Understanding your rights when an insurance claim is denied.
Insurance companies deny claims for many reasons — some legitimate, some not. Common reasons include policy exclusions, late filing, alleged misrepresentation, and disputes over the amount of a loss. Understanding the stated reason for a denial is the first step in evaluating your options.
Most insurance policies include an internal appeal process. You generally have the right to request a written explanation of the denial and to submit additional documentation. For health insurance, federal law provides additional external review rights in many circumstances.
Insurance claims and legal rights may be subject to strict deadlines — including statutes of limitations, policy notice requirements, and appeal deadlines. Missing a deadline can permanently affect your rights. Do not wait to seek legal advice if you believe your claim was wrongfully denied.
An attorney who handles insurance disputes can evaluate whether your claim was wrongfully denied, advise you on your options, and represent you in negotiations or litigation. Many insurance attorneys work on a contingency basis, meaning you pay no fee unless you recover.
Insurance companies have a legal duty to handle claims fairly and in good faith. When an insurer unreasonably denies or delays a valid claim, it may be acting in bad faith. Bad faith claims can result in damages beyond the original claim amount, including attorney fees and punitive damages in some states.
Every state has an insurance regulatory agency that oversees insurance companies and handles consumer complaints. Filing a complaint with your state regulator is free and can sometimes prompt an insurer to reconsider a denial. Your state regulator can also tell you whether an insurer is licensed and in good standing.
The information on this page is general in nature and is not legal advice. WrongfulDenials.com is not a law firm and does not provide legal advice or legal representation. Consult a licensed attorney for advice about your specific situation.