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How to Handle a Denied Insurance Claim

Author: Brandon Yosha

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    Car accidents, medical accidents, slip and fall accidents, and workplace accidents all have one thing in common — insurance coverage should be in place to cover these unexpected tragedies. You trust that the at fault parties in these accidents have insurance to cover injuries or property damage.

    After your accident, you file a claim with the insurance company and assume that your mounting financial losses can be recouped. But what happens if your valid claim is denied and you need monetary relief now? How can you handle a denied insurance claim?

    In such cases, having a knowledgeable advocate on your side is crucial. For instance, if you’re dealing with the aftermath of a slip-and-fall accident in Fort Wayne, an experienced attorney can help you navigate the often complex process of challenging a denied claim. They can assist in gathering the necessary evidence to support your case, negotiating with insurance companies, and, if necessary, representing your interests in court to ensure you receive the compensation you’re entitled to.

    Why Insurance Claims Get Denied

    At times, insurance claims are swiftly settled and paid without issue. However, more often than not, insurance companies are reluctant to pay out claims — a denial could even stem from a miniscule paperwork issue. A denied insurance claim can occur for a plethora of sometimes head-scratching and confusing reasons.

    For example, a 2022 report from the Kaiser Family Foundation showed that a staggering average of 18% (and up to 80%) of federal, in-network health insurance claims were denied. On the other hand, statistics from 2021 show that the auto insurance industry incurred almost $200 million in losses, ostensibly from claims.

    Common Reasons for a Denied Claim

    • Improper coding, clinical validation issues, and patient registration issues:

    Paperwork errors could account for denied health insurance claims. If you’ve been hurt in an accident and are seeking just reimbursement, this could mean astronomical out-of-pocket costs for you in the interim.

    • Lack of auto insurance coverage:

    If the person at fault in your car accident has minimal insurance coverage and your claim exceeds this coverage, their insurer may deny your claim. Similarly, if you’re hit by an uninsured driver, you’ll have to use your own insurance for any initial coverage.

    • Failure to file on time:

    Most insurance companies have a 30-day time window for filed claims, starting with the day of your accident. If you wait too long to file, this could invalidate your claim.

    • Failure to seek medical treatment:

    If you file a personal injury claim as a result of a car, slip and fall, or workplace accident but haven’t received documented medical treatment or a professional diagnosis, your insurance claim could be denied.

    • Lack of proof of liability:

    If you haven’t filed a police report, or cannot prove you don’t hold liability for your accident, an insurance company might deny your claim.

    If your claim is denied, you’ll receive a rejection letter from the insurance company. This is important for your legal records should you decide to appeal the denial or sue the insurer.

    Legal advices during an appointment for a denied insurance claim

    How to Appeal a Denied Claim in Indiana

    Most insurance companies will allow you to appeal a denied claim. However, the likelihood of a reversed decision is slim. If you haven’t already consulted a lawyer about your claim, you may want to do so quickly after your claim is denied.

    In order to appeal a denied health insurance claim, you can ask the insurer for an internal review of your claim. If it’s still denied, you can request an external review. However, this process can take a long time — meanwhile, you’ll still be expected to pay the medical bills that are flooding your mailbox.

    Many car insurance companies have an appeals process as well. In order to begin the appeals process, you’ll need evidence that your claim is valid. You’ll also need to write a detailed letter to the insurance company to explain why their decision should be reversed. Again, it may take awhile for the decision to be reversed.

    Other Steps to Take If Your Appeal Is Denied

    Remember, if your claim appeal falls on deaf ears, it may be time to consult an insurance lawyer. There are also steps you can take to ensure you deal with the rejected claim in a way that will best serve you.

    If your initial appeal has failed, here are some other tips to help you deal with a denied insurance claim:

    • Keep all pertinent insurance documents:

    Insurance documents often include blocks of industry language and fine print. Make sure you carefully review this information before you decide how to proceed. Your claim may have been denied in error, and the documents may help you prove that to the insurer or in a court of law.

    If you can prove that your claim was erroneously denied, the Indiana Department of Insurance may overturn the insurer’s decision. Your complaint will also remain on file should you choose to pursue legal action against the insurance company.

    • Consult an Indiana insurance attorney:

    If the insurance company won’t budge, an Indiana insurance lawyer can help you understand the viability of your claim. Even before you choose to file a lawsuit against an insurer, a lawyer can contact the company on your behalf, and may be able to get your claim reopened.

    How an Indiana Insurance Attorney Can Help

    You don’t have to feel defeated by giant insurance companies. After you’ve taken the necessary steps to file your insurance claim and an insurer rejects it, you may need someone to fight in your corner.

    An Indiana insurance lawyer can help you receive the justice you’re owed. The right lawyer can do the following:

    • Gather all documents and evidence pertaining to your denied claim
    • Send a legal letter to the insurer on your behalf, defending your claim
    • Present forensic experts to lend credibility to your claim
    • Negotiate any settlement offers for you
    • Represent you in any mediation or arbitration meetings with the insurer

    Frequently Asked Questions

    How long do I have to appeal a denied insurance claim?

    Most insurance companies have strict deadlines for appeals, typically within 30 to 60 days from the date of denial. Check your insurer’s policy and act quickly to avoid missing the window to challenge the decision.

    Can I sue my insurance company for denying my claim?

    Yes. If your insurer wrongfully denies your claim, you may have grounds to file a lawsuit for bad faith insurance practices. An attorney can help determine if you have a viable case.

    What should I include in my appeal letter?

    Your appeal letter should be detailed and include all relevant documents, such as medical records, accident reports, witness statements, and any evidence disputing the insurer’s reason for denial.

    Does hiring an attorney increase my chances of winning an appeal?

    Yes. An attorney can navigate the complexities of insurance claims, negotiate effectively, and provide strong legal arguments, significantly improving your chances of overturning a denial or securing fair compensation.

    Contact Yosha Law for Help with Your Denied Insurance Claim

    If your insurance claim was denied in Indiana, Yosha Law can help handle your case. We’ve helped support numerous clients through the insurance claims process, and understand how stressful it can feel. After an accident, you need to be able to focus on your healing and you shouldn’t have to face the insurance giants alone.

    At Yosha Law, we consider our clients as a part of our family. We will fight for your just compensation and help guide you through the legal process of your claim. Contact us today for a free consultation and together we can explore the merits of your case.

    Picture of Brandon Yosha

    Brandon Yosha

    Brandon Yosha is a trial lawyer at Yosha Law Firm, dedicated to advocating for victims of negligence. Recognized as one of the youngest attorneys in Best Lawyers in America, Brandon combines his family’s legal legacy with his own commitment to securing justice for his clients. Mentored by renowned attorneys, he brings empathy and determination to every case.

    Legally Reviewed By

    Brandon Yosha

    Trial Lawyer

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    Right now, you might feel like life will never go back to normal. Despite your mounting medical bills and significant physical and emotional pain, faceless insurance companies will try to devalue your quality of a life – whether it’s yours or a loved one’s. But, you don’t need to fight this battle alone.

    While no amount of money can erase the past, you deserve full and just compensation as entitled by Indiana law. Our team of experienced legal professionals is dedicated to advocating for your brighter future and ensuring your voice is heard.

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