Insurance companies deny valid claims more often than many injured drivers expect. Sometimes it is a technicality, like a missed deadline or a form completed with the wrong code. Other times the denial rides on a disputed medical opinion or a strained reading of policy language. After years of negotiating with adjusters, arguing with special investigations units, and litigating coverage disputes, I’ve learned that the way you respond in the first days after a denial can shift the entire trajectory of a case. The goal is simple: reopen the claim, force a fair re-evaluation, and, if necessary, position the matter for a strong courtroom result.
This guide unpacks how an accident injury lawyer dissects a denial letter, cures curable issues, and builds pressure for payment. Whether you are an injured person gauging your next move or a practitioner refining your approach, the strategies below come from real-world outcomes, not theory.
First, decode the denial
A denial letter is both verdict and roadmap. Adjusters are trained to supply at least a reason code with some supporting text. The wording tells you where the insurer thinks it can defend its position. Common grounds include late notice, disputed liability, policy exclusions, gaps in medical care, preexisting conditions, unapproved treatment, lack of medical necessity, or “malingering” flags triggered by an algorithm.
Look for three things in the letter. The policy basis, any cited facts, and the procedural posture. If the denial quotes specific policy pages or endorsements, pull the exact version that was in force on the date of loss. Policies change mid-year through endorsements, and an incorrect form number can crack a denial wide open. If the letter relies on facts that came from a recorded statement, a police report, or social media, request the underlying materials so you can address inaccuracies. Finally, note whether the letter calls the decision “final,” “preliminary,” or “subject to appeal.” Many states require internal appeals before you can bring certain claims under unfair claims practices laws.
When clients bring me a denial, I mark up the letter like a contract: I highlight policy citations, underline assumptions about causation, and box any deadlines. More than once, the path to reversal was as simple as, “You cited the 2023 exclusion form, but the policy effective on the date of loss used the 2021 form. The 2021 form did not exclude [treatment or circumstance]. Please reconsider.”
Timing is a quiet weapon
Deadlines control everything. Some are in the policy. Others are in statute. You can lose leverage, or the entire case, by waiting too long to act. On the injured party’s side, you typically have a claim notice window spelled out in the policy and, separately, a statutory limitation period for filing a lawsuit. Many states give two years for injury claims, some give three, a few give less. For uninsured and underinsured motorist claims, notice and consent-to-settle rules are especially unforgiving.
On the insurer’s side, states impose performance timelines. For instance, an insurer may have 30 days to acknowledge a claim and 40 days to accept or deny after receiving proof of loss, with extensions for reasonable investigation. If you can document a blown deadline or an investigation that drifted without cause, you gain credibility for a bad faith argument. I keep a simple spreadsheet: date of claim, date of acknowledgment, dates of all requests for information, date of denial, and dates of my responses. The timeline often speaks louder than any demand letter.
Fix the easy things first
A surprising number of denials stem from fixable issues: missing medical records, unsigned authorizations, or unclear billing. An auto accident attorney who has navigated hospital systems knows exactly which department can produce the missing discharge note or MRI interpretation. Before launching a legal broadside, I mop up the gaps. It shows good faith, and it removes excuses. I also address ICD and CPT coding if the billing makes the care look like a preexisting condition. A one-line note from the treating provider tying the diagnosis to the crash date can neutralize a “not medically necessary” denial.
If the insurer objects to specific treatments, ask your doctor for a short statement that explains why that therapy was necessary in plain language. Adjusters respond to clarity. “Patient presented with positive straight leg raise and dermatomal numbness consistent with L5 radiculopathy; MRI confirmed disc herniation; epidural steroid injection reduced pain from 7/10 to 3/10 and restored ability to sit for work” is stronger than “care appropriate.”
Handle the recorded statement with care
If your client already gave a recorded statement that the adjuster is now twisting to deny coverage, order the audio or transcript. I have seen a single imprecise answer, like “No, I’m fine,” at the crash scene undermine months of later treatment. Pain evolves. Shock masks symptoms. A car crash lawyer must put that in context. When I prepare clients for any statement or examination under oath, I emphasize accuracy over speed. We review the timeline, known facts, and uncertainties. “I don’t know” is acceptable if it is true. Guessing is ammunition for denials.
