The Short Answer…
If your insurance company denies your personal injury claim, the first step is to carefully review the denial letter, then gather supporting evidence and compare it with your insurance policy. You can file an internal appeal with the insurer, request an external review if necessary, and involve the state’s Department of Insurance or an attorney if the company is acting in bad faith. Working with a trusted law firm like Stewart Bell, PLLC can help you fight back against unfair denials and secure the compensation you may be entitled to.
Key Takeaways
- Understand the denial letter: It outlines the reason for the denial and your next steps.
- Check your policy: Compare the denial against the actual terms of your coverage.
- Gather documentation: Collect records, bills, photos, and communication with your insurer.
- Appeal the decision: You have the right to file an internal and external appeal.
- Seek legal help: An attorney can hold the insurance company accountable and strengthen your claim.
Why Do Insurance Companies Deny Claims?
Insurance companies often deny claims to protect their bottom line. Some of the most common reasons include:
- Lack of coverage: The loss or injury isn’t included under your policy.
- Missed deadlines: Filing too late can automatically result in a denial.
- Policy lapses: A missed premium payment may cancel coverage.
- Incomplete or incorrect forms: Mistakes or missing documents can trigger denial.
- Disputes over liability: Insurers may argue you were partly or fully at fault.
- Pre-existing damage or conditions: Insurers may argue that the loss or injury existed before the policy period.
- Bad faith practices: Some insurers intentionally delay, undervalue, or deny valid claims.
Steps to Take After a Claim Denial
Knowing what to do if insurance denies your claim can protect your right to fair compensation. Denials can be frustrating, but following the right steps gives you a clear path forward.
1. Review the Denial Letter
- Read the denial letter clearly to understand the specific reason for the denial.
- Check for errors or missing information that could be corrected or clarified to resolve the issue.
- Take note of any deadlines listed, since missing them could affect your ability to appeal.
2. Compare With Your Policy
- Compare the denial reason with the actual coverage terms of your policy.
- Pay attention to exclusions, coverage limits, and definitions that may affect your claim.
- If the insurer’s reasoning doesn’t align with the policy language, you may have strong grounds for an appeal.
3. Gather Supporting Evidence
- Collect all documentation related to your claim, including medical records, repair estimates, receipts, photos, and witness statements.
- Maintain a detailed paper trail of all communication with your insurer, including names, dates, and what was discussed.
- Organized evidence not only strengthens your appeal but also shows the insurer you are serious and prepared.
4. File an Appeal
- Write a formal appeal letter that clearly explains why the denial is incorrect.
- Reference specific terms in your policy and attach all supporting documentation.
- Submit your appeal before the deadline set by your insurer.
5. Request an External Review
- If the company denies your internal appeal, you can request an external review by a neutral third party.
- This process takes the decision out of the insurer’s hands and adds accountability.
- For urgent medical or financial situations, insurers are required to expedite the review.
6. Contact Your State’s Insurance Department
- In West Virginia, you can file a complaint with the Insurance Commissioner if you believe the insurer is acting unfairly.
- Regulators can investigate your complaint, require the insurer to respond, and help enforce compliance with state law.
- This step is particularly valuable if delays or repeated denials appear to be part of a larger pattern of misconduct.
7. Seek Legal Help
- An experienced West Virginia personal injury attorney can review your denial, gather additional evidence, and negotiate directly with the insurer.
- If the insurance company is acting in bad faith, your lawyer can pursue legal action to recover not only your original claim but potentially additional damages.
- Having a lawyer on your side levels the playing field against the insurer’s adjusters and attorneys.
How to Appeal a Denied Insurance Claim
Appealing is often your strongest first line of defense when your personal injury claim is denied, and having legal guidance throughout the process can make a major difference.
- Write a clear appeal letter: Explain in detail why the denial was wrong. Reference specific policy language and highlight how your claim meets coverage requirements.
- Attach evidence: Include medical records, accident photos, repair estimates, receipts, and witness statements. The more documentation you provide, the harder it is for the insurer to dismiss your claim.
- Check for errors: Review both your paperwork and the insurer’s denial for mistakes or omissions. An attorney can help spot inconsistencies that you might miss.
- Submit within deadlines: Insurers impose strict time limits for appeals. Missing them could mean losing your right to challenge the denial.
- Follow up in writing: Keep copies of every letter or email you send. A lawyer can also handle correspondence on your behalf to ensure the insurer cannot later dispute what was said or provided.
- Consult with an attorney early: A personal injury lawyer can draft or review your appeal, help ensure that it meets legal standards, and strengthen your chances of success.
