The Short Answer:
If your insurance claim is denied, start by reading the denial letter to find out why. You may be able to fix the problem by giving more information or correcting an error. If that doesn’t work, you can file an appeal, ask for an external review, or get legal help from Jim Glaser Law. Most importantly, do not give up—you may still have options for getting the money you’re potentially owed.
Key Takeaways
- An insurance denial doesn’t always mean the end of your claim.
- You should always read the denial letter first.
- You may have the right to appeal or request a third-party review.
- Collecting more evidence may help change the outcome.
- You can ask your state’s insurance department for help if needed.
- A lawyer may be able to help you fight back against a wrongful denial.
Why Insurance Claims Get Denied
Insurance companies deny claims for a wide range of reasons. Some are procedural, like missing a deadline, while others are based on policy language, errors, or lack of information. Knowing why claims get denied can help you avoid common mistakes and respond more effectively if your claim is rejected.
Missed Deadlines
Every insurance policy includes strict deadlines for filing claims, submitting supporting documents, or appealing a denial. If you miss even 1 of these deadlines, your claim can be denied automatically, regardless of its validity. Always check the timeline in your policy and act quickly after an incident.
Not Enough Evidence
Your claim needs to be supported by solid documentation. For injury claims, this may include medical records, accident reports, or witness statements. For property damage, you may need repair estimates, photos, or expert assessments. If the insurance company doesn’t believe there’s enough proof to support your claim, they may reject it.
Policy Exclusions
Most insurance policies contain exclusions. Exclusions are specific situations or types of damage that are not covered. For example, some auto insurance policies won’t cover damage caused by racing, or a health plan might not cover experimental treatments. If the reason for your claim falls under one of these exclusions, it can be denied.
Lapsed Coverage
If your premium payments weren’t up to date or your policy expired before the incident occurred, your insurance company may deny your claim due to lapsed coverage. Always keep your policy active and confirm your coverage was in effect at the time of the event.
Mistakes on the Form
Small errors on your claim forms (incorrect dates, missing signatures, wrong policy numbers) can lead to delays or outright denials. Double-check every form before you submit it. If your claim was denied due to a mistake, correcting the error might be all it takes to get it reconsidered.
Pre-Existing Condition (Health Insurance)
In health insurance, claims can be denied if the insurance company believes the treatment relates to a condition that existed before your coverage began. While laws like the Affordable Care Act limit how insurers can use pre-existing conditions to deny coverage, this issue can still arise, especially with short-term or limited-benefit plans.
Cause of Damage Not Covered (Home or Auto Insurance)
Even if your damage is real and well-documented, your claim can be denied if the cause of the damage isn’t included in your policy. For example, standard homeowners insurance might not cover flooding, and auto insurance might not pay for wear and tear or mechanical failure.
What to Do If Your Insurance Claim Is Denied
1. Contact a Lawyer
Before doing anything else, reach out to an experienced insurance attorney. A lawyer can review your denial letter, identify any red flags, and help you understand your options under the law.
At Jim Glaser Law, we offer free case reviews and only get paid if we recover money for you. Starting with legal guidance ensures you don’t make a mistake that could hurt your chances of getting compensated.
2. Review the Denial Letter With Your Lawyer
Your lawyer will go over the denial letter in detail, explaining the insurance company’s reasoning and spotting any errors in their logic or documentation. Whether it’s a missed deadline, a technicality, or a weak argument, your attorney can help determine the best way to respond.
3. Call the Insurance Company (With Your Lawyer Present or Involved)
If a phone call to the insurance adjuster is necessary, your lawyer can either make the call on your behalf or coach you through what to say. Sometimes, a simple clarification or correction, like submitting a missing document, can make all the difference.
4. Gather Additional Evidence
With legal help, you can build a stronger case by collecting more documentation, such as medical records, expert opinions, witness statements, or repair estimates. Your lawyer knows what kinds of evidence carry weight and can help you organize and present it effectively.
5. File an Appeal
If your policy allows for an internal appeal, your lawyer can handle the process for you, meeting deadlines, submitting necessary forms, and writing a compelling argument supported by evidence. Appeals are often time-sensitive, so having a legal advocate ensures everything is filed correctly and on time.
What If the Appeal Is Also Denied?
6. Request an External Review
If your insurance plan offers an external review by a third party, your lawyer can prepare and submit this request on your behalf. They’ll ensure your submission meets all the requirements and deadlines, increasing the likelihood of a favorable outcome.
7. File a Complaint With Your State’s Insurance Department
If your lawyer suspects the insurance company acted unfairly, they may recommend filing a complaint with your state’s insurance regulator. Your attorney can help draft the complaint, include key documentation, and manage any follow-up communication.
