What You Can Do If Insurance Denies Your Claim

Accident Injury Insurance Claim Denied?

Yes, you can fight back when insurance denies a legitimate claim.

After your claim is denied, the insurance company sends a denial letter or email explaining their decision.

That denial may constitute bad faith if the insurer failed to investigate properly, misrepresented policy terms, acted unfairly or denied a legitimate claim without valid reason.

Don't accept their denial without review.

An attorney can review your denial and may be able to file a bad faith lawsuit to seek your damages plus additional compensation for the insurer's misconduct.

Schedule a consultation with our attorneys at Lawsuit Legal if you feel the insurers failed in their duty to act honestly and fairly in handling your claim.

What Counts as Bad Faith Insurance Denial?

Bad faith occurs when your insurer denies a valid claim without legitimate justification or fails to conduct a reasonable investigation.

State laws require insurers to investigate promptly, communicate decisions clearly, and pay valid claims without unreasonable delay.

Unfair practices such as underpaying or denying legitimate claims violate these legal duties and create grounds for bad faith lawsuits.

Denying Claims Without Valid Explanation

Insurance companies must provide specific reasons for denials.

Rejecting your claim without explanation or with invalid reasoning violates their duty of good faith and fair dealing.

Conducting Inadequate Investigations

Insurers must investigate claims promptly and thoroughly. Delayed investigations or failure to review medical records, accident reports, and witness statements constitute bad faith.

Delaying Payment on Approved Claims

Once your claim is approved, payment must occur within reasonable timeframes. Unreasonable delays violate state laws requiring prompt payment.

Offering Settlements Below Claim Value

Low-ball settlement offers are common, but refusing to negotiate fairly when evidence supports higher value demonstrates bad faith conduct.

Refusing to Pay Valid Covered Claims

Denying claims clearly covered under policy terms, especially when liability and damages are well-documented, constitutes bad faith denial.

Making Threatening Statements

Insurance companies must treat claimants professionally. Bullying, threats or intimidation tactics violate standards of good faith and fair dealing.

Misrepresenting Policy Terms or Law

Intentionally misinterpreting policy language or misrepresenting applicable laws to deny claims is bad faith. Insurers must communicate honestly about coverage and legal obligations. Insurers must follow state-specific laws governing claim handling timelines, investigation requirements, and payment obligations.

Our attorneys can help you identify bad faith conduct and hold insurers accountable for wrongful denials.

 

 

Why Insurance Companies Deny Valid Claims

Insurance companies maintain internal policies that encourage denying valid claims.

When you're injured in an auto accident or suffer serious personal injury, insurers start working immediately to reduce what they have to pay.

The law typically requires the party or parties to treat each other honestly, fairly, and in good faith, so as to not prevent the other party or parties from receiving the benefits of the contract.

The insurers don't always play fairly.

Insurance companies that violate this duty can be held liable in court for their bad faith acts.

When insurers fail to honor their contractual obligations, you can sue for bad faith and potentially recover damages beyond your original policy limits.

Potential Reasons for a Denied Insurance Claim

Insurance companies cite specific reasons when denying claims.

Some denials are legitimate, but many valid claims get rejected based on flawed reasoning or bad faith practices.

Common reasons insurers deny accident injury claims:

• Policy coverage exclusions claimed to apply to your accident type
• Alleged lapsed coverage due to missed payments or policy cancellation
• Pre-existing medical conditions blamed for your current injuries
• Treatment gaps between accident date and medical care
• Medical necessity disputes questioning your doctor's prescribed treatment
• Insufficient medical documentation or objective injury evidence
• Comparative negligence alleging you share fault for the accident
• Incomplete claim forms or missing documentation

Review your denial letter with an experienced attorney to evaluate the validity of the insurer's reasoning and explore your legal options.

Your Legal Options After Insurance Denial

When insurance companies violate their contractual duty to handle claims fairly, you can file a bad faith lawsuit.

Bad faith lawsuits allow you to recover your original claim damages plus additional compensation for the insurer's wrongful conduct.

Proving Bad Faith in a Bad Faith Insurance Claim

To establish bad faith, you must demonstrate that the insurance company's actions and the surrounding circumstances show they violated their duty to act honestly and fairly in handling your claim.

If you suspect your claim is not being handled fairly and honestly, document all correspondence with the insurance company and speak to one of our lawyers.