is unsuccessful, the claimants can take their case to court. However, it is important to note that in Louisiana, an insurance contract is a legal contract, so the claimants need to prove that their case is justified, and the court will decide based on the contract’s terms and the state’s laws.

What Documents Must be Submitted When Filing an Appeal?

When filing an appeal in Louisiana, the following documents are typically required to be submitted:

1. A written request for an appeal: This document should clearly state the reason for the appeal and the specific issues that are being challenged.
2. Copy of the original claim and the denial letter: This will provide the insurance company and the Louisiana Department of Insurance with the necessary background information about the claim.
3. Evidence and documentation: This may include photographs, bills, estimates, and any other relevant information that supports the claim. This is particularly important if the denial was based on a disagreement over the coverage or the extent of the damage.
4. A sworn statement: This statement should be signed under oath and should provide the details of the damage, the events that led to the damage, and any other relevant information.
5. Any other relevant documents and agreements: Depending on the specific circumstances of the case, additional documents may be required. For example, if the claim is related to property damage, the insurance company may require a copy of the property’s title or a lease agreement.

Note that the document’s requirement might vary, depending on the type of insurance policy, the claim and the insurer. It’s always good to ask the insurer what documents they need specifically to process the appeal.

Strategies for Increasing Your Chances of a Successful Appeal 

Several strategies can be used to increase the chances of a successful appeal in Louisiana:

• Understand the reason for the denial: It is important to understand the specific reason for the denial of the claim. This will help to identify any deficiencies or errors in the original claim that can be corrected in the appeal.
• Gather additional evidence: Assemble any additional evidence and documentation that supports the claim. This can include photographs, bills, estimates, and any other relevant information. Make sure to highlight the key evidence that supports the claim.
• Hire an attorney: An attorney who is experienced in handling insurance claims can provide valuable guidance and representation during the appeal process. They can help to ensure that all necessary documents are submitted and can persuasively present the case.
• Be Persistent: The appeal process can be time-consuming, and it’s important to be persistent and follow up as necessary. This may include requesting status updates from the insurance company and the Louisiana Department of Insurance and providing additional information or documentation as requested.
• Be Organized: Keep all documents and communication with the insurer and the Louisiana Department of Insurance in a well-organized manner. This will make it easier to find the information when it’s needed, and it will also help to demonstrate to the insurance company that the claim is well-documented and legitimate.

Tips for Navigating the Appeals Process in Louisiana

Here are some tips for navigating the appeals process in Louisiana:

• Seek legal representation: An attorney who is experienced in handling appeals can help guide you through the process and ensure that your case is presented in the best possible way. Also, gather all necessary documentation.
• File your appeal promptly: In Louisiana, there is a specific time frame in which to file an appeal, so be sure to file your appeal as soon as possible.
• Be prepared for the hearing: Make sure you are prepared to present your case in front of an administrative law judge. This includes being familiar with the evidence you plan to present and being able to explain your case clearly and concisely.
• Be prepared for the possibility of a higher court appeal: If the decision of the administrative law judge is not in your favor, you may have the option to appeal to a higher court. Be prepared for this possibility and understand the process and time frame.
• Know the cost: The appeals process can be costly, especially if you’re going to hire an attorney. Be prepared to pay for court fees and any other expenses.

In the long run, the process of appealing a denied claim in Louisiana starts with the initial filing of the claim with the appropriate agency or department. If the claim is denied, claimants can request a hearing before an administrative law judge and if they are still not satisfied with the outcome they have the option to appeal the decision to a higher court. 

If you are dealing with process of appealing a denied claim, contact the firm today at (504) 500-5000 or at our website to schedule an appointment.