Imagine you’ve just been seriously injured in a car accident. You file an insurance claim, and because the other driver was clearly at fault, you feel confident that you’ll receive a reasonable settlement offer that will at least cover your medical expenses. However, instead of a settlement offer, you receive a denial letter. It’s easy to panic in this situation, but after an insurance claim denial, you have options — and an initial denial doesn’t mean you have no hope of receiving any compensation. Here’s what to do after you have a personal injury claim denied.
Having your personal injury claim denied can be frustrating and frightening, especially if you’re unable to work or struggling to pay medical bills after your accident. After a claim denial, the best thing you can do for yourself is to consult a personal injury attorney.
Common Reasons for Personal Injury Insurance Claim Denials
If you see that your claim for a car accident injury or other serious injury has been denied, the first thing you should do is review the denial letter to find out why. These are some of the most common reasons an insurer may deny your claim:
Policy Exclusions
Sometimes, an insurance company might deny your claim because it falls under a policy exclusion. For example, if the driver who injured you was driving someone else’s car without permission, their insurance policy might state that the insurer does not pay for any injuries they cause.
Delay in Medical Treatment
If you didn’t seek medical treatment immediately after an injury, the insurance company might say you aren’t hurt as badly as you claim to be.
Pre-Existing Condition
If you have a pre-existing medical condition related to your injury, the insurer might claim that your injury was a result of that condition.
Lack of Evidence
Insurers may deny claims if they think you haven’t proven the severity of your injuries or the fact that the insured person caused your injuries.
Coverage Lapses
If the insured person had fallen behind on premiums at the time of your injury, the insurer might say it isn’t responsible for paying your claim.
What to Do in the Event of a Denied Claim
You Have More Options Than You May Realize
If the insurance company denies your claim, you have several options:
- Contacting the insurer to discuss the denial
- Sending more evidence in support of your claim
- Filing an appeal with the insurance company
- Filing a complaint with the Pennsylvania Department of Insurance
- Filing a lawsuit.
Technically, you can take these steps yourself. However, to maximize your chances of a favorable outcome, you should talk to a personal injury attorney as soon as you can. Personal injury lawyers are well aware of the tactics insurance companies use to deny even legitimate claims — and insurance companies know that.
If an insurer knows you have legal representation, it has an incentive to offer you a reasonable settlement to avoid a lawsuit and a possible civil trial. Here’s a look at how a lawyer can help you through each option listed above.
Has an insurance company denied your claim? Call Wapner Newman at (800) 529-6600 for a free consultation.
Contacting the Insurer to Discuss the Denial
Sometimes, insurance companies use deliberately convoluted language to convince injured people that their injuries are excluded from a policy. Unfortunately, most people (understandably) think that insurance companies know what they’re talking about, so they don’t push the issue.
However, a skilled lawyer can spot a bad faith denial immediately. In some instances, a lawyer may be able to discuss your situation with the insurance company and convince them to offer you a settlement — then you won’t have to file a lawsuit.
Sending More Evidence in Support of Your Claim
Depending on how much evidence the insurance company needs, you may be able to send the needed evidence without having to file an appeal. For example, if you’ve already sent over your medical records but the insurer says the injury was not related to the accident, you might be able to send a statement from your doctor explaining how the accident directly caused your injuries. If you’re working with a lawyer, your attorney can help you decide what evidence to send to strengthen your case.
Filing an Appeal With the Insurance Company
Each insurance company has its own appeals process and related deadlines. These should be outlined in the denial letter. If you’re planning to file an appeal, having an experienced attorney to represent you is critically important. Personal injury lawyers understand what types of evidence tend to be most effective when you file an appeal.
Filing a Complaint With the Pennsylvania Department of Insurance
The Pennsylvania Department of Insurance (PDI) investigates claims against insurance companies. In some cases, it may even order insurance companies to reverse decisions. You can file a complaint online and track its progress.
Filing a Lawsuit
Sometimes, nothing short of a lawsuit will prompt an insurance company to reconsider a decision. If you do pursue legal action, you should do so with the help of a personal injury attorney. A lawyer can provide vital help and guidance at each stage of the lawsuit process. If it becomes necessary to sue the insurer, your attorney can do the following:
- Gather necessary evidence
- File the lawsuit on time and with the appropriate court
- Attempt to negotiate a reasonable settlement
- Take the case to trial if needed.
The overwhelming majority of personal injury lawsuits settle out of court. However, if the case does go to trial, a judge (and often a jury) will decide whether the insurance company owes you compensation.
Has Your Personal Injury Insurance Claim Been Denied?
Don’t Accept a Denial Without a Fight. Call Us!
The Wapner Newman team has spent decades fighting for justice for injured people. We’ve seen firsthand how unscrupulous insurance companies often deny legitimate claims to boost their profits, and we’re committed to advocating for you to receive the compensation you deserve.
If your claim has been denied, don’t delay — call us at (800) 529-6600 to get started with a free consultation.