What Happens If Your Insurance Claim Is Denied?
Gregg Hollander | September 2, 2024 | Car Accidents
If your insurance claim is denied, the next step should be an appeal. You can file an amended claim but should only do so once you understand why the insurance company denied your first claim. Consulting with a personal injury attorney in Boca Raton is best. You want to take full advantage of your second chance at a claim, so you should always consider hiring an attorney to lead your claim or appeal.
If your appeal is unsuccessful, you’ll need to consider your remaining options—possibly including filing a lawsuit. If you have a lawyer lead your appeal, they will be able to transition to a lawsuit (or any other necessary course of action) without wasting a second.
Reasons Why an Insurance Company May Deny Your Claim
Those who face denied claims generally file their initial claim, cooperate with an adjuster, and eventually receive a denial letter. This letter may:
- State that your entire claim, or a portion of your claim, has been denied
- Explain the insurer’s rationale for denying your claim
Some potential reasons you may encounter in a claim denial letter include:
Deadline-Related Disputes
Insurance companies often impose deadlines related to claims. These deadlines may:
- Require the claimant to file the claim within a certain time after the covered event
- Require the claimant to report injuries within a certain time after the covered event
An insurance company may claim that you did not act quickly enough in some respect, and this can be the insurer’s rationale for denying your claim.
Someone Provided You Fraudulent Insurance Information
Uninsured motorists are a hazard in all 50 states. Sometimes, motorists who lack insurance provide fake or inaccurate insurance information to those whose vehicle they strike during an auto collision.
If you submit a claim based on false insurance information, you can expect the insurance company to deny the claim. An experienced personal injury attorney knows how to seek compensation if an at-fault motorist lacks insurance (or merely gave you inaccurate information).
An Insurance Policy Is No Longer Active
An insurance policy can lapse because:
- The policyholder forgets that they need to renew it manually
- The policyholder cancels their payment method without updating their policy
- The policyholder does not see or respond to correspondence warning them of impending cancellation
If a policy is no longer active, this is a clear reason for an insurance company to deny a claim. You may still have a right to seek compensation (whether through insurance or other means), and a lawyer will explain your options.
Technical Error in the Original Claim
Insurance companies may use factual errors, typing errors, and other imperfections in a claim as reasons to issue a denial. You will need to rectify such errors when filing an appeal, and an insurance claim denial attorney will ensure that your amended appeal is thorough and flawless.
An Event or Loss That the Insurance Policy Does Not Cover
If an insurance company judges that a claimant is seeking compensation for circumstances or specific losses that are not covered, it may deny some or all of the claim. For instance, you might receive a denial letter if you seek compensation for:
- Damage to a vehicle when the policy does not include collision coverage
- Damage caused by an uninsured motorist when the claimant does not have uninsured motorist coverage
- A medical procedure that the insurance company determines is not covered by the policy in question
Your attorney will review the policy to determine if the insurer’s denial was legitimate or not.
Losses That Exceed Coverage Limits
Insurance companies place limits on how much financial liability they will tolerate. Coverage limits set the maximum amount of compensation insurance companies are liable for.
If the value of your claim exceeds the coverage limits on a given policy, an insurance company may deny your request for compensation beyond the limit. You may need to file a lawsuit seeking the difference between the coverage limit and the value of your losses, and a lawyer can lead such a lawsuit.
Disputes About the Losses You’re Seeking Compensation For
The average cost of an auto accident can reach nearly $2 million (before even accounting for non-economic harm like pain and suffering). Insurance companies are for-profit organizations, and they often try to save money by:
- Claiming that the claimant’s injuries happened before the event in question (like a car accident)
- Alleging that the claimant is seeking compensation for medical care that is elective (rather than essential)
- Accusing the claimant of exaggerating the financial value of their losses
You should never accept a claim denial. Allow a personal injury attorney to take over your case and fight for a fair settlement from the insurance company.
Claim Denials Are Just One of Many Bad-Faith Tactics an Insurer May Use Against You
If you face a claim denial, it can signal that an insurance company is determined to avoid financial responsibility. You can face more bad-faith tactics, and you can benefit from having a lawyer deal with:
- Lowball offers, which some claimants accept because they are desperate or do not know any better (and, in doing so, free the insurance company from further financial liability)
- Delays, which may be intended to apply financial pressure to the claimant in hopes that they will cave to a lowball settlement offer
- Refusal to negotiate in good faith, leading to legal action against the insurance company or the person they represent
Insurers may also try to intimidate, confuse, or outright deceive a claimant about the compensation they are entitled to. All you have to do is hire a lawyer, and you won’t have to deal with any such bad-faith tactics (or the general headaches that can come with an insurance claim).
Hire an Insurance Claim Lawyer If Your Initial Claim Is Denied
You need to respond to a denied claim, and you may not know how. Even if you know how to file an appeal, you may lack the energy, time, or confidence to do so.
Hiring a lawyer may solve your most pressing problems after receiving a claim denial, as your attorney will:
- Immediately take complete ownership of your claim, ensuring you don’t have to deal with a single responsibility
- Provide the advice you need, especially in light of a claim denial
- Deal with the insurance company on your behalf
- Oversee your appeal and fight for the compensation you deserve
If you are filing an insurance claim, you likely have plenty to worry about. Let an attorney take over the claims process so you can take a breath and focus on other important matters.