8. Explore Legal Action
If all else fails or if your lawyer finds evidence of bad faith or a breach of contract, they may recommend filing a lawsuit against the insurance company. This is often the last resort, but it may be necessary to recover the money you’re potentially owed. With a skilled attorney like Jim Glaser leading the charge, you won’t have to face the insurance company alone.
FAQs About Denied Insurance Claims
If your claim is denied, don’t assume that’s the end. Your first move should be to contact a lawyer who can review your denial and explain your legal options. An attorney can help you understand the reason for the denial, gather the right evidence, and guide you through an appeal or other next steps. Insurance companies are required to follow specific rules, and with legal support from our office, you can hold them accountable if they’ve acted unfairly.
Yes, in some cases. If your insurance company wrongfully denied your claim, acted in bad faith, or violated state laws, you may be able to file a lawsuit. These cases can include breach of contract or bad faith insurance practices. Before suing, it’s usually best to explore internal appeals and regulatory options, but a lawyer can help you decide when it’s time to take legal action.
Not necessarily. A denied claim doesn’t always result in higher premiums. However, insurance companies may still consider the fact that a claim was filed when calculating future rates. This varies depending on your provider, your policy type, and your claims history. For example, with auto insurance, multiple claims (even denied ones) could impact your renewal rate.
Your chances depend on why the claim was denied and how strong your supporting evidence is. If the issue was a missing document or a minor error, your odds of success are much higher. If the denial is based on a complex policy exclusion or a legal gray area, it may be harder, but not impossible, with help from an attorney or external review.
Types of Claims That May Be Denied
Insurance claim denials can happen across a variety of policy types. While the reasons vary, certain types of claims are more prone to rejection due to strict rules, technicalities, or insurer discretion.
Health Insurance
Health insurance claims are often denied for being labeled “not medically necessary” or because the provider was out of network. If your treatment isn’t covered under the insurer’s list of approved procedures, or if it was performed by someone not included in their network, you could face a denial. Other reasons include clerical errors, incorrect billing codes, or missing pre-authorization.
Car Insurance
If the insurance company believes you caused the accident, they may deny your claim. Policy violations, like driving under the influence or letting an unlisted driver use your vehicle, can also void coverage. Even if you were not at fault, your claim may be rejected if your coverage had lapsed or the damage is considered outside the scope of the policy.
Homeowners’ or Renters’ Insurance
Claims under homeowners’ or renters’ insurance are often denied due to maintenance issues or exclusions in the policy. If damage was caused by something the insurer considers neglect, like a leaky roof that was never repaired, they might deny the claim.
Standard policies often exclude damage from floods, earthquakes, mold, or certain types of pests unless additional coverage is purchased.
How to Prevent a Denied Claim
While not every insurance denial can be avoided, there are steps you can take to reduce the chances of having your claim rejected. Being proactive and thorough from the start can make all the difference.
Here are some tips to protect your claim:
Insurance policies have strict deadlines for reporting incidents and submitting claims. Waiting too long can result in an automatic denial, even if your case is strong. As soon as something happens, whether it’s an accident, injury, or property damage, report it and start the claims process.
Accurate documentation is your best protection. Save all relevant medical records, repair estimates, receipts, photos, police reports, and communication with the insurance company. The more evidence you have, the easier it will be to prove your case if questions come up.
Many denials happen because the policyholder misunderstood what was covered. Take time to read through your insurance policy, especially the exclusions and conditions sections. If something isn’t clear, call your insurer and ask for clarification before a situation arises.
Never exaggerate a claim or leave out key details. Incomplete or inaccurate information can raise red flags for the insurance company and lead to delays or denials. Stick to the facts and double-check everything before submitting your paperwork.
Insurance companies handle a large number of claims, and things can slip through the cracks. Follow up consistently by phone and in writing until you receive a final decision. Keep a record of every call and email, including names, dates, and what was discussed.
You May Still Be Owed Compensation—Learn More Today
Just because your insurance claim was denied doesn’t mean the case is closed. Depending on the reason for the denial and the terms of your policy, you may still be entitled to compensation. Many people walk away too soon without realizing they had the right to appeal or request further review. In some cases, all it takes is stronger documentation or correcting a simple mistake.
At Jim Glaser Law, we know how frustrating it can be to deal with insurance companies, especially when you’re already under stress from an injury or property loss. That’s why we offer straightforward, honest legal guidance to help people like you fight back against wrongful denials. Whether you need help understanding your next steps or you’re ready to take legal action, we’re here to listen and offer real solutions.
Don’t let the insurance company have the final word. Contact Jim Glaser Law today for a free case review. We’ll go over your situation and help you understand whether you still have a path to the compensation you’re potentially owed.
