Steps to Take If Your Insurance Claim is Denied

The whole purpose of paying for insurance is the feeling of having a safety net – knowing that if something goes wrong with your house or car, or you have a medical or disability issue, you have an insurance policy in place to help you navigate the financial aspects of your challenges.

So, it can come as a shock when your claim is denied. Unfortunately, this is common, as insurers are hoping you won’t take the time to fight the denial or refile your claim. 

Here are some key steps you can take if your insurance claim is denied.

Why do insurance companies deny claims?

Many insurance companies will find any little reason to deny a claim. These are some of the most common reasons that insurance companies reject a claim:

Reasons why auto insurance claims are denied:

• It’s not clear which driver is at fault, or both drivers may be responsible
• The policyholder didn’t notify the insurance company of the accident promptly
• There was no medical exam to prove injuries from the accident 
• The claim amount exceeds the policyholder’s insurance coverage

Reasons why homeowners insurance claims are denied:

• The incident that caused the damage wasn’t a “covered event” 
• The policyholder didn’t submit adequate information 
• The policyholder didn’t take steps to mitigate the issue after the cause was identified 
• Concern over false claims or fraudulent statements

What to do if your insurance claim is denied?

If your insurance company denies your claim, it will take some time and determination to get the coverage owed to you under your policy. Your first indication of a claim denial will be a formal letter from your insurance company informing you that the company will not cover your claim. 

Sadly, many people believe they don’t have other options – which is what the insurance company wants you to think. Instead of throwing in the towel, there are ways to appeal the insurance company’s decision.

#1. Start Gathering Evidence

Photos, correspondence, and anything else that strengthens your claim and highlights why the incident should be covered. For car accidents, this could be police statements, car photos, witness statements, auto body shop reports, etc. For homeowners insurance claims, this could include repair/replacement invoices or statements, estimates from contractors, photos of the damage, etc.

#2. Start the Appeals Process

Each insurance company is different – find your specific company’s policy on how appeals should be submitted. Be sure to clearly state why you believe your claim should be covered, along with all possible evidence to support your position. 

#3. Consult an attorney

You can also consult an attorney before you start the appeals process, as a lawyer can help you state your case as to why the insurance company should cover the claim. Other times, individuals choose to talk with an attorney after their appeal has been denied.

Talk to an Attorney About an Insurance Denial

If you have concerns about your situation or want to get a lawyer’s perspective on your options, find an attorney with experience handling insurance disputes.

The McGonigle Law team has extensive experience in these types of complex cases. For example, in the Court of Appeal decision of Thompson v. Fireman’s Fund Insurance Company, a case of first impression in California regarding an insurance company’s obligation to cover mold damage, our team established that the mold exclusion in the Fireman’s Fund policy did not prohibit coverage for all resulting damages caused by defective workmanship to the policyholder’s roof which resulted in water and mold damage.

If you have any questions about your situation, reach out to our team today.

The information contained herein is for general purposes only and does not constitute legal advice.