The Next Step After a Denied Claim: Submitting an Appeal
The majority of insurance claims eventually result in a settlement, though nobody says reaching a fair settlement is easy. Your lawyer’s first step may be to put together an appeal in the form of an amended claim.
Your lawyer’s appeal letter will:
- Recall the reason why the insurance company denied your initial claim
- Rectify any shortcomings in the initial claim (like any factual errors)
- Include any information the initial claim was lacking (such as evidence that an injury resulted from the event in question)
- Present a comprehensive argument for why you deserve the compensation you are seeking
For an experienced insurance claim lawyer, drafting and filing appeal letters is second nature. Even so, your legal team will ensure your appeal letter is detailed and accurate before filing.
Denied for a Second Time? Filing a Lawsuit May Be the Next Step
If your attorney’s appeal letter does not have the intended effect, filing a lawsuit may be the right option for you. If you have hired a lawyer, filing a lawsuit will be no problem—it’s a major part of what insurance claim lawyers do.
Your lawyer will do what you need them to do. You will not have to worry about important case strategy, as your attorney will handle that, too.
How a Denied Insurance Claim Lawyer Will Fight for the Money You Deserve
You already know that your attorney will file an amended claim on your behalf. Attorneys handle many responsibilities, though, and you should know all the benefits you receive when you hire an insurance claim lawyer.
Your lawyer, their paralegals, and their support staff will:
Dive Into All Insurance Policies Related to Your Case
The details of applicable insurance claims will be critically important to your case. Your lawyer will:
- Review your own insurance policy if one relates to your case
- Review any third-party policies that apply to your case
- Detail policy details, including coverage limits, that are relevant to you
Your lawyer will be familiar with the structure and language of insurance policies. This will allow them to efficiently and accurately analyze relevant policies and move forward with your claim.
Document Your Covered Losses
Your legal team must secure proof of the losses you’re seeking compensation for. Some examples of documentation that can be useful to an insurance claim include:
- Medical bills and records
- Photographs of property damage
- Bills related to property cleanup, repair, and replacement
- Evidence that the claimant is unable to work and has lost income as a result
Because attorneys handle the entire claims process for their clients, securing documentation will be your legal team’s responsibility.
Hire Experts Who Can Improve Your Claim
Law firms often have extensive expert networks, such as medical and accident reconstruction experts. If any expert’s opinions or services improve the odds of your claim’s success, expect your lawyer to hire that expert.
Determine How Much Money You Deserve from Insurers
As your attorney documents your covered losses, they will also calculate your losses’ financial value. Your lawyer may need time to let your losses play out, as the cost of injuries, property damage, and certain other losses are not always immediately apparent.
Your attorney will compose their settlement demands as quickly as possible, as they know that you want to complete your case as soon as you can.
Seek a Settlement for You
Your legal team will present their settlement to the insurance company. This may only happen after they have submitted your amended claim. Settlement negotiations often involve:
- Citing details of the insurance policy that prove you’re entitled to compensation
- Presenting documentation of your covered losses (including any relevant expert testimony)
- Explaining how they calculated their settlement demands
- Addressing all counterarguments from the insurance company
When you hire a lawyer, you trust that they will hold the insurance company accountable for the contracts they issue (whether it’s your policy or a third party’s policy).
Represent You in Any Necessary Lawsuit
If the insurance company denies your amended claim or denies you fair compensation in any other manner, your attorney may file a lawsuit on your behalf. Some lawsuits (though not most) end up going to trial, and your legal team will lead any necessary court case, too.
Types of Insurance Claims That May Warrant an Appeal (and Losses You May Deserve Compensation For)
If you file any type of insurance claim, there’s a chance it will be denied. This includes claims related to:
- Car accidents
- Truck accidents
- Motorcycle accidents
- Bus accidents
- Boat accidents
- Property damage (including damage to a home or business)
- Accidents on someone else’s property
- Healthcare claims
Attorneys have a wide range of experience when it comes to denied claims. Trust a lawyer to fight for all the compensation you deserve if an insurer denies your claim.
Losses Your Insurance Claim Lawyer May Include in Their Settlement Demands
The type of losses you seek compensation for will depend on your claim type. While an auto accident victim might need money to cover medical care for whiplash, someone else may need money to repair their home after a hurricane.
Your lawyer will seek compensation for all of your covered losses, which might include:
- Medical expenses
- Vehicle repairs
- Repairs to a damaged property
- Lost earnings
- Rehabilitation costs
- Temporary transportation costs
Your lawyer will create a detailed record of your losses, review insurance policies, and seek fair compensation for your covered losses.
Reasons to Hire a Denied Insurance Claim Lawyer as Soon as Possible
Many claimants have a very brief time to report injuries, file claims, and file lawsuits. Don’t wait to find an insurance claim lawyer serving your area. They can ensure all filing deadlines are met.
Call An Experienced Lawyer Today
Don’t let a denied insurance claim be the end of the road for you. Hiring a denied insurance claim lawyer can make a significant difference in the outcome of your case. They will fight for your rights, navigate the complex legal system, and work towards getting you the compensation you deserve. Don’t delay—contact Hollander Law Firm Accident Injury Lawyers about your denied insurance claim as soon as possible.