What to Do When Insurance Delays or Denies an Injury Claim

Ask for a written explanation

Request the decision, the policy provisions relied upon, missing information, and the next review or appeal step. A phone explanation can be useful, but a written record helps identify whether the dispute concerns coverage, causation, valuation, liability, or paperwork.

Build a claim timeline

Create a chronological file from the incident through every submission and response. Include claim numbers, dates, adjuster contacts, medical records, bills, wage proof, photographs, estimates, and receipts. Send copies rather than irreplaceable originals and keep proof of delivery.

• Use a single index for correspondence and supporting documents.
• Record what the insurer requested and when you supplied it.

Answer reasonable requests carefully

Cooperate with legitimate policy obligations while protecting privacy and accuracy. Ask why a request is relevant, clarify unclear forms, and correct factual errors promptly. Do not guess about medical history or sign a broad release without understanding its scope.

Escalate through available channels

Ask for supervisor review, use the policy’s appeal or appraisal process when applicable, and consider a complaint to the state department of insurance. Those options have different purposes and do not necessarily replace a civil claim or extend a filing deadline.

Get advice before accepting a final settlement

A check, release, or settlement agreement can affect later claims and liens. Compare the offer with documented medical care, income loss, property damage, and future needs. State law, policy language, and the evidence determine what is reasonable; deadlines continue to matter during negotiations.

Frequently asked questions

Related guides