Insurance should be there to help us financially when unexpected injuries occur. Unfortunately, this is not always what happens. Insurance companies frequently deny claims that deserve fair compensation. If your claim is denied, you should contact an attorney for help as soon as possible.
If the other person’s insurance company, or your own, denies your injury claim, your first step is to call a lawyer for legal help. Your attorney should then help you gather the paperwork and documentation related to your claim that you may need to take legal action. When you have everything you need, your lawyer can help you appeal the denied claim to the insurance company or file a lawsuit. If the insurance company still refuses to approve your claim, your attorney may help you sue for wrongful denial of your claim.
Call our Texas personal injury attorneys with Cap City Injury Attorneys at (512) 612-3110 and ask for a free, confidential legal review to start your case.
What Steps Should I Take if Insurance Denies My Injury Claim in Texas?
Taking the following steps after your insurance claim for an injury is denied may help you get the compensation you need.
Call a Lawyer
First, you should call an experienced personal injury lawyer for help. Insurance claims are a normal part of personal injury cases, and an attorney may help you navigate the insurance claims process. In a first-party claim, your lawyer can help you appeal a denied claim. For third-party claims with other people’s insurance, you may not be able to appeal, but you can sue.
Gather Documentation
Next, you and your lawyer must gather documentation related to your claim. Insurance claims revolve around paperwork, and missing paperwork is a common cause of denied claims. If there are any forms or documents you need (e.g., medical records, police reports, specific insurance forms), your attorney should help you gather them. For first-party claims, you should also review a copy of your insurance policy with your attorney so they can help you make sure your policy covers your injuries.
File an Appeal with Your Insurance Company
If you filed a first-party claim that was denied, you have the option of filing an appeal with the insurance company. When you have everything you need, your lawyer can help you file an appeal. Your formal denial letter should include the information needed to begin the appeals process, including the specific reasons your claim was denied. If your letter does not explain the denial, or it does not explain your appeal options, the insurance company might have made a mistake. In such cases, your attorney can help you contact the insurance company about the error.
File a Lawsuit
If you file a third-party claim with someone else’s insurance and your claim is denied, you may file a lawsuit against the other person for damages. If you prove your claims in court, the other person’s insurance company may be legally compelled to cover your damages. Alternatively, the other person might have to pay for your damages out of their own pocket.
Why Might an Insurance Company Deny My Injury Claim?
Insurance companies frequently deny injury claims for all kinds of reasons. Unfortunately, some of these reasons are not always valid, and denied claimants should seek legal counsel.
Improperly Filed Claims
It is possible that your claim was not properly filed, and the insurer denied it on procedural grounds. Missed filing deadlines, missing insurance forms, or incorrect information on insurance forms are among the common mistakes that may result in a denied claim. If this happens, your attorney may be able to help you correct the mistakes and refile the claim.
Lack of Evidence
Another possibility is that you did not provide enough evidence to convince the insurance company of your injuries. When filing injury claims, our Texas personal injury lawyers need extensive information about your injuries, diagnoses, and medical costs. Again, if you can provide additional evidence with a lawyer’s help, you might be able to get your claim approved.
Bad Faith Denial
If the insurance company denies your claim for a bogus reason, you and your lawyer may need to sue for wrongful denial or bad faith dealings. When assessing claims, insurance companies must deal in good faith. If a claim is covered by a policy, the insurance company should approve it, even if it costs them a lot of money. Changing policy terms without informing policyholders, failing to correct errors, and unnecessarily delaying the processing of a claim are common examples of bad faith dealings.
FAQs About What to Do if Insurance Denies Your Injury Claim in Texas
What Should I Do After My Injury Insurance Claim is Denied?
If your insurance claim for an injury is denied, you should contact an attorney to help you. Insurance companies must have an appeals process for denied first-party claims. When you receive your formal denial letter, it should contain specific details about why your claim was denied and how you can initiate the appeals process. If it does not, or you never received such a letter, tell your lawyer immediately.
What Do I Need to Begin an Appeal of My Denied Insurance Claim for an Injury?
To start the appeal process, you need documentation and evidence about your injury claim. The denial letter is crucial because it must include specific details on why your claim was denied. If your letter is vague or fails to explain why your claim was denied, something is wrong. You should alert your lawyer immediately. You should also have a copy of your insurance policy and evidence of your injuries when you begin the appeal.
Do I Need to Sue if Insurance Denies My Injury Claim?
Maybe. For third-party claims, which are very common in injury cases, injured victims may not be able to file an appeal with someone else’s insurance company. However, that does not mean you are out of options. An attorney can help you sue if your third-party claim is denied. If you prove your claims in court, the insurance company may be ordered to pay.
Why Would Insurance Deny My Injury Claim?
Insurance companies often deny injury claims for a lack of evidence. If you did not present enough evidence of your claim, your attorney may help you gather more evidence for your appeal. In other cases, filing mistakes, clerical errors, or missed deadlines might lead to a denied claim. Again, your denial letter should explain why your claim was denied and how you can appeal.
What Evidence Do I Need When I File an Insurance Claim for an Injury?
When you file your initial injury claim, you need evidence of your injuries. Medical records, photos of the injuries, and police reports may all be necessary. Your attorney can contact your insurance provider and inquire about what kind of evidence is necessary before you file the claim. Remember, evidence may be unique to your claim.
Do I Need a Lawyer if My Injury Claim is Denied by Insurance?
While many injured victims attempt to handle insurance claims on their own, this is not always a good idea. An attorney can help you gather necessary evidence and file your claim without any mistakes or clerical errors. Also, insurance companies tend to cooperate a bit more when they know lawyers represent claimants.
Talk to Our Texas Personal Injury Attorneys if Your Claim is Denied
Call our Austin, TX personal injury attorneys with Cap City Injury Attorneys at (512) 612-3110 and ask for a free, confidential legal review to start your case.