What Should I Do If an Insurance Claim Is Denied?

You’ve been in an accident, and you know you deserve compensation, but your claim has been denied. Now what? Receiving a letter that your claim has been denied can be a huge gut punch after you’ve already suffered so much. That’s why you need the help of personal injury lawyers in Houston, TX to represent you when you challenge the insurance company’s decision.

Why Are Insurance Claims Denied in Houston, TX? 

The quick and dirty answer is that insurance companies do everything they can to avoid paying out settlements. For most people, a denial letter is enough to get them to drop the case and go away. That doesn’t have to be the case for you. If you believe you are still owed compensation, the next step is to hire a team of personal injury lawyers in Houston, TX to take on your case and challenge the decision.

Dispute of Liability

Insurance companies often try to skirt their responsibility for paying claims by saying that there is still a question of who caused the accident. Due to Texas law regarding compensation according to the assessment of fault, the amount of your compensation can be rightfully reduced if you are found to be partially at fault. Nevertheless, if you are less than 50% liable for the accident, they do owe you compensation and should be held responsible.

Disputes over liability are often challenged in court with the help of experienced lawyers and witness statements. You will need to build a strong case to show that you are not primarily responsible for causing the accident and that there was no more you could have done to avoid the incident. Then, you will still need to prove that your injuries were significant enough to deserve a settlement after the reduction for your part in the accident.

Breaking the Law

On occasion, your insurance company may deny a claim based on their belief that you were breaking the law at the time of the incident. Whether you were caught with your cell phone in hand or you were traveling too fast, your insurance company may use this as leverage against you. This becomes even more likely if an officer cites you with a violation during the accident, which means they found you at least partially at fault.

But just because you are partly at fault does not necessarily mean you aren’t entitled to any coverage at all. Talk to your lawyer!

Insufficient Policy Coverage

Depending on the seriousness of the situation, the insurance company may simply inform you that you do not have sufficient coverage or the right type of coverage to make your claim. If this is the case, they will likely send you a letter explaining if all or a portion of your claim has been denied due to policy limits.

Reporting Timeline

Insurance companies also tend to deny coverage for claims that were made too long after the fact. If you waited to submit a claim or did not seek medical attention right away, they have grounds to say that the injury occurred in some other way. It will be up to you to prove that the accident was the predominant cause of the injuries you are now suffering from.

Hiring Personal Injury Lawyers After Claim Denial

When your claim denial letter arrives in the mail, it will include a list of reasons why you were denied. This is the first clue as to how you can appeal the decision with the help of an attorney. You should bring the letter directly to your injury lawyer right away so they can begin building the case for your appeal. Next, they will draft a letter of appeal so they can begin the process of seeking compensation on your behalf.

Preparing Your Documents

From police reports to medical records, you are going to want to make multiple copies of all the documentation in your case. Make sure you keep your originals and have enough copies to send along as evidence in your dispute. The more evidence you have, the easier it will be for your attorney to determine the strength of your case and put together your challenge.

The consultation at this stage is crucial because your attorney will be able to tell you whether or not you have a strong enough case to pursue based on the evidence you have. Alternatively, they may ask for additional documentation to improve the merits of your case. You would be wise to take their recommendations to heart.

Sending the Letter of Demand

The reason you want an attorney to draft your letter of demand has to do with presenting a clear case and knowing what is covered in the law. Your lawyer will present the evidence in a succinct way, explaining each and every document as well as making reference to your policy coverage or the other party’s policy information.

In addition, they will be able to fight back against any bad faith claims being made on behalf of the insurance company. Finally, all of this needs to be submitted in a timely manner because you may only have a small window to get the ball moving. While it is possible to draft a letter on your own, most people are not familiar enough with the language used by insurance companies to make a good case. Hiring an attorney is a good way to boost your chances of getting a settlement in the end.

Following the Appeals Process

Another problem many consumers face is getting lost in the many nuances of the appeals process. After you notify the insurer that you intend to appeal their decision, they may try to put you through a variety of hoops to prove your case or attend mediation. Many of these steps are stall tactics to get you off their backs, but if you miss a deadline or don’t have your paperwork in order, they may use it as cause to deny your claim again.

An attorney familiar with the process can help keep you on track and ensure that you answer all of their requests for additional information and play by their rules while you wait for them to reconsider your claim. Still, this does not always mean that they will change their minds, and you may end up pursuing further action even if you’ve done everything right. This is when a formal lawsuit comes into play.

Seek Outside Help

In some cases, an insurance company continues to deny claims long after your case has been proven. In these instances, your attorney may need to take the case higher up and see assistance from the state’s governing body to get the insurance company on board. The insurance industry is tightly legislated, and failure to follow its own rules is a big problem. Your personal injury lawyers will know exactly when your case reaches the point of filing a formal complaint at a higher level.

If your insurance claim has been denied but you have not been made whole, you may be able to file an appeal. The key to a successful appeal is having the right legal team on your side and plenty of evidence to show that your claim was wrongfully denied. When you need help appealing a denial, contact Abraham, Watkins, Nichols, Agosto, Aziz & Stogner right away and schedule a consultation to review your denial and your case.