When The Insurance Company Won't Pay Your Claim, Here's What to Do in Four Easy Steps

denied insurance claim

 

After you've been paying monthly premiums for years, car insurance denial can be angering and costly. Similarly, if you've been hit by another driver and their insurance company isn't cooperating, it can lead to stress and frustration. But you don't have to accept the insurance company's verdict. 

As a Dallas-Fort Worth car accident attorney, I can tell you that insurance claims are denied all the time. It's in an auto insurance company's best interest to deny (or undervalue) as many claims as possible - the less money they pay out, the more profit they make. This doesn't mean they're dishonest, but it does mean they're strict. Sometimes, more strict than is fair or necessary. 

So how do you fight the insurance company when they deny your claim? 

1)  Figure Out Why Your Insurance Claim Was Denied

It's very important that you understand why the insurance adjuster denied your claim before you go about fighting it. Sometimes, the denied claim was simply a mistake. Insurers deal with hundreds of claims every day, and it's possible you're actually covered for the accident even if the insurance company said you weren't. 

Mistakes aside, there are a few common reasons insurance claims are denied (many of which can be appealed). Here are a few examples. 

When Making a Claim Against Your Own Insurance Policy

  • You don't have appropriate coverage for the kind of wreck you were in. For example, maybe you only carry liability insurance but don't have any collision coverage. In this case, your insurance company denied your claim correctly. 
  • You made a claim using your Uninsured Motorist Coverage, but it turns out the other driver had insurance after all. 
  • You tried to make a claim using a policy that didn't include your name. For instance, a teenager who is not listed on their parent's policy. 
  • You bought a new car but didn't tell your insurance company to add it to your policy. 
  • If the damage from the car accident exceeds your policy limits, the insurance company won't cover the difference. 

When Making a Claim Against the Other (At-Fault) Driver's Insurance Policy

  • The insurance company thinks YOU are at-fault for the accident. (You can fight this with evidence or an attorney). 
  • You waited too long to seek treatment after the wreck. When this happens, the insurance company might argue that you "weren't that hurt" or that your injuries weren't from the accident, and they'll refuse to pay your bills.
  • You don't have enough evidence to prove that the other driver caused the wreck. 
  • You have a pre-existing medical condition or you got procedures that the insurance adjuster deems "unnecessary." (These are two of their most ridiculous arguments insurance companies make. If they denied your claim on these grounds, you should absolutely fight it). 

As you can see, some arguments are valid while others are absurd. If after figuring out why your claim was denied you still think the insurance adjuster is in the wrong, there are several steps you can take to appeal a denied insurance claim. 

I want to stress - if your claim was wrongly denied by the insurance company, you should absolutely fight it. Insurance adjusters aren't going to give you a fair offer unless you fight for it. If you've been in an accident, you shouldn't have to front the costs on your own. 

2) Gather Your Evidence

This part's very important. If you're going to appeal an insurer's decision, you'll need to gather evidence that proves your side of the story and shows why they should give you a fair offer. Pictures from the scene of the accident, prescriptions ordered by your doctor, witness testimonies, medical history records - these can all by used to make your case. 

If you've been hit by another driver and their insurance company is denying your claim, I've written a helpful article about why gathering evidence is so important. You can find it here:

Why It's So Important to Document Your Claim

In addition to gathering evidence, you need to stay organized. The insurance company does this for a living, and they have software that allows them to easily keep track of your claim, your history and your appeals. You have to keep your facts and evidence just as organized to stay on top of any details that could make a difference. 

Here's another tip - get the name and reference number of every claim adjuster you talk to. That way, when you call back you can quickly refer to that person and keep your conversations straight. 

3) Appeal Your Denied Insurance Claim 

Appeals can be made directly through your insurance company. When you make the appeal, be sure to include all the relevant evidence you gathered from step two. The best evidence is the kind that directly contradict's the insurance company's reason for denying your claim. 

If your claim is denied a second time, you can take it to the "higher ups." In Texas, we have something called the Texas Department of Insurance that's responsible for investigating complaints, and they can help you with a denied claim. 

Learn more about the Texas Department of Insurance.

4) Talk to a Car Wreck Attorney

Sometimes you need a professional's help. One of the main reasons clients come to me is because the other driver's insurance company denied their claim or gave them a low, unfair offer. Especially if my client has been seriously hurt in the wreck, they don't want to risk losing their claim. 

When you hire an attorney, they take over your case for you. They'll fight the insurance company on your behalf, gather evidence, subpoena records and even take the case to trial if they must. Having an attorney on your side "evens the playing grounds," so to speak. Just like insurance adjusters, personal injury attorneys do this for a living. 

At the Anderson Law Firm, I offer free, no obligation consultations to anyone in the Dallas-Fort Worth area who's been hurt in an accident and is having trouble with the insurance company. Similarly, I work on a no win, no fee basis, meaning if I don't get your insurance denial reversed, you don't owe me a dime. 

If you're frustrated with the insurance company and you need help, call me at 817-294-1900. 

Other Articles You Might Be Interested In:
Insurance Company Goal No. 1: Pay You as Little Money as Possible 
Insurance Company Goal No. 2: Delay the Claim As Long As Possible     
The Legal Process Explained  
How to Investigate Your Texas Motor Vehicle Accident 
Why We Do Not Represent Sue-Happy People