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Options for Overturning a Denied Insurance Claim

June 14, 2023
overturning denied insurance

After months of waiting for the insurance company’s decision about your claim, you hear the bad news: The insurer has denied your claim, and you aren’t eligible for any compensation for your injuries.

So what do you do next? Thankfully, all is not lost. You have a few options to attempt to overturn a denied insurance claim in Texas.

Option 1: Request a Written Explanation and Review It Closely

The insurance company will likely send your claim denial in the mail. It may ask you to sign the document and send it back, finalizing the denial. 

First, don’t sign anything. Your signature will indicate that you agree with or accept the denial. Instead, read the denial letter closely to understand why the insurance company denied the claim. 

If the letter doesn’t give much detail, contact the insurance company to request a written explanation of the denial. Insurance companies may deny claims for any of these valid reasons:

  • The injuries are from pre-existing conditions.
  • There are no injuries or damages to pay for.
  • The accident was avoidable.
  • The policy excludes the specific type of accident that you are involved in.
  • You did not file the correct paperwork.
  • The coverage has lapsed.
  • There is no coverage

Review the denial letter closely with an attorney to determine whether the insurance company’s reasoning is valid. 

Option 2: Appeal the Decision 

Typically, you have a right to appeal the insurer’s claim denial. You’ll need to provide additional evidence to account for the insurance company’s reasoning for the claim denial. For instance, if the insurance company says:

  • There are no injuries or damage to pay for, you’ll need to submit medical bills and evidence of property damage. 
  • Your injuries were pre-existing, you can submit additional medical records to substantiate your claim.
  • The accident was avoidable, you must provide additional showing why you couldn’t avoid the accident, such as through videos or witness testimonies. 

Approaching this process strategically is essential to improve your outcome. You’ll want a personal injury to review your appeal application closely or even help you write it. Most insurance companies only allow two internal appeals, and you don’t want to waste either of these opportunities and risk ending up with no compensation for your injuries and expenses.

Option 3: Request an External Review

Submitting an internal appeal should be your first step. If the insurance company denies the claim again, you can consider requesting an external review of the claim. 

Insurance companies must act in good faith, treating all customers and claimants fairly and reasonably. If the insurance company denied your claim for no good reason, it may have acted in bad faith. You can request that an outside, independent organization review the claim.

The third party will either uphold the insurance company’s decision or rule in your favor. 

Option 4: Seek Compensation Directly from the At-Fault Party

If you’ve exhausted every option to overturn your denied insurance claim, you may need to use a different route for seeking compensation. For example, you could file a personal injury lawsuit against the at-fault party to seek a payout for your injuries and physical damage. 

Your attorney can help you determine your next steps after a claim denial. If you decide to take legal action, they can guide you through the appeals process and represent you in court or mediation. 

Your Attorney Can Guide You Through a Claim Denial 

If you’re dealing with a denied insurance claim, you don’t have to take the insurance company’s decision as final. The attorneys at Fadduol, Cluff, Hardy & Conaway, P.C. help accident victims appeal denied insurance claims. Call 432-335-0399 to schedule a consultation.