Free Consultation

Facing a denied insurance claim after you’ve experienced a traumatic event is frustrating and disheartening. Insurance companies may deny claims for various reasons: some are legitimate, and others can be quite questionable. You don’t have to accept their decision passively. Talk to your car accident attorney in Caldwell, TX and Buffalo, TX to go over the various strategies that can be helping when your claim is denied.

8 Legal Strategies for Denied Insurance Claims

1. Review the Denial Reason

Your first step should be to examine the denial letter carefully. You need to thoroughly understand the specific reason cited for refusing your claim so you can counter it effectively. Is it missing information? A different form or a phone call could clear everything up. Is it a coverage dispute? Your lawyer will help you uncover who is liable for your accident and thus responsible to pay, as well as help you wade through all the terms and conditions of your policy.

Is it an allegation of fraud? Again, your lawyer will help you gather the necessary evidence to show that you’ve really been injured by the actions of another. Also, keep a detailed record of all communications with the insurance company, including dates, times, and a summary of your conversations. If you have been corresponding via email or letters, make sure to keep copies of all these communications. This documentation can be crucial if you need to escalate your claim or take legal action.

2. Gather Evidence

Assemble as much evidence supporting your claim as you can. This might include medical records, accident reports, police statements, eyewitness testimonies, photographs of damage or injuries, repair estimates, and receipts for out-of-pocket expenses. The more comprehensive your evidence file, the stronger your case.

3. File an Appeal

After reviewing your policy and gathering additional evidence, the next step is to contact the insurance company. Reach out to the representative who handled your claim or the company’s claims department for clarification. In some cases, the denial may be a result of a misunderstanding or an error that can be resolved through discussion.

Most insurance companies have an internal appeals process, and this is often the best first line of attack if the issue isn’t simple. If it’s your own insurer, review your policy documents. If you’re dealing with another driver’s insurance company, contact the insurer directly to understand the procedure and deadlines for filing an appeal. Submit a formal letter contesting the denial, addressing the specific reasons cited, and providing your supporting evidence.

4. Negotiate with an Adjuster

Sometimes, reaching a settlement offer through negotiation with the insurance adjuster can resolve the issue. Be prepared to present your case logically and calmly, highlighting the validity of your claim and the financial burden you’re facing due to the denial. Even better, have your lawyer do this. Your lawyer will know how to deal with the insurance company, what kind of language they find persuasive, and how to negotiate from a position of strength.

5. File a Complaint with the Texas Department of Insurance

If you’ve attempted to resolve the issue with your insurance company without success, the next step is to file a complaint with the Texas Department of Insurance (TDI). The TDI oversees insurance companies operating in Texas and ensures they comply with state insurance laws and regulations. Filing a complaint is a formal way to request an investigation into your claim’s denial.

To file a complaint, you will need to provide details about your claim, the reason for the denial, and any relevant correspondence with the insurance company. The TDI will review your complaint and may contact the insurance company for their response. While the TDI cannot force an insurance company to pay a claim, their involvement can put additional pressure on the insurer to resolve the dispute fairly. Moreover, if the TDI finds that the insurance company has violated any insurance laws or regulations, it may take regulatory action against the company.

6. Consider Alternative Dispute Resolution Methods

Before proceeding to litigation, you might consider mediation or arbitration. These methods are often quicker and less expensive than going to court. They involve having a neutral third party help the disputing parties reach a settlement.

Mediation is a collaborative approach, where the mediator facilitates discussion and helps both parties find a mutually agreeable solution. Arbitration, on the other hand, is more like a court proceeding, but less formal. An arbitrator hears both sides and then makes a binding decision. Many insurance policies include arbitration clauses, so review your policy to see if this is an option for your dispute.

7. Take Legal Action

If all else fails and you believe strongly in the validity of your claim, litigation might be the final step. Taking legal action against an insurance company is a significant decision, and going to court will certainly be time-consuming and may be expensive. However, if you have a strong case and can show that the insurance company is withholding legitimate compensation or acting in bad faith, the court may require them to pay your court expenses and fees. Talk with your car accident attorney about the best course of action for your case.

During litigation, your attorney will present your case, including all evidence supporting your claim and demonstrating how the insurance company’s denial violates the terms of the policy. The court will then decide on the matter. Keep in mind that success in court can depend on many factors, including the strength of your evidence, the specifics of your policy, and the particular circumstances of your case.

Understanding the Legal Process

If your case goes to court, the litigation process begins with filing a complaint against the insurance company, outlining the basis of your claim and the reasons why you believe the denial was unjust. The insurance company will then respond, and the discovery phase will begin. During discovery, both sides exchange evidence and information relevant to the case. This phase is crucial, as it’s an opportunity to gather further evidence supporting your claim, such as depositions, documents, and expert testimony.

As the case progresses, be prepared for pre-trial motions and hearings. These determine what evidence will be admissible in court or even if the case should be dismissed. After this will come the trial proper, unless things are halted by a late negotiated settlement.

8. Negotiate a Settlement Before Trial

Even after initiating litigation, there is still the possibility of settling the case before it goes to trial or even after trial has begun. Settlement negotiations can occur at any stage of the litigation process. In Texas, many cases are settled out of court, as it can save both parties the time and expense of a trial.

In some cases, the insurance company may be hoping you won’t call their bluff and will accept their denial; when you show them otherwise by taking things to court, they may suddenly come to the bargaining table in better faith. Your attorney will negotiate with the insurance company on your behalf, striving to reach a settlement that adequately compensates you for your claim.

Contact a Car Accident Attorney in Caldwell, TX and Buffalo, TX for Help

Dealing with a denied insurance claim is frustrating, and especially when you’re facing the vast resources and experienced legal teams of an insurance company. With the right strategy and legal support, you can get a better result. For experienced help that will level the playing field for you, contact Brian Gutierrez, Personal Injury Trial Lawyer right away for a free consultation.