What to Do If an Insurance Company Denies Your Claim

Receiving a denial letter from your insurance company can be deeply frustrating—especially when you're relying on coverage to recover from a loss or injury. Whether it’s medical bills, car damage, or property repair, a denied claim can feel like a personal setback. But don’t give up. You have options—and rights.

Here’s a step-by-step guide to responding to a denied insurance claim and increasing your chances of a successful appeal.

1. Review the Denial Letter Carefully

Your first step is to read the denial notice thoroughly. Insurers are legally required to provide a written explanation that includes:

• The specific reason(s) for denial
• Relevant policy language
• Instructions for how to appeal
• Deadlines for response or review

Look for vague language like "not medically necessary" or "not covered" and highlight any provisions they reference.

Pro Tip: Compare the denial letter to your original insurance policy or summary of benefits to see if their reasoning holds up.

Check the National Association of Insurance Commissioners (NAIC) guide for common reasons claims are denied.

2. Gather All Supporting Documentation

To build a strong appeal, organize every document related to your claim:

• Medical claims: Doctor’s notes, treatment records, itemized bills, prescriptions, and prior authorizations.
• Auto/property claims: Police reports, photographs, damage assessments, repair estimates, receipts, and witness statements.

Make sure everything is labeled and easy to reference.

Pro Tip: If a denial involves “insufficient evidence,” submitting additional or corrected documentation can sometimes reverse it quickly.

3. Call Your Insurance Adjuster for Clarification

It’s often helpful to speak directly with your claims adjuster before submitting a formal appeal. Ask:

• Was anything missing from my original submission?
• Is there any way to resolve this without filing an appeal?
• Can you walk me through exactly what part of the policy was cited?

Why it matters: Denials are sometimes caused by coding errors, miscommunication, or incomplete paperwork—and a simple phone call can fix it.

4. Submit an Internal Appeal

If the denial stands, initiate the insurer’s internal appeal process. Most insurance policies provide detailed steps for how to appeal within the company:

• Submit your appeal in writing (email or certified mail is best).
• Include a copy of the denial letter, your policy, and all supporting evidence.
• Provide a clear, concise explanation of why the denial is wrong.
• Meet all stated deadlines—usually within 30 to 180 days of the denial.

Pro Tip: Get written confirmation that your appeal was received, and request a timeline for response.

5. Request a Third-Party Review or Involve Your State Regulator

If your internal appeal is denied, you have the right to an external appeal in many cases. This is a review conducted by an independent third party who cannot have ties to the insurer.

You can also:

• File a formal complaint with your state’s department of insurance.
• Request regulatory intervention if you suspect bad faith or unfair practices.

The U.S. Department of Health & Human Services offers guidance on external reviews and connects you to state-specific appeals offices.

6. Contact a Personal Injury Attorney (If Applicable)

If your denied claim involves a serious injury, major property damage, or you suspect bad faith practices (e.g., unreasonable delays, lowball offers, or misrepresentation of your policy), it may be time to contact an attorney.

A personal injury lawyer can:

• Analyze your insurance policy
• Communicate with adjusters or insurer legal teams
• Handle arbitration, settlement negotiations, or lawsuits

Pro Tip: Attorneys often work on a contingency fee basis, meaning you pay nothing unless they win compensation on your behalf.

Learn more about the legal process with personal injury lawsuits.

7. Keep Meticulous Records

Throughout the appeal process, maintain organized, dated records of:

• All letters and emails
• Phone calls and contact names
• Claim numbers and reference codes
• Submissions and responses

Why it matters: If your case escalates to legal action or regulatory review, these records can support your claim and demonstrate that you acted in good faith.

Conclusion

Insurance claim denials are frustrating—but they aren’t the end of the story. By understanding the reason, gathering strong documentation, pursuing internal and external appeals, and involving legal help when necessary, you significantly increase your chances of getting the compensation you're entitled to.

The process takes persistence, but your rights as a policyholder are protected under state and federal law. Don’t hesitate to advocate for yourself—or to ask for help when you need it.