Your Injury Claim Got Denied. Now What?
It stings. You’re hurt, you’ve got medical bills piling up, and the insurance company just told you they won’t pay. But a denial doesn’t mean your case is over. It just means you need to understand why they said no and what your next move should be.
We’ve seen this happen countless times. Insurance companies deny legitimate claims every single day, and many of those denials don’t hold up under scrutiny. Let’s talk about why these denials happen and what you can actually do about them.
Common Reasons Insurance Companies Deny Injury Claims
Insurance adjusters don’t deny claims randomly. They use specific justifications that sound official but often fall apart when challenged. Here are the most common ones we see:
Disputed Liability: The insurance company claims its policyholder wasn’t at fault. They might argue you caused the accident, or that road conditions were to blame. In North Carolina, this matters even more because of our contributory negligence rule. If they can pin even one percent of fault on you, they can deny the entire claim.
Insufficient Medical Evidence: Adjusters love this one. They’ll say your injuries aren’t as serious as you claim, or that your medical records don’t prove the accident caused your condition. Sometimes they argue that you had pre-existing injuries that weren’t made worse by the incident.
Policy Exclusions or Coverage Gaps: The insurance company might claim the type of accident or injury isn’t covered under their policy. They’ll point to specific exclusions buried in the fine print. Or they’ll say their driver didn’t have coverage at the time of the accident.
Late Notification: Most insurance policies require prompt notification after an accident. If you waited too long to report what happened, they’ll use that as grounds for denial. What counts as “too long” varies by policy and situation.
Lack of Documentation: No police report, missing witness statements, or gaps in your medical treatment all give adjusters ammunition to deny your claim. They’ll argue that if the accident was serious, you would’ve documented everything immediately.
What A Denial Letter Actually Means
When you get that denial letter, read it carefully. The insurance company has to explain why they’re rejecting your claim. Sometimes the reason is legitimate. Often it’s not.
The letter will include the policy guidelines and facts that support their final decision. However, just because they have those things, doesn’t mean that your claim is dead. Insurance companies are hoping you won’t push harder after receiving a letter like that.
A denial isn’t a final answer from a judge or jury. It’s just one company’s position. You’ve got options to challenge it.
Your Options After A Claim Denial
Request a Detailed Explanation: If the denial letter is vague, you can demand more specifics. Ask for all documentation they reviewed, the policy provisions they’re relying on, and any statements they obtained. You’re entitled to know exactly why they made their decision.
Gather Additional Evidence: Sometimes, a denial happens because the insurance company didn’t have complete information. Getting more medical records, additional witness statements, or expert opinions can change the outcome. We work with accident reconstruction specialists and medical professionals who can provide the evidence needed to overturn weak denials.
File an Appeal: Most insurance companies have an internal appeals process. You submit new evidence and arguments explaining why their denial was wrong. This can work, but don’t expect the same adjuster who denied you to suddenly change their mind without compelling reasons.
File a Lawsuit: North Carolina gives you three years from the date of your injury to file a personal injury lawsuit. This is often the most effective option because it forces the insurance company to defend its position in court. Once litigation starts, they know you’re serious, and they can’t just brush you off with form letters.
Why Legal Representation Changes Everything
Insurance companies deny claims to save money. When you’re dealing with them alone, they know you probably don’t understand insurance law, policy interpretation, or your legal rights. They use that knowledge gap to their advantage.
A Raleigh personal injury lawyer changes that dynamic completely. We know which denials are legitimate and which are just insurance company tactics. We know what evidence actually matters and how to present it effectively.
At Burton Law Firm, we’ve overturned countless claim denials by building stronger cases and holding insurance companies accountable. We gather the evidence that adjusters conveniently overlooked. We challenge their interpretations of policy language. And when necessary, we take them to court.
Don’t Let A Denial Be The Final Word
Getting your claim denied feels like the end of the road. It’s not. Many denied claims eventually result in full compensation once someone challenges the insurance company’s reasoning and presents a complete case.
The worst thing you can do is nothing. Time limits apply, and evidence gets harder to gather as months pass. Witnesses forget details. Medical records become harder to obtain. Your ability to fight back weakens.
If your injury claim was denied, we can review the denial letter, evaluate your case, and explain what options make sense for your situation. A Raleigh personal injury lawyer can help you determine whether an appeal or lawsuit gives you the best chance at recovery. Don’t accept a denial without understanding whether you can challenge it successfully.