Insurance companies aren’t directly responsible for your injuries in a personal injury case, but they usually control the money. More often than not, the insurer is the one you must convince that you deserve compensation. That means these companies have strong incentives to reject claims. If you receive a rejection, winning a denied personal injury claim appeal in Tampa isn’t easy.
At Jurewitz Law Group Injury & Accident Lawyers, our Tampa injury lawyers have dedicated themselves to protecting Floridians against big insurance companies. We know their tricks and the strategies they use to deny liability and reduce compensation. We also know how to fight back and are happy to share our experience and advice.
Steps to Take After Receiving a Denial
Don’t get upset or angry if an insurer rejects your claim. It happens more than you might think, and letting your emotions take over won’t help. Here’s what to do:
- Read the denial letter carefully – Review the insurer’s letter carefully to understand their reasons for denying your claim.
- Compare the denial with the applicable insurance policy – Review the insurance policy to see if the stated reason matches the liable party’s coverage and terms.
- Look for errors or missing information – The denial may be based on incomplete records, misstatements, or overlooked evidence. Identify anything that seems incorrect or missing.
- Gather supporting documents – Collect any medical records, accident reports, photos, and witness statements that support your injury and how it happened.
- Review the timeline of events – Make sure you submitted all the claim paperwork on time. Late filings often lead to automatic denials, but you might still be able to recover compensation.
- Contact the insurance adjuster – Ask for a detailed explanation and clarification of why the company denied your claim. Take notes during the conversation, and request everything in writing.
- Document everything – Keep a record of every phone call, email, and letter between you and the insurance company.
- Avoid making emotional statements – Stick to facts when speaking with insurance representatives. Remember that they can use anything you say against you later.
How to Appeal a Denied Personal Injury Claim
Appealing and overturning a denied insurance claim isn’t easy, but it’s possible if you’re patient and methodical. Here are the steps to take:
- Hire an experienced personal injury attorney – A lawyer can guide you through the appeals process and help you build a strong case to overturn the denial.
- Let your attorney review the denial letter and policy – Your lawyer will identify any errors, weak points in the denial, and how the liable party’s coverage should apply to the claim.
- Submit a written appeal – Your attorney can prepare a formal appeal letter that explains why the denial is incorrect. This appeal letter usually also includes additional supporting evidence. For example, your lawyer may collect more detailed records, expert opinions, or updated treatment notes to strengthen your case.
- Address any mistakes in the insurance company’s review – If the insurer based its denial on incorrect facts, your attorney can correct the record and provide accurate details.
- Include statements from witnesses or healthcare providers – Signed statements can help prove how your injury happened and its impact on your daily life.
- Meet all appeal deadlines – Your attorney will make sure to submit every document on time while following the insurer’s appeal process.
- Request a second review or independent evaluation – Your lawyer may ask for a neutral third party to review your case, assuming the insurer allows it under their policy.
- Prepare for possible litigation – If the insurer denies your appeal again, your attorney may recommend filing a lawsuit to pursue the compensation you deserve.
Most Common Reasons for Denied Personal Injury Claims
Insurance companies can find many reasons to deny a personal injury claim. Some of the most common reasons for claim denials include:
Lack of Medical Evidence
Delays in treatment or missing documentation can make proving what caused your injury harder. The insurance company may deny your claim if your medical records don’t clearly link your injuries to the accident.
Missed Filing Deadlines
Every policy has time limits for reporting injuries and submitting documentation. Missing these deadlines, even by a few days, can result in an automatic denial.
Pre-Existing Conditions
If you had a similar injury before the accident, the insurer may argue that your current pain isn’t from the new incident. While this doesn’t automatically disqualify your claim, it often leads to disputes and denials. A personal injury lawyer can gather evidence to show your injuries are new and unrelated to your prior condition.
Policy Exclusions
An insurer might deny your claim if the type of accident or injury isn’t covered under the specific terms of the policy. For instance, some policies exclude injuries resulting from certain recreational activities or off-duty conduct.
Disputes Over Fault
Disagreements about liability are a leading cause of denials. If the insurer believes (or thinks they can credibly argue) that you were mostly or entirely at fault for the accident, they may deny the claim.
Insufficient Documentation
Missing records, unclear accident reports, or a lack of witness statements can make your claim appear weak. Without strong, organized documentation, the insurer might say there’s insufficient proof to justify a payout.
When to Consider Legal Action
It may be time to consider legal action if an insurer denies or delays your appeal without a clear reason. You shouldn’t have to fight endlessly to receive compensation for injuries that weren’t your fault.
If the insurer is acting in bad faith (ignoring evidence, misapplying policy terms, etc.), a lawsuit may be your best option. Legal action is especially important if your bills are piling up and you can’t afford to wait any longer. A personal injury attorney can explain your rights and determine whether filing a lawsuit makes sense.
Contact Our Tampa Injury Attorneys for Help
You don’t necessarily have to put up with a denied personal injury claim. The Tampa personal injury attorneys at Jurewitz Law Group Injury & Accident Lawyers can help you make a persuasive case to recover fair compensation. However, it’s crucial to act before the two-year deadline for Florida personal injury lawsuits lapses. Call (619) 233-5020 now or complete our contact form for a free consultation.
