Steps to Take When Your Personal Injury Claim Is Denied

1. Understand the Reason for Denial

The first step is to review the denial letter from the insurance company. Common reasons for denial include:

• Lack of Evidence – Insufficient medical records, police reports, or witness statements.
• Disputed Liability – The insurer claims you were at fault or partially responsible.
• Policy Exclusions – The injury isn’t covered under the policy (e.g., intentional acts).
• Missed Deadlines – Failure to file within the statute of limitations or insurer’s required timeframe.
• Pre-Existing Conditions – The insurer argues your injury existed before the accident.

Request a detailed explanation in writing if the denial is vague.

2. Gather Additional Evidence

Strengthen your claim by collecting:

• Medical Records – Updated treatment notes, diagnostic tests, and physician statements linking the injury to the accident.
• Expert Testimony – A doctor’s report confirming causation or an accident reconstruction specialist’s analysis.
• Witness Statements – New testimonies from bystanders or experts.
• Photographs/Videos – Additional images of the accident scene, injuries, or property damage.
• Employment Records – Proof of lost wages if applicable.

3. File an Appeal with the Insurance Company

Most insurers have an internal appeals process. Follow these steps:

• Submit a Written Appeal – Clearly state why the denial was incorrect, referencing policy terms and new evidence.
• Meet Deadlines – Appeals often have strict time limits (e.g., 30–60 days).
• Request a Supervisor Review – Escalate the claim if the adjuster refuses to reconsider.

4. Negotiate a Settlement

If the insurer is open to negotiation:

• Present a Strong Demand Letter – Outline damages (medical bills, lost income, pain and suffering) with supporting documents.
• Use Comparative Fault Laws – If shared fault applies, argue for proportional compensation.
• Consider Mediation – A neutral third party can help facilitate a fair settlement.

5. File a Complaint with State Regulators

If the insurer acts in bad faith (e.g., unjustified delays, lowball offers), report them to:

• State Insurance Department – They can investigate and penalize misconduct.
• Consumer Protection Agencies – Some states have additional oversight bodies.

6. Consult a Personal Injury Attorney

If appeals fail, hire a lawyer to:

• Evaluate Your Case – Determine if litigation is viable.
• Send a Legal Demand Letter – A formal notice may prompt a settlement.
• File a Lawsuit – If necessary, your attorney will initiate court proceedings.

7. Prepare for Litigation

If your case goes to court:

• Discovery Phase – Exchange evidence with the defendant.
• Depositions – Sworn testimonies from witnesses, experts, and involved parties.
• Settlement Talks – Many cases resolve before trial through negotiation.
• Trial – Present your case before a judge or jury if no settlement is reached.

8. Explore Alternative Compensation Options

If litigation isn’t feasible:

• Underinsured/Uninsured Motorist Coverage – File a claim under your own policy if the at-fault party lacks coverage.
• Health Insurance/Medicare – Use these to cover medical bills, though reimbursement may be required later.
• Worker’s Compensation – If injured at work, file a separate claim.

9. Document All Communications

Keep records of:

• Denial Letters – Including dates and reasons provided.
• Emails/Calls – Log conversations with adjusters, attorneys, and medical providers.
• Expenses – Track all accident-related costs (travel, prescriptions, etc.).

10. Stay Persistent and Patient

Insurance disputes can take months or years. Stay organized, follow legal advice, and avoid accepting lowball settlements out of frustration.

By systematically addressing the denial, strengthening your claim, and leveraging legal options, you can maximize your chances of securing fair compensation.