Posted in Ask An Attorney on April 25, 2023

If you get injured in a preventable accident, you may be able to hold someone else financially responsible for your medical bills and losses. In this scenario, you will most likely file a claim with the at-fault person’s insurance company. Unfortunately, it is not always easy to receive a fair insurance settlement, especially if you suffered severe or catastrophic injuries. An insurance company may deny your personal injury claim in an effort to protect its own interests. Luckily, you have options when faced with a denial.

Read the Rejection Letter Carefully

Under state law in Texas, an insurance company is required to give you an explanation for a claim it denied. This explanation will be in writing, typically with your rejection notice. Read the explanation carefully to understand the reason the insurance company cannot accept your claim or offer coverage. It may be a simple fix, such as missing information on your original claims form that you can supply. Other common reasons for claim denials include a lapse in coverage, a lack of coverage on the policy, a missed deadline or a liability dispute.

Determine whether you can remedy the problem, such as by offering further proof of your losses. If not, read the language of the insurance policy to determine if the rejection is valid. Sometimes, insurance companies will wrongfully reject claims without due cause. Insurance companies are for-profit businesses that may try many tactics to save their investors money. If the reason for the denial does not make sense or is not aligned with the terms of the policy, you may be a victim of insurance bad faith.

Appeal the Decision Internally

If you believe your claim has been denied in error, you can request an internal review by someone else at the insurance company, also known as an appeal. Contact the insurer and let them know that you believe there has been an error. It may be a mistake that someone can easily fix. Otherwise, tell them that you wish to request an internal review of your claim. The claims adjuster originally assigned to your case will pass it to a supervisor, who will review the facts and may reverse the decision.

Seek an External Review or File a Complaint

If the insurance company’s review of your claim does not result in a different outcome, you can seek help from an outside party. For example, you can report the unfair claim denial to the Texas Department of Insurance. They can conduct an unbiased third-party review to give an opinion as to whether the rejection was valid. If not, the Department may require the insurance company to pay your claim. The insurance company may also face penalties, such as owing you an additional amount in accrued interest.

Fight the Denial With Help From an Attorney

If the insurance company continues to wrongfully reject your claim or deny liability for your injuries, contact a San Antonio personal injury lawyer for advice. An attorney can take over your case and communicate with the insurance company on your behalf. Hiring a lawyer is often enough to motivate an insurance company to reevaluate a claim. The insurance company knows an attorney has the power to go to trial – something the insurer wants to avoid, as it can be costly for the carrier. Hiring a lawyer may be enough to result in a fair settlement offer.

File an Insurance Bad Faith Claim

With help from an attorney, you may also be able to file a bad faith insurance claim against the provider. Insurance bad faith refers to a company knowingly or intentionally mishandling a claim (handling it in “bad faith”). All insurance companies have a legal obligation to make a reasonable effort and a good faith attempt to resolve valid claims. Rejecting a claim without reason or refusing to offer a reasonable settlement are examples of insurance bad faith that could entitle you to further compensation on top of your original claim.

For assistance with a denied insurance claim, contact Maloney & Campolo for a free case consultation with an attorney.