Appealing a Denied Injury Claim
Receiving a denied insurance claim can be frustrating and overwhelming. Whether it is from car insurance, workers’ compensation, a homeowner’s policy, or some other type of insurance, a denial can add stress to an already difficult situation.
Were you denied in an accident caused by someone else’s negligence? Was your insurance claim denied? If so, don’t give up hope. There are steps you can take to appeal the decision or pursue other options for seeking compensation.
In this article, we will discuss common reasons claims are denied, how to appeal a denied personal injury claim, and tips for success. For help during any stage of the claims or appeals process, contact Harker Injury Law to schedule a free consultation.
Understanding Why Personal Injury Claims Are Denied
After being injured in an accident caused by someone else’s reckless or negligent actions, you have the right to file a personal injury claim to pursue damages for your losses. Unfortunately, it is not uncommon for personal injury claims to be denied.
Some of the most common reasons for denial include:
- Insufficient evidence: You need solid evidence to prove a personal injury claim. This can include police reports, medical documentation, and witness statements. Without sufficient evidence, your claim may be denied.
- Disputes over liability: The insurance company may argue that you were partially or fully at fault. If there is a dispute over liability, the claim may be denied or delayed until fault can be established.
- Pre-existing conditions: Insurers may claim your injury was pre-existing and not caused by the accident. They can use this as a reason to deny your claim.
- Missed deadlines: Personal injury claims are subject to strict deadlines. Filing too late can lead to an automatic denial.
- Failure to mitigate damages: You have an obligation to take reasonable steps, such as seeking medical treatment, to mitigate damages after an accident. Failure to do so can result in a claim being rejected.
How to Appeal a Denied Personal Injury Claim
Receiving a denial letter from the insurance company is frustrating to say the least. However, a denial is not necessarily the end of the road. You have the right to appeal.
Knowing the right steps to take can mean the difference between receiving compensation and your claim being denied again.
Review the denial letter
The insurance company is required to provide a written explanation of why your claim was denied. Review the denial letter carefully to understand why your claim was denied. Look for any errors or inconsistencies in the denial, such as misinformation about the accident.
Understanding why your insurer denied your claim will help you and your attorney develop a strategic appeal strategy.
Gather additional evidence
After you understand why your personal injury claim was denied, gather any additional evidence or information that supports your claim.
This may include:
- Medical records and bills
- Expert medical testimony
- Photos and videos from the accident scene
- Witness statements
- Accident reports
Talk to an experienced lawyer for further guidance on how to do this. This step can be tricky, but Harker Injury Law can help you.
Submit a formal denial appeal letter
Your personal injury lawyer can draft an appeal letter on your behalf. An appeal letter is a formal request to the insurance company to reconsider its decision.
The following are some important steps when writing a successful appeal letter:
- Address it correctly: You need to know where to send the appeal request and who to address it to. This information can usually be found on the denial letter, or you can call the insurer.
- Provide your insurance information: Give your full name, policy number, claim number, and a brief summary of the accident.
- State that you are appealing the denial and give a brief explanation: Clearly outline why you believe the denial was incorrect. Reference specific policy terms that support your claim.
- Reference evidence supporting your claim: Briefly outline the documents you have submitted as evidence along with your letter. Highlight any points where the initial claim may have been misunderstood.
- Maintain a polite and respectful tone: The tone of the letter should be polite and professional. Focus on the facts and avoid being accusatory.
- Request a specific resolution: Ask for a specific resolution. This could be the full amount of the claim or a partial reimbursement based on new information.
Consider mediation
Mediation allows you and the other party to discuss the personal injury claim with the help of a neutral third party. This can save time, reduce stress, and still result in a fair settlement.
Follow up with the insurance company
After submitting your appeal, be sure to follow up with the insurance company. Contacting them ensures that your appeal didn’t fall through the cracks and that you’re aware of any updates or any further documentation they need from you.
However, it is ideal to leave all contact with the insurance company to your lawyer, if you have one. Contact Harker Injury Law if you need advice on this matter.
How an Experienced Personal Injury Attorney Can Help With an Appeal
In 2023, about 1 in 5 people in the U.S. sought medical assistance for an injury. If you were harmed due to someone else’s actions, you should be compensated for your medical expenses and other losses. An experienced personal injury attorney can be the difference between a failed appeal and a favorable outcome.
Here are some ways a lawyer can help:
- Case evaluation: Your attorney can determine whether the denial was valid and identify the best path forward
- Evidence collection: A lawyer can organize and gather crucial records to strengthen your personal injury claim
- Deadline management: Experienced personal injury lawyers will make sure all filings meet the insurer’s and court’s strict deadlines
- Negotiation skills: Your personal injury attorney will communicate with the insurance adjusters and advocate for a fair settlement agreement
- Litigation experience: Choose a lawyer who is trial-ready and can represent you in court if needed
What to Do If an Appeal Is Denied
If your appeal is denied, this doesn’t mean that you are completely out of options. A personal injury lawyer can let you know your legal options and give advice on your best course of action.
Here are some other avenues you may be able to pursue:
- Request an internal review: You could ask the insurance company to re-examine your case with a different adjuster or review panel
- File a complaint with your state’s Department of Insurance: If you believe that the insurer acted unfairly or violated state law, you can file an official complaint
- Seek an independent medical or legal review: In certain cases, you can request an outside expert evaluation of your injuries or claim
What If the Insurance Company Is Acting in Bad Faith?
State laws prohibit insurers from denying valid claims or delaying payment without a sound reason. Unfortunately, many insurance companies still engage in bad faith practices.
Signs of bad faith may include deliberate delays in processing your claim or misrepresenting policy terms or coverage.
Take the following steps to protect your rights if you believe bad faith practices may have been used in your case:
- Document everything: Be sure to keep copies of letters, emails, and any other documentation from the insurer.
- Request a written explanation: California law requires insurers to provide the reason for the denial in writing.
- Consult a personal injury lawyer: Reach out to an experienced attorney as soon as possible. Bad faith claims often require aggressive legal action.
- File a bad faith lawsuit: If successful, you may recover not only the compensation owed under the policy but also additional damages for the insurer’s misconduct.
Schedule your free consultation with Harker Injury Law for help determining whether you may have a bad faith case.
You Don’t Have to Face an Insurance Denial Alone
A denied insurance claim can be frustrating, but you don’t have to accept it without a fight. It’s important to know you still have options for seeking compensation.
Whether you choose to file an appeal, negotiate a settlement, or file a personal injury lawsuit, our skilled and compassionate personal injury attorneys are here to help. With the right legal strategy and professional guidance, you give yourself the best chance of securing the compensation you’re entitled to receive.
Don’t give up hope if your personal injury claim is denied. Act promptly, take action, and pursue the compensation you deserve.
Contact Harker Injury Law today for a free consultation. Working with our legal team means you will get just the answers, guidance, strength, and peace of mind you need at a stressful time like this.
