Receiving a denial from an insurance company can be frustrating, especially when you are counting on compensation for medical bills, property damage, or lost wages. A denied claim does not mean the end of the road. Understanding why claims get denied and how to challenge the decision can help you get the compensation you deserve.
Common Reasons Insurance Companies Deny Claims
Insurance companies deny claims for various reasons, including:
1. Disputed Liability
If the insurer believes you were at fault or partially responsible, they may reject your claim. California follows a comparative negligence rule, meaning you can still recover compensation even if you are partially at fault.
2. Lack of Evidence
Insufficient documentation, such as missing medical records, accident reports, or photos, can lead to a denial. The insurer may argue there is not enough proof that their policyholder was responsible.
3. Delayed Reporting
If you did not report the accident or your injuries promptly, the insurance company might claim the delay raises doubts about the validity of your claim.
4. Policy Exclusions
Insurance policies contain exclusions that limit coverage. The insurer may argue that your specific accident or injury falls outside of their coverage terms.
5. Pre-Existing Conditions
If you have prior injuries, the insurance company might claim your current condition is unrelated to the accident and deny coverage.
6. Claim Errors or Missing Information
Simple mistakes on a claim form, missing signatures, or incorrect details can cause a denial. Insurers may use minor technicalities to avoid paying out claims.
Steps to Take If Your Insurance Claim Is Denied
1. Review the Denial Letter
Insurance companies must provide a written explanation for why they denied your claim. Carefully review this letter to understand the reason for the denial and whether it can be challenged.
2. Gather Additional Evidence
If the denial was due to lack of evidence, strengthen your claim by collecting:
- Police reports
- Medical records and doctor statements
- Witness statements
- Photos and videos of the accident scene
- Receipts for expenses related to the accident
3. Contact the Insurance Adjuster
Call the insurance adjuster to discuss the denial and ask for further clarification. Sometimes, denials result from missing documents or misunderstandings that can be corrected.
4. File an Appeal
If the denial was unfair, you have the right to appeal. Submit a formal appeal letter with additional evidence supporting your claim. Be clear, factual, and direct in your response.
5. Consider Mediation or Arbitration
Many insurance policies include dispute resolution options like mediation or arbitration, which allow a neutral third party to review the claim and help resolve disputes without going to court.
6. Consult a Personal Injury Attorney
If the insurance company continues to deny a valid claim, a lawyer can step in to handle negotiations and, if necessary, file a lawsuit. An attorney can:
- Review your policy for coverage details
- Collect and present evidence to counter the denial
- Negotiate with the insurance company on your behalf
- File a lawsuit if the insurer refuses to negotiate in good faith
What If the Insurance Company Acts in Bad Faith?
Insurance companies are required to handle claims fairly. If an insurer unfairly denies a claim, delays payment, or fails to properly investigate, they may be acting in bad faith. In these cases, you may have grounds for a separate legal claim against the insurer.
Do Not Accept an Unfair Denial – Fight for the Compensation You Deserve
A denied claim is not the final word. If the insurance company has denied your claim, the Law Offices of Brent W. Caldwell can help you fight back. Contact us today for a free consultation and learn about your options for appeal.
