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Your Personal Injury Claim Has Been Denied. What is the Next Step?

Your Personal Injury Claim Has Been Denied. What is the Next Step?

"personal injury claim form" written on document

You were out biking, as usual on your day off, following all the rules of the road. Suddenly, a speeding car from runs into you from behind knocks you down, and you’re left with multiple injuries. Fortunately, the injuries were not that severe. Yet, it took you weeks to recuperate.


Next, armed with all documents, you file the accident claim. You were pretty sure about getting the claim without any delay as it was entirely the fault of the car driver. You get the shock of your life when you hear that your claim was denied.


What do you do then? Just forget it and carry on with the burden of all bills and expenses? Of course not! The denial of a claim can be shattering but do not lose hope and give up. Contact a personal injury lawyer so that you can proceed further and dispute the denial. Here’s what you should do next:


Study the Denial Letter


Go over the insurance policy carefully for a detailed review and consult a lawyer if you don’t understand something. Find out if there is any exclusion mentioned. The policy document may contain lots of clauses and sub-clauses, some of the terms may be hard to decipher. That is where your attorney can simplify the text for you. Sometimes, there can be misleading information that can be used while you challenge the insurance company.


Thus, it is important to understand each and every clause of the insurance policy. Also read the denial letter carefully, and you can ask your lawyer to correlate the letter and policy to see if there are any mismatches.


Discuss with an Attorney


Accidents most often require hospitalization and may take a few days for the injury to heal. In case of a severe injury, it will not only require weeks of hospital stay but also a long time to completely recover. This will mean losing out on work and also not being able to enjoy your day to day life. Receiving the claim amount is important to help you regain the reins of your life. You just cannot afford to lose it. So, you should discuss with a lawyer experienced in personal injury cases and then proceed to file your appeal. Never deal with the insurance company alone. They may try to confuse you with technical jargon, and you may be then left with no choice but to forego the claim or settle for a lower amount.


Send Your Reply


Take the help of your personal injury attorney to draft a concise reply, also known as the dispute letter, to the insurance company. The letter should mention the reasons clearly. You should state why you find the denial to be unjust and also mention the points that you could not understand. At the same time, list one or more incorrect information you have found.


This letter is important and hence you should take utmost care in drafting it. Your lawyer would know how an impressive and hard-hitting dispute letter is prepared.


Generally, insurance companies opt for an arbitration hearing. These hearings often give the company an upper hand. In such a case, your lawyer who has dealt with such hearings in the past can be your best guide. A legal professional’s presence will not only make the insurance company see that you mean business, but you will also be better prepared to deal with the proceedings.


Seek Legal Action


If the insurance company still sticks to its denial even after receiving your dispute letter, your next course of action is to file a lawsuit. Your lawyer will do the needful. There are mainly two grounds on which the lawsuit can be filed, breach of contract or bad faith.


When you sign the insurance papers, there is a contract with the insurance company that is drawn to protect your interests as well. When the insurance company denies the personal injury claim you deserve, they are breaching the contract.


“Bad Faith” is referred to improper handling of your case which involves the insurance company’s failure to take steps to investigate, analyze and study your claim and thereby, denying a rightful claim.


The Law Offices of Craig Altman are here for you. If your claim has been denied, and you are struggling the get all the answers, give us a call at 215-569-4488 to find out how we can help you with a dispute letter or filing a lawsuit.

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