Internal appeals, external reviews, and regulatory complaints for denied health, auto, and homeowner insurance claims. This guide is customized for Warwick residents with Rhode Island-specific consumer protection information.
Warwick Local Tip: Warwick residents can file with RI AG's Consumer Protection Unit at riag.ri.gov.
Rhode Island law: Deceptive Trade Practices Act (R.I. Gen. Laws § 6-13.1-1) — private right of action
Request a written explanation of why your claim was denied. The insurer must cite the specific policy provision or reason. This is required under most state laws and ERISA.
Compare the denial reason against your actual policy language. Insurers sometimes deny claims based on incorrect interpretations or apply exclusions that don't actually apply.
Most insurers have a formal internal appeal process. Write a detailed appeal letter citing the specific policy language that supports your claim. Include any additional evidence.
If the internal appeal is denied, you have the right to an independent external review (required by the ACA for health insurance). The external reviewer is not employed by the insurer.
If external review fails, file with your state's insurance commissioner. They have regulatory authority over insurers and can order claim reconsideration.