Receiving a denial letter from an insurance company is a punch in the gut. You paid your premiums, you followed the rules, and now, when you need help the most, they turn their back on you. But a d...
Receiving a denial letter from an insurance company is a punch in the gut. You paid your premiums, you followed the rules, and now, when you need help the most, they turn their back on you. But a denial is not the end of the road. In fact, for many personal injury lawyers, it's just the beginning. Insurance companies deny valid claims every day hoping you will just walk away. Don't let them win.
Why Was My Claim Denied?
Common reasons include: 1) Coverage disputes (claiming the accident isn't covered by your policy), 2) Liability disputes (blaming you for the accident), 3) Pre-existing conditions (claiming your injury isn't new), 4) Missed deadlines (like the 14-day PIP rule), or 5) Failure to cooperate. The denial letter must state the specific reason.
Review Your Policy
The first step is to read your insurance policy. It is a contract. Does the reason for denial match the language in the contract? Often, adjusters misinterpret their own policies or rely on ambiguous exclusions that won't hold up in court.
The Appeal Process
You have the right to appeal the decision. This usually involves sending a formal letter with additional evidence (medical records, photos, witness statements) that refutes their reason for denial. A lawyer can draft a powerful appeal that cites Florida law and case precedents.
Filing a Lawsuit
If the appeal fails, your next step is to file a lawsuit for breach of contract. This takes the decision out of the insurance company's hands and puts it in front of a judge or jury. Often, just filing the lawsuit is enough to get the insurance company to come to the table with a settlement offer.
Bad Faith Claims
If the denial was unreasonable and made in bad faith, you may have a separate claim for 'Bad Faith' damages, which can exceed the policy limits. This is a powerful tool to hold insurers accountable.
Contact Emas Law Group Today
A denial is an invitation to fight. At Emas Law Group, we specialize in overturning insurance denials. We review your policy, gather the evidence, and force the insurance company to honor their contract. If you've been denied, call us for a free review.
Frequently Asked Questions
How long do I have to appeal?
Your policy will specify the timeline for internal appeals, but the statute of limitations for filing a lawsuit is generally 5 years for contract disputes (though injury claims are 2 years). Act quickly.
Does it cost money to fight a denial?
We handle these cases on contingency. If we don't recover money for you, you don't pay us. In some cases, the insurance company has to pay our legal fees separately if we win.
Can I just complain to the state?
Yes, you can file a complaint with the Florida Department of Financial Services, but they cannot force the insurer to pay. A lawsuit is often necessary.