What Should I Do If My Insurance Claim is Denied?

You’ve done everything you were supposed to. You reported your car accident promptly, you submitted your medical records, you sent in the repair estimates, and you waited patiently. Then, a letter arrives from the insurance company—a thick envelope that makes your stomach tighten. Inside are the words you’ve been dreading: “Your claim has been denied.”

It’s a moment that feels deeply unfair and final. A wave of frustration and panic sets in. How can they just refuse to pay? Does this mean you’re on your own, stuck with thousands of dollars in medical bills and car repairs?

It is crucial to understand this: An insurance company’s denial is not the end of the road. It is the beginning of a dispute. You have the right to challenge their decision, but you must do so in a strategic and organized way. A denial is simply the insurer’s initial position, and you have the power to make them reconsider.¹

Useful Information for You: In a Nutshell

• Don’t Panic: A denial is a common tactic.² It is not the final word.
  
   
• Review the Denial Letter: The first step is to carefully read the letter to understand the specific reason for the denial.
• Gather Your Evidence: Collect all the documents that support your claim and contradict the insurer’s reason for denial (e.g., the police report, medical records, photos).
• Write a Formal Appeal Letter: Do not just argue on the phone. You must formally appeal the decision in writing, presenting your evidence and stating why you believe the denial is wrong.
• Consider Filing a Complaint: If the insurer is acting unreasonably, you can file a formal complaint with the Washington State Office of the Insurance Commissioner (OIC).
• Seek Legal Advice: A claim denial is the single clearest sign that you need a professional advocate on your side.

Step 1: Understand Why Your Claim Was Denied

The first thing you must do is carefully read the denial letter from top to bottom. The insurance company is legally required to provide you with a specific reason for their decision. Vague explanations are not acceptable. Common reasons for denial include:

• Liability Dispute: They believe their driver was not at fault.
• Coverage Issues: They claim the specific loss is not covered by the policy.³
  
   
• Lack of Medical Necessity: They argue your medical treatment was not necessary or related to the accident.
• Missed Deadlines: They claim you waited too long to report the accident or file the claim.⁴
  
   
• Alleged Misrepresentation: They accuse you of not being truthful about the accident or your injuries.

Knowing their exact argument is the key to building your counter-argument.

Step 2: Gather Your Evidence to Refute Their Reason

Now, act like a detective. Your goal is to find every piece of evidence that proves their reason for denial is wrong.

• If they dispute fault: Your best evidence is the official police report, photos from the scene, and witness statements.
• If they question your injuries: Your best evidence is your complete medical records, photos of your injuries, and a letter from your doctor explicitly stating that your injuries and treatment are a direct result of the accident.
• If they claim a missed deadline: Your evidence is your phone records or email history showing when you first contacted them.

Organize all of these documents into a dedicated file.

Step 3: Write a Formal Appeal Letter

A phone call is not enough. You need to create a paper trail. Draft a professional, factual, and firm appeal letter.

• State Your Purpose: Begin by clearly stating that you are writing to appeal the denial of your claim (include your claim number).
• Address Their Reasoning: Directly address the reason they gave for the denial and explain why it is incorrect.
• Present Your Evidence: Systematically refer to the evidence you have gathered. For example, “Your letter states that your insured was not at fault; however, the attached police report clearly cites your insured for ‘Failure to Yield’.”
• State Your Demand: Clearly state what you want them to do (e.g., “I demand that you reverse this denial and process my claim for payment.”).
• Send it via Certified Mail: Send the letter and copies of your evidence via certified mail with a return receipt requested. This proves they received it.

Step 4: Know Your Rights and Escalate if Necessary

If your formal appeal is ignored or denied without a valid new reason, the insurance company may be acting in “bad faith.” At this point, you have further options:

• File a Complaint with the OIC: You can file an official complaint with the Washington State Office of the Insurance Commissioner.⁵ The OIC will investigate the complaint and can penalize insurers for unfair claims practices.⁶
  
   
   
• Consult an Attorney: This is the most powerful step you can take. An insurance company’s entire calculus changes when they know they have to deal with an experienced lawyer. An attorney can take over all communication, manage the appeal, and, if necessary, file a lawsuit against the insurer for both the value of your claim and potentially for bad faith.

You do not have to accept an unfair denial. If your car accident claim has been denied in the Tacoma area, it’s time to get a professional advocate. Search the Car Accident Lawyer Directory Tacoma to find and compare trusted local attorneys who specialize in fighting insurance companies and winning the compensation their clients deserve.

References

• Washington State Office of the Insurance Commissioner (OIC) – Appealing a denied claim:The official consumer guide from the OIC, explaining your rights and the formal process for appealing a denied insurance claim in Washington.https://www.insurance.wa.gov/what-do-if-your-claim-denied-or-you-disagree-settlement-offer
• Washington State Legislature – RCW 48.30.015 – Unfair practices with respect to insurance claims:The state law that defines unfair and deceptive acts in the business of insurance, which is the legal basis for a bad faith claim.7https://app.leg.wa.gov/RCW/default.aspx?cite=48.30.015
• Washington Administrative Code (WAC 284-30) – Trade Practices:The official state regulations that govern how insurance companies must handle claims and communications with policyholders.https://apps.leg.wa.gov/wac/default.aspx?cite=284-30