Receiving a denied insurance claim can be frustrating and overwhelming, especially when you’ve been paying premiums for years expecting coverage in times of need. Whether your claim involves property damage, medical expenses, business losses, or auto accidents, insurance companies often deny claims to protect their profits—but that doesn’t mean their decision is final.
The good news? You have the right to challenge an insurance denial, and with the right approach, you may still be able to recover the compensation you deserve. In this guide, we’ll walk you through why insurance claims get denied, the steps you can take to fight back, and when to involve an experienced insurance lawyer.
Common Reasons Insurance Claims Get Denied
Insurance companies use a variety of tactics to deny claims, often hoping policyholders will simply give up. Some of the most common reasons include:
Lack of Sufficient Documentation
If your claim lacks proper evidence—such as photos, repair estimates, medical records, or invoices—the insurer may reject it for insufficient proof.
✔️ How to Fight Back: Gather additional documentation and resubmit your claim. If necessary, get expert reports from contractors, doctors, or specialists to support your case.
Policy Exclusions
Insurance policies often contain fine print exclusions that limit coverage. For example, standard homeowner’s policies do not cover flood damage, requiring separate flood insurance.
✔️ How to Fight Back: Review your policy carefully to determine if the exclusion was properly applied. Some exclusions are vague or misinterpreted by insurers, and an attorney can help you challenge their decision.
Late Claim Filing
Most insurance policies have strict time limits for filing claims. If you miss the deadline, your claim could be denied—even if it’s legitimate.
✔️ How to Fight Back: If the delay was due to extenuating circumstances, such as medical emergencies or disasters, submit a formal appeal explaining why you missed the deadline. An attorney can help argue for an exception.
Insurance Company Acting in Bad Faith
Some insurers unfairly deny valid claims to save money. Signs of bad faith insurance practices include:
- Denying your claim without a proper investigation
- Unreasonably delaying payments
- Offering an unreasonably low settlement
- Failing to provide a clear explanation for the denial
✔️ How to Fight Back: If you suspect bad faith, consult an insurance lawyer immediately. You may be entitled to additional compensation beyond your claim amount.
What to Do After Your Insurance Claim is Denied
If your insurance claim has been denied, don’t panic. Follow these steps to increase your chances of overturning the decision.
Review the Denial Letter Carefully
Your denial letter should outline:
✔️ The exact reason for the denial
✔️ Any policy exclusions or clauses the insurer is relying on
✔️ Steps for appealing the decision
📌 Pro Tip: If the explanation is unclear, request additional clarification in writing.
Gather Additional Evidence
If your claim was denied due to lack of documentation, gather as much supporting evidence as possible.
✔️ Photos & Videos – Capture clear images of the damage or injury
✔️ Receipts & Invoices – Provide proof of related expenses
✔️ Medical Records – If it’s a health claim, obtain doctor’s notes and test results
✔️ Expert Reports – Get written assessments from contractors, engineers, or doctors
📌 Pro Tip: Keep detailed records of all communication with your insurance company.
File an Appeal
Most insurance companies offer an appeals process where you can request a reconsideration of your claim.
Key Steps for Filing an Appeal:
✔️ Submit a written appeal letter explaining why the denial was incorrect
✔️ Include new evidence that supports your claim
✔️ Reference your policy terms to argue why your claim should be covered
✔️ Meet all deadlines—appeals often have strict time limits
📌 Pro Tip: Be clear, concise, and professional in your appeal. Avoid emotional arguments and focus on facts and policy language.
Escalate the Claim with a Formal Complaint
If your appeal is ignored or denied unfairly, escalate the matter by filing a formal complaint with:
✔️ Your state’s Department of Insurance
✔️ The Better Business Bureau (BBB)
✔️ The National Association of Insurance Commissioners (NAIC)
📌 Pro Tip: Insurance companies do not like regulatory complaints—sometimes, just the threat of a complaint can lead to a reconsideration of your claim.
Consult an Insurance Attorney
If your claim is still denied after an appeal, or if you suspect bad faith, it’s time to bring in legal help.
💼 How an Insurance Lawyer Can Help:
✔️ Review your policy for coverage loopholes
✔️ Negotiate with the insurance company for a fair settlement
✔️ File a lawsuit if necessary to force the insurer to pay
✔️ Prove bad faith practices and pursue extra damages if applicable
📌 Pro Tip: Many insurance attorneys work on a contingency fee basis, meaning you only pay if they win your case—so there’s no risk in seeking legal help.
When to Consider Legal Action Against Your Insurance Company
If your insurer is refusing to pay a legitimate claim, delaying payments unnecessarily, or acting in bad faith, you may have grounds for a lawsuit.
Signs It’s Time to Sue Your Insurance Company:
❌ Your claim was denied without a valid explanation
❌ The insurer is unresponsive or keeps delaying payments
❌ You were pressured into accepting a lowball settlement
❌ The insurance company misrepresented your policy coverage
❌ The insurer failed to properly investigate your claim
📌 Pro Tip: Before filing a lawsuit, have an insurance attorney send a demand letter—this often results in a settlement without the need for a court case.
Final Thoughts: Fight for the Compensation You Deserve
A denied insurance claim is not the end of the road. By understanding your rights, gathering strong evidence, and appealing the decision, you can fight back and recover the compensation you’re owed.
🔹 Need help challenging a denied claim?
At SJJ Law, we specialize in helping policyholders fight wrongful denials, negotiate settlements, and hold insurers accountable for bad faith practices.
📞 Contact us today for a FREE consultation and take the first step toward getting the coverage you deserve.