Steps to Take if the Insurance Company Denies Your Injury Claim

Insurance companies spend millions of dollars on ads designed to make them look like they are your defender and champion. But if they could, they would never pay you a dime. They operate to make money, and they make more if they refuse to pay claims.

When forced to live up to their obligations, they reluctantly will pay out. But you have to understand your full legal rights and how to effectively assert those rights to get results. 

What to Do After an Insurance Denial

The easiest way to handle a denial is to call a personal injury lawyer for guidance, because they deal with these situations all the time. When an insurance company gets contacted by an attorney, they generally know they have to start taking the claim seriously.

On your own, however, here are some steps to take to help get coverage:

  1. Study the insurance policy terms. You may have to go online or contact your insurer to get a full copy of all the rules because they will be very detailed. You need to understand exactly what is and what is not covered under your policy. If you’re dealing with workers’ compensation insurance, you may not be able to see the policy because it will be between your employer and the insurance company. Instead, take a look at your state’s workers’ compensation rules to make sure you have complied with requirements.
  2. Get a full explanation of the reason for denial. If the insurer did not provide a detailed statement explaining why they denied the claim, contact the company and request a thorough explanation. Then go through reasons in detail to determine whether they accurately reflect the situation.
  3. Get full medical records. Claims are often denied due to lack of evidence. To succeed, you will need solid medical evidence to support your claim
  4. Follow medical instructions. While you are trying to get your care covered, it is important to continue receiving follow up treatment. This protects your health and prevents a company from claiming that your medical problems are due to failure to follow doctor’s orders.
  5. Review appeal procedures. If your denial involves workers’ compensation, the state has procedures for appealing a denial, including requesting an administrative hearing. If your claim involves another type of insurance, you need to determine whether you have a breach of contract claim, a bad faith claim, or both.

Make sure that you start the process of appealing the denial within the timeframe allowed by your contract or the applicable laws. You may have only a few days to act. 

Get Help with an Insurance Denial

It is an unfortunate fact that many insurance companies will not take you seriously unless you have legal representation. To get fair treatment, you either need to serve as your own attorney, or work with an experienced personal injury lawyer.

At The Leach Firm, we fight to get our clients fair treatment for their injuries, including pain and suffering damages when appropriate. Call us today to find out how we could help.