If the insurer demands an examination under oath, read the policy to confirm the carrier’s right to it and limit the scope to relevant topics. Bring your own recorder. Object to harassing or compound questions. Afterward, send a concise letter correcting any transcription errors and clarifying ambiguous answers.
Disputed liability: build the facts, not the volume
Liability denials come in flavors. Rear-end collisions are often admitted, but the fight shifts to causation. Intersection crashes trigger comparative negligence arguments. Parking lot collisions become “he said, she said” battles. Quantity of documents helps, but quality wins.
I start with the scene. Obtain the full police report, not just the front page. Ask for supplemental narratives, diagrams, and any bodycam or dashcam if your jurisdiction allows it. Canvas the area for cameras. Many gas stations and stores overwrite footage within days. If damage patterns matter, hire a reconstructionist early. A modest spend on a 3D scan of the vehicles and skid marks can refute an aggressive denial. When an insurer insists that your client was speeding, show them the airbag control module data instead of arguing about estimates.
Witnesses fade. Track down phone numbers from the police report, then reach out with a polite, neutral request for a short call. If the person is hesitant, offer to accommodate their schedule and explain that you only need their independent recollection. Jurors care about ordinary people who saw what happened, not speculative narratives. Adjusters know this and adjust their posture when you bring witness statements that would play well at trial.
Medical causation: connect the dots without overreaching
Carriers love the word “degenerative.” It appears whenever an MRI shows any preexisting condition, which is true for most adults past 30. The question is not whether the spine showed wear; it is whether the crash aggravated a condition to the point of disability. A careful accident injury lawyer anticipates this argument by obtaining prior medical records and having the treating physician speak to baseline function. If your client jogged five miles three times a week before the collision and cannot stand for more than 15 minutes after, that delta is powerful evidence, regardless of disc desiccation.
Independent medical examinations are rarely independent. That does not make them useless. Read them closely. Look for internal contradictions. I once turned a denial around because the IME doctor wrote, “Patient reports no prior neck complaints,” then dismissed the injury as preexisting. That sentence locked the insurer into an awkward position. Your own expert should be chosen for communication skills as much as credentials. Jurors and adjusters car accident law firm respond to clear, conservative opinions that acknowledge uncertainty while drawing fair conclusions.
When policy language is the battlefield
Policy interpretation is where an auto injury attorney can create leverage others miss. Exclusions, endorsements, and definitions carry weight. Examples that often trigger denials: rideshare exclusions, “livery” provisions for delivery drivers, resident relative disputes, permissive use limitations, step-down clauses, and late notice provisions. Many of these have exceptions or are interpreted narrowly in your jurisdiction.
Pull the most recent appellate cases and the Department of Insurance bulletins. A three-paragraph letter that cites a controlling case can do more than a ten-page diatribe. I keep a small bank of go-to authorities by state for uninsured motorist offsets, med pay coordination, and consent-to-settle rules. If a carrier denies under a rideshare exclusion, check whether the platform’s policy applies primary coverage during app-on status and whether the facts place your client in a coverage gap. I have resolved several denials by coordinating the rideshare insurer and the personal policy, each of whom assumed the other would pay.
The appeal packet that actually gets attention
An internal appeal is not a formality. It is your best shot at a quiet win. I structure an appeal like a trial brief, then edit it down so a busy claims manager can absorb it in one sitting. The packet includes a cover letter summarizing the dispute and the precise relief sought, a factual timeline with citations to records, the key medical reports, targeted photos or diagrams, and a short legal section addressing policy language and applicable statutes. I avoid noise. If the issue is medical necessity, I don’t bury the adjuster in liability materials.
The tone matters. Respectful, organized, firm. If the carrier made a procedural misstep, note it and reserve rights for a bad faith claim without bluster. I propose a clear path to resolution, such as reinstating PIP benefits through a specific date or tendering policy limits on liability while UM/UIM issues remain under evaluation. Giving the insurer a reasonable off-ramp can move a file off the denial track.
When to escalate to regulators or litigation
Not every denial deserves immediate litigation. Filing too early can stall negotiation and harden positions. That said, regulatory leverage helps when an insurer ignores clear obligations. If your state has an Unfair Claims Settlement Practices Act or similar regulations, cite it selectively. Complaints to the Department of Insurance work best for systemic delays, repeated failure to explain denials, or refusal to provide policy documents. Keep the complaint factual, attach exhibits, and avoid advocacy that reads like a demand letter. Regulators look for compliance failures, not damages narratives.
