Why Insurance Claims Get Denied

Insurance companies are businesses, and their goal is to make a profit. That means they don’t always approve every claim, even when it seems clear you’re entitled to coverage. Some of the most common reasons for denials include:

1. Incomplete or incorrect paperwork.
   Small mistakes—like missing signatures, wrong dates, or unclear information—can cause your claim to be rejected.

2. Missed deadlines.
   Many policies require you to report an accident or injury within a certain time frame. Waiting too long to file can lead to automatic denial.

3. Policy exclusions.
   Some damages or types of accidents aren’t covered under your specific plan. For example, certain medical treatments, natural disasters, or “intentional acts” may be excluded.

4. Disputed liability.
   The insurer might claim you were partly or fully responsible for the accident, reducing or denying payment entirely.

5. Lack of evidence.
   If you don’t provide enough proof—like photos, witness statements, or medical records—the insurer might argue that your claim isn’t valid.

6. Bad faith actions.
   Sometimes, insurance companies deny claims without a valid reason or delay payment to pressure you into accepting a smaller amount. These tactics are illegal and can be challenged in court.

Step 1: Review the Denial Letter Carefully

When your claim is denied, the insurance company must send you a written explanation. This letter outlines why they denied your claim and which part of your policy they’re relying on.

Take time to read the letter closely. Look for:

• The specific reason for the denial.

• Any deadlines for appeal or submitting more information.

• References to sections of your policy that supposedly justify their decision.

Keep all communication in writing, and don’t ignore the denial. The sooner you respond, the better your chances of getting it reversed.

Step 2: Gather Supporting Evidence

Next, start collecting every piece of information related to your claim. The more evidence you have, the stronger your case will be if you appeal or take legal action. Helpful documentation may include:

• Photos or videos of the accident scene.

• Medical records, bills, and treatment notes.

• Police or incident reports.

• Witness statements.

• Repair estimates or receipts.

• Copies of all correspondence with the insurance company.

If you believe the insurer acted unfairly, keep a log of phone calls and emails. This documentation can help show a pattern of delays or bad faith behavior.

Step 3: File an Appeal

Most insurance companies allow policyholders to appeal a denial. The appeal process gives you the chance to provide additional information or clarify details that might change their decision.

When appealing:

• Follow all deadlines listed in the denial letter.

• Submit new evidence or documentation to strengthen your case.

• Write a clear, professional letter explaining why you believe the denial was wrong.

Sometimes, the appeal process works, and the insurer reverses its decision. But if they continue to deny your claim, you may need to take further action with help from Chicklo Law Group.

Step 4: Know When to Call a Lawyer

Insurance policies can be complicated, and it’s easy to feel overwhelmed by confusing terms and endless paperwork. That’s where an experienced attorney can make a difference.

A lawyer from Chicklo Law Group can:

• Review your policy and identify any misinterpretations by the insurer.

• Collect and present evidence to strengthen your case.

• Communicate directly with the insurance company on your behalf.

• File a bad faith insurance claim if the company acted dishonestly or unreasonably.

• Represent you in court if the insurer still refuses to pay.

Having legal support not only helps you understand your rights but also sends a clear message to the insurance company that you’re serious about getting fair treatment.

Step 5: Understand Bad Faith Insurance Practices

“Bad faith” is a legal term for when an insurance company fails to deal with you honestly or fairly. Examples include:

• Denying a claim without investigating properly.

• Delaying payment without reason.

• Offering an unreasonably low settlement.

• Ignoring communication or failing to explain a denial.

If your insurer acted in bad faith, you may be entitled to additional compensation, including punitive damages meant to punish their behavior. A lawyer can help you determine if your case qualifies.

Protecting Yourself After a Denied Claim

While you can’t control every outcome, there are steps you can take to protect yourself before problems arise:

• Read your policy carefully so you understand your coverage.

• Document everything after an accident or injury.

• File your claim promptly and follow up regularly.

• Avoid giving recorded statements without legal advice.

• Contact a lawyer early if something doesn’t seem right.

Insurance companies have teams of adjusters and lawyers on their side. Having your own advocate levels the playing field and ensures your rights are protected.

Final Thoughts

A denied insurance claim can be stressful and financially devastating—but it’s not always the end of the road. By understanding why claims are denied, gathering strong evidence, and working with an experienced attorney, you can often turn things around.

If your insurance company refuses to pay what you’re owed, don’t face them alone. The dedicated team at  Chicklo Law Group is here to stand up for your rights, challenge unfair denials, and help you get the compensation you deserve.