What to Do If an Insurance Adjuster Denies Your Injury Claim

Having your injury claim denied is frustrating, but it can derail your finances and emotional wellbeing. When you can’t work for a while because of your injury, your household bills pile up alongside those massive medical bills you don’t know how you’re going to pay.
Getting denied is common. Each year, around 12.5% of all insurance complaints are related to denied claims. It’s no secret that insurance companies protect their profits by denying as many claims as possible. They’re hoping you’ll just accept your fate and move on with your life. But don’t just sit back and take it. Fight your denied claim, even if it’s only a partial devaluation. 

1. Talk to a personal injury attorney

The insurance company is counting on you to do nothing, so contact an injury attorney as soon as possible to find out if your claim actually has merit. A lawyer will review your situation to determine whether or not the insurance company is correct in denying your claim. If they’re in the wrong, or acting in bad faith, your attorney will help you get compensated through the legal system.
Fighting a denied claim is logistically over most people’s heads, and that’s why you shouldn’t attempt it alone. An attorney will know exactly how to handle the insurance company and their lawyers to get you compensated with the full value of your claim. 

2. Review the denial letter and your policy

The denial letter you were given will tell you everything you need to know about how the insurance adjuster views your claim. It will outline the reason your claim was rejected, which can give you leverage in fighting it. For example, maybe they claim you had a pre-existing condition, insufficient medical documentation, or a lack of coverage. Once you identify the reason for the denial, you can verify its accuracy.
Some denials can’t be overcome, such as filing your claim after your state’s required deadline or not having the correct coverage. However, insufficient medical documentation can be overcome, and so can claims of a pre-existing condition, provided you have a lawyer on your side. There’s no guarantee you’ll win your appeal, but insurance companies are notorious for getting people to make recorded statements that suggest their injury was from a pre-existing condition even when it’s not. Talk to an attorney, and they’ll tell you if your rejected claim is worth fighting. 

3. Gather stronger evidence

If you’re going to appeal a denied claim, you’ll need as much evidence as possible. Whatever you provided the first time wasn’t enough, so this time around, be thorough. Obtain a copy of your medical records from every provider you’ve seen. Get copies of imaging results, charts, test results, lab results, and physician notes. Ask your treating physicians for a written statement that links your injury to the accident. And document how the injury affected your ability to work. For instance, maybe you had to take unpaid time off, or you’re now permanently disabled and can’t work in the same field.
If possible, gather witness statements from anyone who can confirm the accident and your injuries. Don’t leave any room for the insurance company to argue about whether or not your injury is documented. 

4. Follow the proper appeal protocol

Refer to your denial letter or policy to find out how the appeals process works and follow it to the letter. Stick to all deadlines and paperwork requirements outlined in the appeals process. If you don’t know how to write an effective demand letter, hire an attorney. Your letter needs to outline your losses and reference policies that make you eligible for compensation, and that’s routine for injury attorneys. A professionally crafted appeal is more likely to result in approval. 

5. Escalate a denied appeal

If your appeal is also denied, don’t stop there. Escalate your claim to the next step, whether it’s appealing through a higher internal process or filing a complaint with an external regulator like your state’s Insurance Department. If your claim was unfairly denied or was denied in bad faith, ask them to launch an investigation on your behalf. 

Fight your denied claim

Getting a denial letter from an insurance adjuster can feel like the end, but it’s not. With solid documentation, persistence, and the help of a good lawyer, you can challenge the decision through a formal appeal and get the compensation you deserve.