Litigation becomes necessary when evidence must be preserved or when the denial rests on a legal question ripe for the court. A car accident law firm familiar with the venue’s judges can often predict how a coverage issue will land. Filing a declaratory judgment action early can lock in a favorable forum, especially in UM/UIM disputes. Just remember that filing shifts timelines and triggers defense resources. Have your proof ready. The best car accident lawyer I know keeps a “complaint-ready” folder from day one: photos, certified policy, recorded statement transcripts, medical summaries, and witness contacts.
Don’t let property damage set the tone for injury denials
Insurers sometimes soften resistance on bodily injury if the property damage claim is handled professionally. Make sure the PD file is clean. Provide clear photos, repair estimates, and total loss valuations. If the https://www.legalreader.com/5-common-mistakes-to-avoid-when-filing-a-truck-accident-claim/ car’s diminished value is real, document it with market comparables rather than aspirational numbers. When the defense cannot cast your client as opportunistic on the PD side, it undercuts the narrative that the injury claim is inflated. Small disciplines matter: prompt title submission, clarity on rental dates, and avoidance of double-dipping on storage fees.
Social media and surveillance: assume you are being watched
Denial letters occasionally contain a line that reveals surveillance: “We observed the claimant lifting heavy items” or “We identified recreational activities inconsistent with reported limitations.” Most surveillance is mundane. The footage shows a person living life, not running marathons. Context beats panic. If a clip shows a client carrying groceries, have the client explain pain afterward or the need for help at home. The worst move is to attack the existence of surveillance rather than integrating it into an honest story. I also tell clients, early and often, to avoid performative posts. A selfie at a wedding does not equal a pain-free spine, but it can fuel skepticism.
Special investigations and fraud flags
Special Investigations Units open files when the algorithm blinks. Late-reported crashes, low-impact collisions with high treatment costs, and prior claims histories trigger extra scrutiny. Treat SIU like a formal process. Deliver requested documents that are reasonable, refuse fishing expeditions, and keep a calm tone. If they ask for tax returns without a wage loss claim, push back. If they insist on a blanket HIPAA authorization, propose targeted releases. A professional, boundaries-respecting posture signals you are not afraid of a fair look but will not tolerate overreach.
Med pay and PIP: don’t leave easy money on the table
Medical payments coverage and personal injury protection are often overlooked or mishandled. These benefits are contractual, fault-blind, and can keep treatment on track while liability is sorted. Insurers sometimes deny med pay or PIP by claiming treatment was not reasonable or necessary. The strategy mirrors the bodily injury playbook: clean records, concise doctor letters, prompt submissions. If the policy allows the insurer to offset PIP against UM/UIM, understand how your jurisdiction calculates that offset. I have preserved thousands for clients by sequencing settlements carefully, such as resolving liability first, then negotiating PIP liens and UM/UIM offsets in a coordinated fashion.
The negotiation posture that moves money
Adjusters evaluate three things: the likelihood you will prove liability, the credibility of the injury, and your willingness and ability to litigate. Posture flows from preparation. A car accident lawyer who can recite the treatment timeline, explain gaps, and walk through policy language without notes radiates readiness. I rarely send a separate “demand package” after a denial. Instead, I deliver the appeal packet described above, then schedule a call. I ask the adjuster to tell me, point by point, what would change their decision. Sometimes it is a single missing piece, like prior primary care records or a current work status letter.
Money is timing-sensitive. End of quarter and calendar year can influence authority. While you should never bluff about filing suit, you can signal timeline pressure by sharing that you have drafted pleadings and booked service if the matter does not resolve by a specific date. Keep the promises you make. If you say you will file, file.
Client management: candor over comfort
After a denial, clients need clarity, not platitudes. I explain uncertainty and options, then put target ranges on likely outcomes. For soft-tissue cases with clean liability, I might say, “We have a strong shot at reversing the denial and then settling in the low to mid five figures within six months.” For contested liability with disputed causation, I may outline a longer path that could involve suit, discovery, and a trial window 12 to 18 months out. People plan their lives around these timelines. A professional tone, frequent updates, and no surprises do more for trust than any pep talk.
