You’ve been injured in an accident, diligently sought medical treatment, and filed your personal injury claim, expecting your insurance company or the at-fault party’s insurer to cover your damages. But then, the unexpected happens: your claim is denied, delayed, or you receive a settlement offer that barely scratches the surface of your losses. When insurance won’t pay fairly, it can feel like a dead end. However, this isn’t the end of your journey. You have options, and understanding them is crucial to protecting your rights and securing the compensation you deserve.
Why Insurance Companies Deny or Undervalue Claims
Insurance companies are businesses, and like any business, they aim to minimize their payouts. They employ various tactics to deny or reduce personal injury claims, even valid ones. Common reasons for denial or lowball offers include:
- Disputing Fault: They may try to shift blame to you or argue that their policyholder was not entirely at fault for the accident.
- Minimizing Injuries: They might claim your injuries aren’t as severe as you state, were pre-existing, or weren’t directly caused by the accident.
- Delaying Treatment: If there was a gap between the accident and your first medical visit, they may argue your injuries weren’t serious enough to warrant immediate care.
- Insufficient Evidence: They might claim you haven’t provided enough documentation to support your claim.
- Policy Exclusions: They may cite obscure clauses in the policy to deny coverage.
- Recorded Statements: If you gave a recorded statement without legal counsel, they might use it to find inconsistencies in your story.
Your Options When Your Claim Is Denied or Lowballed
Receiving a denial or an inadequate offer can be frustrating, but it’s not the final word. Here are the steps you can take:
1. Request a Written Denial Letter
If you receive a verbal denial, immediately request a formal written denial letter. This letter is crucial as it must state the specific reasons for the denial. Understanding their reasoning is the first step in formulating your counter-strategy. The denial letter often contains insurance jargon and legal terms, so it’s vital to review it carefully.
2. Review Your Policy
Thoroughly review your own insurance policy (if applicable) and, if possible, the other party’s policy. Understand what coverage limits and exclusions apply to your situation. Sometimes, a denial is due to a simple misunderstanding of policy terms or maximums.
3. Gather Additional Evidence
The denial letter might point to “insufficient evidence.” This is your cue to strengthen your case. Gather all available documentation, including:
- Comprehensive medical records, including diagnostic test results (X-rays, MRIs), treatment plans, and prognoses.
- Medical bills and receipts.
- Photos and videos of the accident scene and your injuries.
- Witness statements.
- Police reports.
- Lost wage statements from your employer.
- Any correspondence with the insurance company.
4. Initiate an Internal Appeal
Most insurance companies have an internal appeal process. You can submit a formal appeal, often with a detailed letter and additional evidence, requesting that they reconsider their decision. Follow their specific appeal procedures and deadlines meticulously. This step can sometimes resolve the issue, especially if the initial denial was based on a misunderstanding or missing information.
5. Consider Uninsured/Underinsured Motorist (UM/UIM) Coverage
If the at-fault driver has insufficient insurance or no insurance at all, your own UM/UIM policy (if you have it) might be your next recourse. This coverage is designed to protect you in such scenarios, but you would still need to file a claim with your own insurer and potentially face similar challenges.
6. File a Lawsuit (Litigation)
If direct negotiation and appeals fail, the next significant step is often to file a personal injury lawsuit against the at-fault party. This moves the dispute from the insurance company’s internal process into the court system. Filing a lawsuit signals to the insurance company that you are serious about pursuing your claim and are willing to go to trial if necessary. While most cases settle before reaching a courtroom, litigation provides the formal framework to compel discovery of evidence and potentially achieve a jury verdict.
7. Explore a "Bad Faith" Claim
In some cases, an insurance company’s refusal to pay or their unreasonable delays may constitute “bad faith.” Insurance companies have a legal duty to act in good faith and deal fairly with policyholders. Actions that might constitute bad faith include:
- Unreasonable delay in investigating or paying a claim.
- Denying a valid claim without a reasonable basis.
- Failing to properly investigate a claim.
- Misrepresenting policy terms or limits.
- Making unreasonably low settlement offers.
In some cases, an insurance company’s refusal to pay or their unreasonable delays may constitute “bad faith.” Insurance companies have a legal duty to act in good faith and deal fairly with policyholders. Actions that might constitute bad faith include:
The Indispensable Role of a Personal Injury Attorney
Navigating the complexities of insurance denials, appeals, and potential litigation is extremely challenging, especially when you are recovering from an injury. This is where an experienced personal injury attorney becomes your most valuable asset.
A skilled lawyer can:
- Decipher Denial Letters: Help you understand the specific reasons for the denial and how to counter them.
- Gather & Present Evidence: Systematically collect all necessary medical records, accident reports, expert opinions, and other evidence to build a robust case.
- Negotiate Aggressively: Leverage their experience to negotiate effectively with insurance adjusters, recognizing their tactics and advocating for the full value of your claim.
- Manage Appeals: Handle the internal appeal process efficiently and correctly.
- Initiate & Manage Litigation: If necessary, file a lawsuit and guide you through every stage of the litigation process, including discovery, depositions, mediation, and trial.
- Identify Bad Faith: Determine if the insurance company’s conduct rises to the level of bad faith and pursue additional legal action if warranted.
- Protect Your Rights: Ensure you don’t inadvertently sign away your rights or make statements that could harm your case.
At The Aref Law Firm, we have a deep understanding of insurance company tactics and a proven track record of successfully challenging unfair denials and lowball offers. We fight tirelessly for our clients to ensure they receive the full compensation they deserve for their medical bills, lost wages, pain and suffering, and other damages. Our commitment to client advocacy means we’re prepared to take your case to trial if that’s what it takes to achieve justice, as evidenced by our success in cases where initial insurance offers were woefully inadequate, leading to significantly higher recoveries for our injured clients.
Don't let an insurance company's refusal to pay dictate your recovery or your future.
If your personal injury claim has been denied or undervalued, you have options.
Contact The Aref Law Firm today for a free, no-obligation consultation. Let our experienced personal injury lawyers evaluate your situation, explain your legal options, and fight on your behalf to get the compensation you rightfully deserve.