What Happens When Insurance Denies Your Injury Claim?

Insurance Denials: More Common Than You Might Think

Receiving an insurance denial letter after an accident is frustrating and frightening — but it is not necessarily the end of your claim. Insurance companies deny claims for a wide range of reasons, some legitimate and some not. Understanding why your claim was denied and what options you have is the critical first step.

Common Reasons Insurance Companies Deny Claims

Disputed Liability

The insurer may deny your claim because they contest that their policyholder was at fault. This is particularly common in accidents without clear evidence of fault — no police report, no witnesses, no video footage.

Coverage Denial

The insurer may claim that the specific accident or injury is not covered under the policy. Common coverage arguments include: the accident occurred outside the policy period, the driver was excluded under the policy, or the vehicle was being used for commercial purposes not covered by a personal policy.

Late Reporting

Most policies require prompt reporting of accidents. If you delayed reporting beyond the required timeframe, the insurer may deny coverage on that basis.

Alleged Pre-Existing Condition

The insurer may claim that your injuries are pre-existing rather than caused by the accident. This is a common strategy to minimize or deny payment for claimed medical expenses.

Failure to Seek Medical Treatment

If you didn't seek medical treatment promptly, insurers sometimes argue there is no evidence that you were injured in the accident.

Statement or Evidence Issues

If you gave a recorded statement that contradicts your current claim, or if your social media activity appears inconsistent with your claimed injuries, the insurer may deny or reduce your claim on that basis.

What to Do When Your Claim Is Denied

Step 1: Request the Denial in Writing

If you received a verbal denial, demand a written explanation stating the specific reason for the denial and the policy provision relied upon. This creates a documented record and helps you identify the exact basis for the denial.

Step 2: Review Your Policy

Read the specific policy provisions cited in the denial letter. Sometimes denials are based on a misinterpretation or misapplication of policy language. An attorney can help you analyze whether the denial is legally justified.

Step 3: File a Formal Appeal

Most insurers have an internal appeals process. Request a formal review of the denial by a different adjuster or supervisor, and submit additional evidence supporting your claim — medical records, photographs, police reports, witness statements.

Step 4: File a Complaint with Your State Insurance Commissioner

Every state has an insurance regulatory authority that oversees insurer conduct. Filing a complaint can prompt a regulatory review of the denial and sometimes results in reversal. Insurers take regulatory complaints seriously.

Step 5: Consider Legal Action

If an insurer wrongfully denies a valid claim, you may have the right to sue for bad faith — a legal claim that holds insurers accountable for unreasonable claims handling. In many states, bad faith claims can result in damages beyond the policy limits, plus attorney fees.

If your claim was denied, check your eligibility for legal assistance here.

Frequently Asked Questions

How long do I have to appeal a denied insurance claim?

Deadlines for appealing denials vary by state and policy. Don't wait — contact an attorney immediately after receiving a denial to protect your rights and ensure you don't miss any critical deadlines.

What is insurance bad faith?

Bad faith is a legal claim against an insurer that unreasonably denies, delays, or underpays a valid claim. Remedies for bad faith vary by state but can include compensatory damages, punitive damages, and attorney fees.