Do you know what does pended mean on an insurance claim? Allow us to help you find the answers you have been looking for with this article. Then, we will take you step by step in understanding what it means to have a pended insurance claim.
We support further research on insurance claims and the importance of people being aware of their rights to such.
About a majority of insured people have not been lectured about the different processes they may go through when filing a claim. We are going to take you through those other statuses too. Let us get right into it, shall we?
What Is An Insurance Claim?
When an insurer needs to contact the insurance company for coverage, they must file an insurance claim. It is a formal request of the insurance they are entitled to. When everything is processed and settled, they will receive the payment according to the terms of their policy. But that is not always the case for insurance claims. There are instances in which necessary information is missing or the adjuster has been denied access.
Insurance claims go through a tedious process to be approved and for good measure.
What Is A Pended Insurance Claim?
So, what does pended mean on an insurance claim? When cases like these arise, the status of the claim will change to pended. An insurance claim will only be pended when not giving important information about the incident important information was not given. This claim cannot be approved due to lack of evidence or denied; therefore, it will stay pending until further information is gathered.
What To Do When Your Claim Is Pended?
When this happens, there will only be fourteen days left to decide the claim. If the employer is self-insured, then they may be given seventeen days. Further investigation to obtain additional information will need to take place to confirm who is held liable. The insurer may have to take a leave while the claim is being assessed and will be given financial support for the time being.
But what if, after fourteen or seventeen days, the insurer has not yet decided the claim? Then you, the injured insurer, are entitled to weekly compensation money. It is essential to know your insurance rights so you aren’t missing services like these that are entitled to you as the insured person.
Most people with pended claims aren’t aware of this and most probably will not be informed unless they have brought it up.
There isn’t much to do for now while your insurance claim is on pended status. All you can do is wait for the results, do some personal research about your rights in your situation, and you may check on your insurer every few days.
If fourteen days have passed without any news, this is when it may be wise to consult for some legal advice and talk to your insurer about the weekly compensation payments. When you suspect the insurance company has not been doing a great job in responding to your pended insurance claim, you may contact a lawyer. If I were you, know when to hire a lawyer for an insurance claim.
What Are The Other Statuses Of A Claim?
There are many statuses a claim can be categorized as. Since we have already talked about the pended status, let us talk about the other statuses. These would be helpful to know when filing a claim.
Status #1. Prepared
This claim status is when the claim has already been made but hasn’t been submitted yet. It means the insurance company hasn’t received the claim yet to process. A claim can be submitted electronically or by paper.
Status #2. Submitted
When the claim has already been sent to the insurance company, it s categorized as submitted. But these haven’t been looked into yet. It is different from a pended insurance claim because they haven’t been opened and inspected yet.
Status #3. Received
When your submitted claim has been opened, you may see on your account that its status will be “received” if you have submitted it electronically. If submitted by paper your claim may be stamped as received after it has been reviewed.
Status #4. Accepted
The received status of a claim merely means that it has been opened and reviewed. It is where the following status determined will be dependent on the review of the claim. Three possible statuses come after received, and that would be pended, denied, or accepted. An accepted claim means that the insurance company has reviewed and accepted that covers worker’s compensation covers it.
Status #5. Denied
On the other hand, your received claim could go to the other status, which is denied. An insurance claim is denied after being processed and assessed, they have detected some error or flagged some lack of authorization from your claim. To know it better, read on understanding the pre-authorization process.
Considering everything, what does pended mean on an insurance claim is that it has already been reviewed and started being processed but may need more evidence.
Insurance companies don’t just give insurance money without a fool-proof claim. It is to prevent their resources from being depleted by undeserving policyholders. Do you want to read more about insurance articles? Read on when car is stolen how does insurance cover it and how to get vision therapy covered by insurance. Thank you for reading this article!