What If the Appeal Is Also Denied?
Even if your appeal doesn’t succeed, you are not out of options:
- Request an external review: A neutral third party will evaluate the denial and issue a binding decision.
- File a complaint with regulators: In West Virginia, you can report bad faith conduct to the Insurance Commissioner for investigation.
- Pursue legal action: An attorney can file a lawsuit to fight the denial in court, seek full compensation, and hold the insurer accountable for bad faith practices.
How a Lawyer Can Help With a Denied Claim
Insurance companies have adjusters, investigators, and legal teams working to protect their bottom line. Having your own advocate ensures you are not at a disadvantage. Here’s how an attorney from Stewart Bell, PLLC can make the difference:
- Review your denial and policy language: Our attorneys carefully analyze the denial letter and compare it to your coverage to identify weaknesses in the insurer’s reasoning.
- Gather and strengthen evidence: We help you collect medical records, expert opinions, and documentation that directly support your claim.
- Handle all communication with the insurer: By speaking on your behalf, we prevent the insurance company from twisting your words or pressuring you into settling for less.
- Appeal and negotiate effectively: We prepare strong appeals and negotiate aggressively to help secure fair compensation, whether through settlement or litigation.
- Take legal action when necessary: If your insurer acted in bad faith or refuses to pay, we can file suit and pursue additional damages under West Virginia law.
Why Work With Stewart Bell, PLLC?
If your insurance claim has been denied in Charleston, Huntington, Dunbar, or anywhere across West Virginia, our firm is here to help. We know how local insurers operate and what it takes to hold them accountable under state law.
- Local West Virginia knowledge: We understand state insurance laws and know how to deal with local insurers and regulators.
- Proven results: For decades, our firm has helped injury victims overturn denials and recover full and fair compensation.
- Personalized attention: We treat every client with compassion, keeping you informed and supported throughout the process.
- No upfront costs: You don’t pay us unless we win your case.
When your claim is denied, don’t go it alone. The sooner you involve our team, the better your chances of reversing the denial and protecting your financial recovery.
FAQs About Denied Insurance Claims
Why do insurance companies deny claims?
Insurers may deny claims to save money, citing policy exclusions, insufficient documentation, or liability disputes.
What’s a claim denial letter?
A claim denial letter is a written notice from your insurance company explaining why your claim was rejected. It typically outlines the reason for the denial, references the relevant sections of your policy, and may provide instructions on how to appeal. Reading this letter carefully is important for understanding the insurer’s position and planning your next steps.
How long does it take for an insurance company to process a claim?
Most insurance companies are required to process claims within a “reasonable” time frame, which usually means 30 to 60 days depending on the type of claim and state law. However, delays are common, and insurers sometimes stall investigations to pressure policyholders. If your claim is dragging on longer than expected, you have the right to demand a written explanation and seek help from an attorney.
What should I do if my insurance company is acting in bad faith?
Bad faith occurs when an insurer unfairly denies, delays, or undervalues a valid claim. If you suspect bad faith, document every interaction with your insurer, keep copies of all correspondence, and avoid accepting a low settlement offer without review. In West Virginia, you may be entitled to additional compensation if bad faith is proven, and an experienced lawyer can help you hold the insurance company accountable.
Is there a deadline for filing an injury lawsuit in West Virginia?
Yes. In West Virginia, you generally have 2 years from the date of the accident or injury to file a personal injury lawsuit. Missing this statute of limitations usually means losing your right to compensation entirely. Because insurers sometimes delay or deny claims strategically, it’s important to keep this deadline in mind and involve an attorney early.
Do I need a lawyer to appeal my injury claim?
While you can technically file an appeal on your own, having a lawyer greatly improves your chances of success. An attorney can review the denial letter, spot errors in the insurer’s reasoning, gather strong evidence, and draft an appeal that directly challenges the denial. At Stewart Bell, PLLC, we take on the legal burden so you can focus on your recovery while knowing your claim is in capable hands.
Get Help With Your Denied Claim in West Virginia
If your injury claim was denied, it doesn’t mean the fight is over. Insurance companies often deny valid claims in hopes that policyholders will give up. At Stewart Bell, PLLC, we know the tactics insurers use, and we are prepared to push back. Our team has decades of experience helping clients across West Virginia overcome denials and recover fair compensation.
You don’t have to face the insurance company alone. We can review your denial, explain your legal options, and fight for you through appeals, negotiations, or even in court if necessary. Best of all, we work on a contingency fee basis, meaning you pay nothing unless we win your case.
Contact Stewart Bell, PLLC today for a free consultation and let us help you challenge your denied claim.
