What is the difference between a claim and an appeal?

A claim is a request for payment from an insurance company after an incident has occurred and the insured party believes they are entitled to reimbursement. This is typically the first step an insured party takes in an effort to receive benefits from their insurance plan. An appeal is a request for a review of an insurance company’s decision or lack of response to a claim. It is a way for an insured party to express dissatisfaction with a decision that has been made concerning their claim. An appeal is filed after a claim has already been submitted and the insured party feels they have been wrongfully denied a benefit or payment. In the state of Hawaii, insurance companies must make a decision on a claim within 45 days of receiving the claim. If a decision has not been made, then an insured party may file an appeal. An appeal for a claim must be made within 60 days of the date the claim was received, or within 30 days of the 45-day decision deadline, whichever comes later. Under Hawaii insurance claims law, an appeal is the insured party’s last chance to challenge a claim. If an appeal is not successful, the insured party may have to pursue other options such as filing a lawsuit.

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