What Happens If the Insurance Company Denies Your Injury Claim
What Happens If the Insurance Company Denies Your Injury Claim
If an insurance company declines your injury claim, it implies they won’t pay for your damages right now. That denial may really hurt, especially when you already have to pay for medical bills, miss work, and live with pain that won’t go away. But the truth is that a denial isn’t necessarily the end of the road. In many cases, this is merely the start of a new phase that requires you to be persistent, keep accurate records, and understand your rights.
You’re not the only one who has ever thought, “what happens if I’m submitting a claim to insurance and they say no? Many people face this moment of frustration and confusion. Maybe the adjuster says there’s “insufficient evidence.” Maybe they argue your injury isn’t covered. Whatever the reason, understanding what happens next can help you stay calm—and take the right steps forward.
Table of contents
Why Insurance Companies Deny Injury Claims
Insurance companies deny claims for many reasons, and not all of them are fair. Sometimes it’s a paperwork issue. Other times, it’s about money. Their goal is to protect profits, and your claim is part of that equation.
Here are the most common reasons for denial:
- Lack of evidence – If there’s not enough proof linking your injury to the accident, they may deny it. Medical records, photos, and witness statements matter.
- Pre-existing conditions – They might argue your injury wasn’t caused by the accident but by something you already had.
- Missed deadlines – Every policy has time limits. Miss a reporting or filing deadline, and your claim could be void.
- Policy exclusions – Some injuries or situations aren’t covered under your plan. Reading the fine print early helps.
- Disputed fault – In car accidents or liability claims, the insurer might argue that you were partly or fully to blame.
Under state insurance laws (like California Insurance Code §790.03 or similar “unfair claims practices” acts in many states), companies must handle claims reasonably and investigate thoroughly. But “fair” doesn’t always feel fair when your claim gets tossed aside.
What to Do Right After a Denial
Take a breath. Then take action. A denial letter isn’t the end of your claim—it’s a document full of clues.
1. Read the denial letter carefully
It explains why they denied the claim. Look for specific terms like “coverage exclusion” or “insufficient documentation.”
2. Gather your paperwork
Collect medical reports, bills, police reports, and any emails or letters from the insurer. These documents will matter later.
3. Request your claim file
Under laws like the Health Insurance Portability and Accountability Act (HIPAA) or your state’s insurance code, you can often request copies of what the insurer used to make its decision.
4. Talk to your doctor
Sometimes, medical notes require more detail to establish a direct connection between your injury and the accident. Ask your doctor to clarify or update the report if needed.
5. File an appeal
Every insurance policy outlines the process for appealing. Deadlines vary, with some as short as 30 or 60 days. Missing that window can result in the loss of your right to appeal.
Key Takeaways
- A denial is not final.
- You have the right to appeal and request your claim file.
- Laws protect you from unfair claim practices.
- Evidence and documentation increase your chances of approval.
- Staying organized and persistent keeps the process moving.
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