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How Does the Appeals Process Work if Your Personal Injury Claim is Denied?

Posted on behalf of Anderson Cummings on Aug 24, 2020 in Personal Injury

claims-binder-yellowInsurance companies are known for denying personal injury claims, even if the victim has a valid claim. However, all hope of recovering compensation is not lost. If your personal injury claim was denied you may be able to file an appeal with the help of a licensed attorney. You may also have the right to file a lawsuit.

The Fort Worth personal injury lawyers at Anderson & Cummings have in-depth knowledge and experience with denied insurance claims. We can review the details of your denied claim in a free case evaluation and determine whether you may still be able to obtain compensation to cover medical costs, lost wages, pain and suffering, and other damages. Our goal is to pursue the maximum compensation to help you through the recovery process.

Below, our lawyers explain the common reasons why claims are often denied and the steps our lawyers may be able to take to file an appeal.

What Causes Claims to be Denied?

Since insurance companies are in the business of saving money, they are always looking for any minor misstep to use as a reason to avoid paying the full value for your claim. If you have a viable claim, our lawyers can help you understand why your claim was denied and what to do next.

Claims are often denied for one or more of the following reasons:

  • Your claim was filed after the due date – Every state has a statute of limitations, which is the deadline when you must file your claim. Texas requires most personal injury claims to be filed within two years, however, your deadline may be different, depending on the details of your situation.
  • Lack of evidence – You did not provide enough evidence to prove your claim. Our lawyers can help gather the evidence you may need to strengthen your claim.
  • Your statements are inconsistent – If you give false, misleading or inconsistent statements, the insurance company could use this against you to deny your claim.  
  • Your demands are too high – Insurers will usually deny your claim if they feel your demands far exceed your damages. Your lawyer can help calculate a fair amount for the damages you sustained.
  • You were under the influence – Sometimes claims are denied if the victim was under the influence of alcohol or drugs at the time of the accident.

Steps to Take After Your Claim is Denied

The first thing you should do after your injury claim was denied is discuss your situation with a licensed attorney. Since our attorneys deal with these types of claims daily, we know what to look for to try to overturn the denial of your claim. This may include additional evidence, such as interviews with industry experts and testimony from industry experts.

It is important to continue attending medical appointments and save all documentation, including bills and reports related to your injury. We suggest keeping a medical journal documenting your pain and suffering and any other improvements or setbacks with your health.

Try to avoid communicating with insurance adjusters and let your lawyer discuss the details on your behalf. You may say something that could be used against your claim.

Filing a Lawsuit

If you are not satisfied with the outcome of your claim, your lawyer may be able to file a lawsuit to pursue the compensation you are seeking. You may be required to go through mediation first – this is where the parties involved meet with a neutral mediator to try and come to a mutual agreement.

If mediation does not solve the issue, your case may proceed toward trial. Both sides would prepare to present their case before a judge and jury.

Talk with an Attorney about Your Denied Claim

Call Anderson & Cummings today to learn more about the appeals process. We handle cases of all sizes, big and small.

We can determine if you have a viable claim during your free initial consultation. There are no hidden costs or fees to pay up front. We only receive payment if we win compensation on your behalf.

Our dedicated team of legal professionals is ready to help. (877) 920-9009