What Should You Do if the Insurance Company Denies Your Claim After an Injury?

Almost nothing in life is more frustrating than having suffered an injury and finding yourself facing an insurance company that’s denying your claim for compensation. When that happens, contacting an injury lawyer quickly can make a big difference. Here are some other suggestions about what to do if you find yourself in this situation.

What Should You Do if the Insurance Company Denies Your Claim After an Injury?

1. Get an Injury Lawyer

Getting an injury lawyer is a smart move for a couple of reasons. For one thing, it’s not unheard of for insurance companies to just deny claims outright in the hopes that lay persons who don’t really know their rights will just “go away.” Insurance companies may also employ this tactic as a way of discouraging you. They hope that you will see your request as unreasonable and then be willing to accept a much smaller settlement in negotiation.

A lawyer protects you from tactics like this and also signals to the insurance company that you’re serious and you know what your rights are. Sometimes just getting a lawyer at all is enough to push the insurance company to come to the bargaining table, since the presence of a lawyer signals that you are willing to go to court if necessary to hold them accountable.

And even if the issue is not some kind of underhanded behavior on the type of the insurance company, having a lawyer can make a big difference. Your lawyer can help you to better understand the terms of the policy as well as all the insider jargon of the insurance industry so that you better understand why you were denied coverage and what to do next.

2. Figure Out the Reason Behind the Denial

An insurance company is supposed to give you a reason if they deny your claim, and this usually comes in the form of a letter. If you haven’t received any explanation for the denial, talk to your lawyer, who will reach out. If you have, you and your lawyer should go through the letter very carefully to fully understand its details.

In some cases, the denial can easily be fixed by simply providing more information that you may have neglected to send the first time or by correcting a mistake they have made. But even if you think the insurance company is completely incorrect, you can’t move forward unless you have a very clear idea of their position.

3. Review the Insurance Policy

Once you and your lawyer have understood the denial letter, the next thing to do is to compare it to your insurance policy. You’ll want to know all the terms of the policy, the conditions that have been placed on reimbursement, and also any coverage limits. These policies can be so complicated that sometimes even the adjusters don’t fully understand the terms of each individual’s policy, and you and your lawyer may uncover some points that support your position.

In addition, it is possible that a certain point may be open to more than one interpretation, and your lawyer will be able to show that to the insurance company and bring them to the bargaining table.

4. Gather and Organize Evidence

Once you know exactly why your claim has been denied, you’ll be in a place to gather any additional evidence that you need to show why you are right and your claim needs to be honored. You might be looking at gathering medical records, finding photos of the accident scene, providing more witness statements, showing proof of your losses, and even providing any previous correspondence that you’ve had with the insurer. Essentially, you have to show that your injuries are real, that the other party caused them, and that the insurer is responsible to cover that the other party.

Your lawyer can help you to organize all this evidence so that it’s easy to present if the dispute continues. Your lawyer will also become familiar with it so that they can make a compelling case using it.

5. Reach Out to the Adjuster 

At this point, you may want to reach out to the insurance adjuster again, and it’s highly advisable to do this with your lawyer. It’s critical to have a calm and reasoned conversation here. Remember that you always catch more flies with honey than with vinegar!

The goal is to politely, professionally, and yet firmly present the new information that you’ve gathered and point out sections of the policy that support your position. Under no circumstances do you want to deliberately accuse the adjuster of treating you dishonestly at this stage, which can be difficult if you’re feeling frustrated. This makes it a good idea to let your lawyer handle most of it.

If the adjuster refuses to reconsider, do not give up. This denial does not have to be the end of the road. It only means that you may need to try a different approach. Sometimes, insurance companies will reject claims to test whether a claimant is willing to push back. Showing that you are prepared to stand up for yourself can make a difference.

6. File a Complaint With the Missouri Department of Insurance

If your discussions with the insurance company are not resolving your problem, you can consider filing a complaint with the Missouri Department of Insurance. Missouri does have certain requirements and rules that insurance companies have to follow, and once you file a complaint, the DOI will review the matter to see if they believe the insurer has acted appropriately. This does not guarantee that you’re going to get the outcome that you want, but in many cases it does put pressure on the insurer to reconsider and can get them to come to the bargaining table in good faith. Just knowing that the government agency is looking over their shoulder can sometimes encourage them to do the right thing.

It’s important that you present your complaint in a way that the MDI will find compelling. Your lawyer will help you to do so by gathering all the evidence, communicating with the insurer, and writing a clear explanation of what happened and an argument for why the insurer’s decision is not supported by the facts.

7. Bring a Lawsuit

If you have tried everything else and not been successful, filing a lawsuit might be the only remaining option. Under Missouri law, you have the right to bring a legal action against the insurer if they are not honoring the terms of the policy, and when you file a lawsuit, you’re putting the matter in front of a judge or jury who can review all the evidence.

Most claims are settled out of court, so this is a less common path and can take longer and be more expensive than negotiations, but it does allow you to force the insurer to explain their denial and produce any evidence they’re relying upon.

Just remember that you have to follow all laws, as well as the rules of the court, when you bring a lawsuit. This will include keeping to all the deadlines, sharing evidence as required, and providing whatever testimony the court requires. This is where having a lawyer will be most valuable of all.

If you’re struggling with an insurance claim denial, contact the Wendt Law Firm P.C.
for help in Kansas City and throughout Kansas, Missouri, Nebraska, Iowa, and the Midwest.