Can You Appeal a Claim Denial?

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When you get that initial denial, or that slap-in-the-face low settlement offer, the first question that comes to mind is how you can appeal this decision. Regardless of what type of insurance claim you’re going through, or even if you went to court for your personal injury, an appeal is an option. Now, how you go about that appeal and how you managed it will drastically change the final outcome. Claim disputes are complex and often require a professional. The best professional that you can pull in to an appeal on any type of injury claim is a Florida personal injury attorney.

Fortunately, Florida has a great many personal injury attorneys, and most have experience in handling claims denials and appeals. At Winters Yonker, we have handled our fair share of claim denials over the years and happily take on appeals. Although it’s typically best to start out with an attorney, it doesn’t mean that when your denial comes in that, an attorney isn’t an option. Fight the denial or fight the extremely low settlement. Personal injuries happen because someone else is responsible, but when you get a denial, it now feels like you have two parties responsible for not helping you get the support you needed.

Why Would a Tampa Personal Injury Claim be Denied?

Personal injury claims can receive a denial for different reasons. The most common reason, however, is that the insurance provider claims you had a significant role in those injuries or the entry for pre-existing. Insurance companies are always on the defense and more than reasonably suspicious at attempts of fraud. So they take every claim very seriously, and they usually approach each claim with the idea that it’s fraudulent.

If you slipped in a store, for example, the insurance company would spend thousands of dollars calling through your past medical records and even past employment history in an attempt to show that you’ve had fraudulent claims in the past. If they believe they find anything suspicious at all, they deny the claim and leave you to sort out the overcomplicated appeals process on your own.

The FBI perpetuates this concern and suspicion of fraud by noting their findings of insurance fraud, costing more than $40 billion per year. Of course, a suspicious note from this information is that the data supporting this comes directly from the insurance companies. What they count as “suspected fraud,” and what they claim are their damages attributed to fraud. Of course, they’re as capable of inflating their numbers as their clients are, so who’s patting now?

Claim Denials and Legal Options

To start an appeal on a claim denial, you can issue a very polite letter or email to the insurance provider, simply stating that you don’t accept their determination. It is very important to remain polite and calm in this process. Aggression and assertion of other clans really discredit your voice and instead supports their suspicion of fraud.

If you feel that had a string of polite letters isn’t going to do anything, which really isn’t too far off base, you can involve an attorney. A personal injury attorney will craft that same letter but would address particular elements of the denial and the evidence provided with the claim. They would essentially draw clear lines between where the denial was unjust or that the evidence wasn’t reviewed properly.

After the appeal gets started, you can go through the appeals department within the insurance provider or head to court. If you open a lawsuit, then you would begin mediation and possibly go to a courtroom, although that’s not always the

Winters Yonker Tampa Personal Injury Attorneys

Contact the Tampa personal injury attorneys at Winters & Yonker for a full review of your claim and why you received a denial or low settlement offer. You don’t have to accept a low settlement offer, and you don’t have to accept a claim denial. The appeals process exists because mistakes happen during clean reviews. So many people work on claims, and it’s possible that anyone from a support team member to the actual claims adjuster could have made a mistake. It is more likely, however, that the involved insurance company simply wants to avoid a payout, and to do that, they turn to some unsavory tactics to achieve unfair claim denials.

At Winters Yonker, we fight those claim denials, and we fight them against car insurance providers, home insurance companies, business liability insurance providers, and more. We’re not afraid to stand up to the high-powered teams that make these decisions. Instead, we take these cases head-on to deliver the best support for our clients.

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