What to Do If Your Insurance Claim Is Denied

Key Takeaways:

• Insurance claim denials are common, but there are clear steps you can take to challenge the decision.
• Review the denial letter, gather relevant documentation, and contact your insurance to clarify the denial.
• File a timely and well-supported internal appeal to try to reverse the denial and secure compensation.
• A personal injury attorney can help interpret policy language, gather additional evidence, challenge unfair exclusions, and take legal action if necessary.
• Contact Lambrou Law today for a free consultation if your insurance company has denied your claim.

When you file an insurance claim after an injury or loss, you expect financial support to pay for the mounting medical bills. It can feel like a slap in the face when insurance instead sends a rejection letter. Unfortunately, insurance companies deny thousands of legitimate claims each year, sometimes based on technicalities or insufficient documentation. If this happens to you, don’t panic. There are clear steps you can take to challenge the denial and assert your rights.

While some people fight insurance denials themselves, you’re usually up against a huge insurance company with a plethora of resources. You need someone in your corner, too. A personal injury legal team like Lambrou Law can walk you through the process. Below, we outline exactly what to do if your insurance provider denies your claim and how legal guidance can make all the difference.

Step 1: Review the Denial Letter Carefully

First, carefully read the denial letter sent by your insurance company. This letter should outline:

• The specific reason for the denial (e.g., lack of coverage, late filing, missing information);
• The relevant sections of your policy that the insurer is relying on;
• Your right to appeal the decision;
• Instructions and deadlines for filing an appeal.

Insurers are legally required to explain why they are denying your claim but can use complex legalese or policy jargon. A personal injury attorney can help you understand why the claim was denied.

Knowing the exact reason for denial is critical. Many claims are rejected due to administrative errors or minor omissions that can be corrected. 80% of appeals can be successful, but only 1% of denied claims are ever appealed. 

How a Personal Injury Attorney Can Help

One of the first things a personal injury lawyer will do is carefully review the denial letter and your insurance policy. Many people find the language in these documents difficult to interpret, as insurers often cite technical policy terms or vague exclusions that seem to contradict your understanding of coverage.

Your lawyer will break down the insurer’s reasoning into plain language, helping you understand whether the denial is based on a justifiable issue or an error and identify whether the insurer may be acting in bad faith. This initial analysis is key to determining the best path forward, whether it’s a simple correction or requires a more aggressive legal strategy.

Step 2: Gather and Document Everything

Next, you’ll want to assemble a complete file of all relevant documents. This will help strengthen your appeal. Be sure to collect:

• All correspondence with your insurance provider (letters, emails, and notes from phone calls);
• The full denial letter;
• Your insurance policy and any related endorsements;
• Medical records, accident reports, photos, repair estimates, and receipts;
• Any previous submissions or communications tied to your original claim.

Documentation is one of your strongest assets. The more evidence you provide, the better chance you have of reversing the denial.

How a Personal Injury Attorney Can Help

A common reason for insurance denials is “lack of evidence” or “insufficient documentation.” A law firm like Lambrou Law works with clients to collect comprehensive supporting materials that respond directly to the insurer’s stated reason for denial. In addition to gathering this evidence, a lawyer helps ensure it is presented in a way that directly addresses the insurer’s concerns and supports your eligibility for coverage. They also make sure that all documentation meets the formatting, procedural, and timing requirements of the appeals process.

Insurance companies are governed by strict state laws and regulations. If your insurer has failed to comply with these legal obligations (such as by delaying responses, refusing to communicate in writing, or issuing blanket denials without investigation), you may be able to take legal action for bad faith insurance practices.

Bad faith can expose the insurer to additional liability, including punitive damages and attorney’s fees. A legal team like Lambrou Law investigates whether these violations occurred and, if so, uses them as leverage during negotiations or litigation.

Step 3: Contact Your Insurance Provider

Once you have reviewed the denial and gathered your documents, it’s a good idea to contact your insurer directly, especially if the denial letter is vague or confusing. When speaking to your insurer, be sure to:

• Ask for a detailed explanation of the denial;
• Confirm what specific information or documents are needed for reconsideration;
• Request a written copy of the denial if you haven’t received one;
• Take detailed notes during the conversation (date, time, name of the representative, and key points);
• Check when the formal appeal is due (if not included in the denial letter).

Occasionally, insurers may reconsider the claim informally once they receive missing or clarifying information.

How a Personal Injury Attorney Can Help

Insurance policies often include exclusions that limit coverage under certain circumstances. For instance, policies may exclude injuries sustained while engaging in “high-risk activities” or claims involving “pre-existing conditions.” However, many of these exclusions are broadly worded and open to interpretation. An experienced personal injury attorney can challenge the insurer’s use of these exclusions if they are overly vague, inconsistently applied, or contrary to public policy. 

Step 4: File an Internal Appeal

Most insurance companies have a formal appeal process, and you are entitled to use it. The appeals process is your chance to make a persuasive case for why the denial should be reversed. Generally, your appeal should include:

Make sure you follow the exact instructions provided by your insurer and meet all stated deadlines. Using the proper forms and submission process is critical.

How a Personal Injury Attorney Can Help

If your internal appeal is denied and the insurer continues to refuse payment despite clear evidence supporting your claim, litigation may be the next step. At Lambrou Law, we are fully prepared to file a lawsuit against the insurance company and fight for your rights in court if necessary.

Litigation is not always the right answer (sometimes insurance denials can be settled out of court), but when it is, we:

• Draft and file a formal complaint;
• Engage in discovery to obtain internal insurance company communications and records;
• Depose insurance representatives;
• Present expert testimony to support the validity of your claim;
• Argue your case before a judge or jury.

Filing a lawsuit sends a strong message to the insurer that you are serious about enforcing your rights. In many cases, it prompts the insurer to settle the matter before trial. Our team at Lambrou Law handles all negotiations to prevent insurers from pressuring you into accepting a low settlement.

Maximizing Your Recovery

Beyond simply overturning a denial, our goal is to help you recover full compensation. That means identifying all categories of damages you may be owed, which may include:

• Past and future medical expenses: Hospital bills, rehabilitation, prescription medication, surgeries, and long-term care;
• Lost wages and earning capacity: Time missed from work due to injury, including potential future income if your ability to work has been impaired;
• Pain and suffering: Compensation for the physical and emotional toll of the injury;
• Property damage: In auto accident cases, this may include repair or replacement costs;
• Out-of-pocket costs: Travel to medical appointments, home modifications, or equipment related to your recovery.

We work closely with economic and medical experts to ensure your damages are properly calculated and supported by evidence. Medical experts can offer insights into the cause of your injury and the long-term impact on your health. Economic experts can help assess financial losses that may impact you after an accident, such as lost wages, diminished earning capacity, or future medical costs.

Take Action With Confidence: Contact Lambrou Law Today

We know how debilitating it can feel when an insurance company seems like it belittles your pain. At Lambrou Law, we walk you through every step of the process when dealing with an insurance claim denial. Whether your insurer is dragging its feet, denying your claim without cause, or relying on technicalities to avoid payment, our legal team has the experience and determination to stand up for your rights.

Insurance companies have teams of adjusters and attorneys working to protect their bottom line. You deserve someone in your corner with the same level of knowledge and commitment.

If your insurance claim has been denied, don’t give up. If you’re in New York, Florida, New Jersey, or Pennsylvania, schedule a free consultation with one of our experienced personal injury attorneys today.