Your personal injury claim can mean the difference between recovering from your accident with minimal undue stress or adding to your problems in substantial and life-changing ways.
This is because your insurance payout isn’t just a consolation prize for getting hurt or losing your property due to damage. It’s meant to take care of your medical bills, cover your house payment while you’re unable to work, or get your car back on the road so you can keep earning a living. Without the funds to do those things, your life can fall apart very quickly at no fault of your own.
Unfortunately, the insurance company isn’t incentivized to actually pay you when you make a claim. Its business model simply doesn’t work like that. So, it strives to deny your claim and keep all the money it has made off of your monthly payments.
When that denial notice comes in, it can be heartbreaking. Today, we’re going to teach you how to get over that setback and fight to get what you deserve.
Let’s get started.
1. Formally Request a Written Explanation
The insurance company doesn’t get to simply say that your claim is denied and move on without you having any power to do anything. They are required by law to be cooperative and facilitate a proper appeals process.
The first step of that process is to contact the insurance company immediately and formally request a written explanation.
The key part of that is that the explanation needs to be written. Don’t call in, speak to a representative, get a quick recap of why they think you were denied, and then try to take action.
You want the explanation in written form for a couple of reasons.
First, that provides a document that you can present if you have to take things beyond the insurance company. You can’t get a phone conversation transcript in a practical manner, and you certainly can’t expect a judge to consider your account of an in-person verbal explanation. When they write their explanation down, they can’t deny what they said the reasoning was or try to change it to something else, later.
This also forces the insurance company to prove they have a reason. Like we said, an insurance company can’t just deny your claim because they don’t want to pay. They have to have a reason that fits the policy and provable factors in the specific case. While it’s easy to create a denial notice without proof of a reason, writing a formal explanation requires details and provable reasoning.
2. File for an Appeal
If you receive the written explanation in a timely manner, the next step is technically to determine if the reasoning is legitimate or something that you can easily fix.
For example, they might quote a lack of documentation because you failed to send it. That’s simple to fix, because you can simply get the documentation they require and refile your claim. They might also have a legitimate reason to deny your claim such as the event not being covered by your insurance policy. In that event, you’re out of luck.
However, unless your denial explanation clearly states that your personal injury isn’t eligible per the policy you have, it’s time to file an appeal and have the decision looked at a second time.
At this stage, you’re still working with the insurance company. Follow your insurance provider’s appeal process, and if the reason was something you can fix, make sure to do that while you make your appeal.
3. Call a Personal Injury Lawyer
If you know your personal injury is covered by your policy and you’ve filed everything correctly, and you still get a second denial, it’s no longer a matter that you need to stick with the company for. Instead, it’s time to get the law involved.
Your first step at this point is to call a personal injury lawyer who works with insurance claim denials.
The lawyer is going to go through their own process to make sure you get what you deserve.
1. Collect All Documentation and Evidence
The first thing your lawyer is going to do is gather all the relevant documentation, evidence, and your side of the story. Essentially, they’re building a case to bring to the insurance company, and if that doesn’t work, they’ll bring it to the court.
2. Confront the Insurance Company
Once your lawyer is prepared, they’ll do a lot of what you just did, but they have an advantage. A lawyer works with insurance companies on practically every case they handle. They know what the insurance company is doing, and they know how to counter them professionally and with far more leverage than you have.
In some cases, this might be enough to get your claim processed and approved. Especially if the insurance company has a weak reason for denying you.
3. Proceed to Take Legal Action
In some cases, even lawyers can’t get stubborn insurance companies to give you what they owe you, and the only option is to take the case to court. This is the least optimal path to take, but at a certain point, it’s all you can do except for give up.
Luckily, your lawyer is prepared to convince the court that you deserve your payout, and while it might be stressful, you’re one step closer to getting what you deserve.
Throughout this process, your lawyer is likely going to demand the full value of your claim. However, it’s common to end up settling for a slightly lower amount to end the process faster and let everyone move on.
This is critical to point out because if it does come down to a settlement, your lawyer will help ensure that it’s fair and doesn’t sacrifice too much of what you’re owed.
Fight Your Personal Injury Claim Denial with DeSalvo Law
When your personal injury claim is denied, it can feel like an uphill battle. At The Law Office of Scott D. DeSalvo, we specialize in helping clients navigate the appeal process and fight for the compensation they deserve. Whether you’re dealing with a slip and fall injury, work injury, or dog bite case, our team has the expertise to handle complex claims and insurance disputes.
Our team is experienced in handling denied personal injury claims, appeals, and legal actions involving insurance disputes. We understand the strategies insurance companies use to deny claims and know how to counter them effectively. From gathering evidence to confronting insurers and pursuing court action when necessary, DeSalvo Law is committed to protecting your rights.
Don’t let a denied claim derail your recovery. Contact us today to get the legal support you need to turn your denied claim into a successful outcome.
