How Personal Injury Lawyers Help Dispute-Denied Claims

Imagine the scenario: You get into a car accident and sustain injuries. You file a claim with your insurance provider to recover money for your medical bills and other accident-related expenses. However, the insurance company then denies your claim. What’s next?

The good news is that an insurance claim denial is not necessarily the end of the story. You can dispute a claim denial and appeal the decision if you feel it was in error. If the insurance company continues to deny your claim in bad faith, you may be able to initiate a formal lawsuit against them to recover compensation. A personal injury attorney can help you weigh options and challenge a claim denial effectively.

Common Reasons for Insurance Claim Denials

At the end of the day, insurance companies are businesses, and the point of a business is to make money. Every claim and insurance company pays out means they make less money, so they have a vested interest in paying as little as possible. To that end, insurance companies are notorious for denying claims for all kinds of reasons:

• Waiting too long to file a claim. Florida law does not specify how quickly injury victims must contact the insurance company after an accident, so each company has a different deadline ranging from a few days to a month. Keep in mind these time limits are not the same as Florida’s two-year statute of limitations for personal injury lawsuits.
• Insufficient evidence. When you file a claim, you will submit documents proving the accident occurred and proving the extent of your injuries. Insurance companies might deny a claim if there is insufficient evidence to validate your story.
• Delaying medical treatment. Certain injuries, like concussions, might not become apparent until much later. If you delay medical treatment because you initially feel ok, that delay could be grounds for a claim denial. The insurance company might argue the denial means your injuries weren’t serious or weren’t due to the accident. Hence, you should always see a doctor immediately after an accident, even if you have no obvious injuries.
• Policy exclusions. Insurance policies usually have exclusions, which limit situations where they are obligated to pay claimants. For instance, many personal auto policies will not cover someone if they were using their car for commercial purposes when they sustained injuries.
• Liability concerns. Insurance companies might also deny a claim if they think you were actually at fault for the accident. If the insurance company successfully argues you were at fault, it could reduce or outright eliminate your compensation. 

When an insurance company denies a claim in Florida, they must provide a written explanation for the denial and which policy sections were grounds for it. If they do not provide an explanation when they notify you of denial, you can request a written explanation.

How Lawyers Challenge Insurance Claim Denials

Most insurance companies have an appeals process where claimants can dispute decisions they disagree with. The exact appeals process will differ depending on the policy and company. An attorney can help you with disputing your denied insurance claim by:

Communicating Effectively

Above all, an attorney can mediate the appeal process to meet all filing deadlines and procedural requirements. An attorney can present your appeal in a logical and persuasive manner and also negotiate your settlement if the insurance company tries to lowball you. They can also resolve any ambiguity or vagueness that gives insurance companies a reason to nitpick claims.

Gathering Additional Evidence 

If the claim was initially rejected due to insufficient evidence, your attorney can help you gather additional evidence of the accident scene and more medical documentation that corroborates your claims about your physical and mental condition. By gathering the necessary evidence and presenting it at an appeal, an attorney can greatly increase the chances of a claim reevaluation.

Identifying  Legal Violations

The state highly regulates insurance companies’ behavior and imposes strict requirements concerning notices, appeals, and communication. If an insurance company breaks these rules by unnecessarily delaying communication or denying claims without a valid reason, an attorney can put pressure on them to honor their legal obligations and work to protect your rights and interests.

Formal Litigation

Most insurance claims eventually end with negotiations and a final settlement, but a handful do not. If the insurance company continues to illegitimately deny your claim or delay payment without good reason, an attorney can file a lawsuit against them and initiate formal litigation. During litigation, you will present your case at hearings or a trial and a judge or court will reach a verdict. Mediation and arbitration are two other legal resolution processes that may be a better option than a trial.

What to Do After an Insurance Claim Denial

It is important that you understand the insurance claim dispute process so you can know your legal rights after a claim denial.

• Read the entire denial letter and ensure you understand the reason for the denial. A denial may also list additional evidence or documentation that would be useful for a claim appeal.
• Working with your attorney, gather whatever additional evidence you need to reinforce your claim. Keep a copy of the denial letter and all correspondence between you and the insurance company.
• Begin the internal appeals process. Every insurance company should have a policy for appealing claims with timelines, specific forms, and other necessary documents. You need to follow these details exactly, or else your appeal might get rejected on a technicality.
• Consult with an attorney about the possibility of a lawsuit. Through formal litigation, you can pursue the maximum possible amount of compensation.

Insurance denials are no doubt frustrating, and the appeals process can seem obtuse and challenging. A personal injury attorney can work with you to hold insurance companies accountable and seek the compensation you are due.

Contact Schuler, Weisser, Zoeller, Overbeck & Baxter P.A. online or call (561) 689-8180 to speak to a personal injury attorney in Florida today.