What to Do If an Insurance Claim Is Denied

Facing a personal injury is challenging enough without the added stress of a denied insurance claim. At Southern Maryland Law, we understand the frustration and uncertainty that comes with such denials. Insurance companies don’t always make the process easy, but you don’t have to navigate this alone.

We’re here to guide you through the steps to understand why your claim may have been denied, what to do if insurance denies your claim, and when to seek legal assistance to improve your chances of a successful outcome.

Why Was My Insurance Claim Denied?

The first step in addressing a denied claim is understanding why it was rejected. Insurance companies may deny claims for various reasons, including:

• Lack of coverage. The insurer may argue that the policy does not cover the specific type of injury or incident.
• Policy lapses. Coverage may have lapsed if premiums were not paid, leading to a denial.
• Insufficient documentation. Missing or incomplete medical reports, accident details, or witness statements can cause insurers to reject a claim.
• Disputed liability. The insurance company may claim you were partially or entirely at fault, reducing or eliminating their obligation to pay.
• Pre-existing conditions. If an insurer believes your injury was not caused by the accident but was a prior condition, they may deny your claim.
• Failure to report the incident on time. Many insurance policies have strict deadlines for filing a claim. If you miss the window, they may deny coverage.

Carefully review the denial letter from your insurer, which should outline the specific reasons for the rejection. This information will inform your next steps and help you address the issue directly.

What to Do If Insurance Denies Your Claim

If your insurance claim has been denied, don’t panic. You have options to fight back. You should get a consultation with an attorney before you take action, to make sure you are on the right track. If you have a claim worth a significant amount of money, you would be very wise to hire a lawyer to help you. Here’s how to start the appeal process.

1. Review the Denial Letter Thoroughly

The denial letter from your insurer should explain why they denied your claim. Ensure you fully understand their reasoning to effectively challenge their decision. If you need help understanding the insurer’s position, consider contacting a personal injury attorney for guidance.

2. Gather Supporting Documentation

Once you know the reason for denial, collect all relevant records that can support your appeal, including:

• Medical reports,
• Police or accident reports,
• Photos and videos of the incident,
• Witness statements, and
• Communication records with the insurer

Providing clear and compelling evidence is essential to making a strong case for your appeal.

3. Submit a Formal Appeal

Draft a clear and concise appeal letter that:

• Directly addresses the denial reasons listed by the insurer,
• Provides additional evidence or clarifications,
• Requests a formal reconsideration of your claim, and
• Includes your policy number and all relevant details

Some insurance companies require specific forms for appeals, so check their guidelines to ensure your submission meets their requirements.

4. Consider an External Review

If your internal appeal is unsuccessful, you may have the right to request an external review. In Maryland, the Maryland Insurance Administration (MIA) provides a complaint process for consumers who believe they have unfairly had their insurance claim denied. You can file a complaint with the MIA for an independent review of your case.

5. Keep Track of Deadlines

Appeals must be submitted within a specific timeframe. Missing the deadline may cost you your right to challenge the denial. Read your insurance policy carefully or contact the insurer to confirm the deadline.

Why Acting Quickly Is Crucial

Time is of the essence when dealing with denied insurance claims. In Maryland, insurance policies often have specific deadlines for filing appeals, and missing these can forfeit your right to contest the denial. Additionally, under Maryland law, the statute of limitations for personal injury claims is generally three years from the date of the injury. Prompt action ensures you preserve your rights and options.

Delays in the appeals process can also work against you. Insurance companies may use prolonged response times to discourage claimants from pursuing further action. Keeping meticulous records of your communications with the insurer, including dates, names, and call details, can help strengthen your case.

Recognizing Bad Faith Insurance Practices

While insurance companies have the right to investigate and assess claims, they are also required to act in good faith by law. Unfortunately, some insurers engage in bad faith tactics, including:

• Unreasonably delaying claim processing,
• Providing misleading information about coverage,
• Denying valid claims without proper justification, or
• Refusing to communicate or provide required documentation

If you suspect your insurer is acting in bad faith, you may have legal recourse under Maryland’s Unfair Claims Settlement Practices Act. A skilled attorney can help you hold the insurer accountable and seek appropriate compensation.

When to Seek Legal Assistance

Navigating the complexities of insurance claims can be daunting. Seeking legal assistance can be beneficial in situations where:

• The denial reasons are unclear or unjustified;
• The appeals process becomes overly complex or stalled;
• You’re unsure of your legal rights and the best course of action; or
• The insurer is using bad faith tactics, such as delaying responses or making unreasonable demands.

An experienced attorney can provide valuable guidance on what to do if insurance denies your claim, negotiate with insurers on your behalf, and represent you in legal proceedings if necessary. Studies have shown that individuals represented by legal counsel are more likely to receive favorable outcomes in insurance disputes.

How Southern Maryland Law Can Help

At Southern Maryland Law, we’ve been serving the Waldorf and Lexington Park communities for over 60 years. Our team of dedicated attorneys focuses on various legal areas, ensuring you receive the expertise you need. We pride ourselves on being approachable, friendly, and committed to reducing the stress associated with legal challenges.

Don’t navigate this journey alone if your insurance claim has been denied. Contact us today for a consultation, and let us help you secure the compensation you deserve. Our experienced and knowledgeable team can work with you to understand your options, protect your rights, and remove the stress of navigating the legal process so you can focus on your recovery.