Common traps that sink valid claims
- Waiting to see a doctor, then facing a “gap in care” argument. If pain persists beyond a few days, document it. Urgent care notes are better than silence. Over-treating without functional improvement. Track outcomes. If therapy is not moving the needle, adjust the plan rather than stacking identical visits. Posting bravado on social media. A single “I’m good” caption can overshadow months of nuanced records. Ignoring subrogation and liens. Health plans, Medicare, and providers can torpedo a settlement if not addressed early and correctly. Letting the narrative drift. Align the police report, recorded statement, and medical notes. Inconsistencies are denial fuel.
How experienced counsel shifts outcomes
There is no magic phrase that unlocks insurance funds. What changes outcomes is sustained, methodical pressure backed by facts. A seasoned auto accident attorney knows which levers to pull and in what order. On a recent case, a carrier denied a shoulder surgery as unrelated, citing a prior sports injury. We obtained the athlete’s pre-crash orthopedic file, which documented full recovery years earlier, then had the surgeon write a three-paragraph note explaining the biomechanical difference between the past labral tear and the current rotator cuff tear. We paired that with photos of the steering wheel deformation from the crash and a short reconstruction report tying shoulder impact to the collision dynamics. The denial flipped in two weeks, and the surgery bills were paid.
In another matter, a rideshare driver faced a denial due to a “livery” exclusion in his personal policy after being struck by a red-light runner. The rideshare insurer tried to pay only during active rides. We mapped the timeline with app data, showing the driver was in app-on status waiting for a ping at the moment of the crash, and cited a state bulletin clarifying primary coverage during that period. The personal carrier withdrew its denial, and the rideshare policy tendered.
These are not outliers. They are examples of what happens when a car crash lawyer treats each denial as a solvable puzzle rather than a wall.
When policy limits and underinsurance collide
Serious injuries often blow past at-fault policy limits. If a liability carrier denies or lowballs and you have underinsured motorist coverage, sequence your moves carefully. Get the liability carrier to disclose limits in writing where your state allows it. If you plan to accept the at-fault limits, comply with your UM/UIM policy’s consent-to-settle requirement to protect your underinsured claim. I have seen UM claims denied for lack of consent even when liability was clear. Keep your own carrier informed without volunteering arguments that help them later. A concise notice letter attaching the offer and requesting consent within a set period is enough.
When your injuries exceed limits, damages presentation becomes surgical. Vocational assessments, life care plans, and economist reports add weight, but they must be proportional. Spending heavily on experts for a $50,000 policy is wasteful. For a policy stack in the high six figures, the investment makes sense.
Litigation tactics that respect jury attention
If litigation becomes necessary, plead with precision. Avoid shotgun complaints. Identify the denial’s actual fault lines: breach of contract, violation of unfair claims practices, bad faith, declaratory relief. In discovery, ask for claims handling manuals, training materials for the specific denial code used, and communications between the adjuster and supervisors. Be disciplined with depositions. A focused, respectful examination of the adjuster can yield concessions that carry through to mediation. Jurors and mediators respond to a narrative where an accident injury lawyer methodically tried to resolve the claim, met unreasonable resistance, and used the court as a last resort.
Fees, costs, and the business side
Most injured clients hire on contingency. Be transparent about how fees interact with medical liens and costs. A car accident law firm that explains the order of distribution and provides draft settlement statements builds trust and reduces friction at the finish line. When you reverse a denial that has delayed care and piled up bills, the client is often emotionally exhausted. The more predictable you make the financial wrap-up, the better the experience and the cleaner your reputation.
Final thoughts from the trenches
Insurance denials feel final to clients. They are not. They are the opening bid in a structured game with rules you can use. The best car accident lawyer treats each denial as data. What code, what policy clause, what timeline? Then comes the quiet work: cure defects, close loops, put medical opinions in plain language, and force the insurer to defend its decision under the right law, not just its workflow.
If you are facing a denial, act quickly, stay organized, and assume the insurer will take a second look if you give them a professional reason to do so. And if you are counsel refining your craft, remember that credibility compounds. Adjusters remember the auto injury attorney who sends tight packets, meets deadlines, and files suit only when it matters. That reputation turns denials into negotiations, and negotiations into checks.