What Happens If an Insurance Company Denies Your Claim in Florida?

Introduction

After an accident or injury, many people assume their insurance company will provide coverage as promised. However, insurance companies often deny claims to minimize payouts and protect their profits. A claim denial can be frustrating and financially devastating, but it does not necessarily mean the end of your case.

This guide explains why insurance claims are denied, what steps to take after a denial, and how an attorney can help you fight for the compensation you deserve.

Common Reasons Insurance Companies Deny Claims

Insurance companies must provide a reason when they deny a claim. Some of the most common justifications for denial include:

1. Lack of Coverage

The insurer may argue that the policy does not cover the type of accident or damages claimed. This often happens when:

• The policyholder did not have the required coverage at the time of the accident.
• The type of claim falls under an exclusion in the policy.

2. Missed Deadlines

Most insurance policies require claims to be filed within a specific timeframe. If a claim is submitted too late, the insurer may deny it.

3. Alleged Policy Violations

Insurance companies may argue that the policyholder failed to follow the terms of the policy, such as:

• Driving under the influence during an accident.
• Failing to report the accident promptly.
• Not seeking medical treatment within the required time period (for example, Florida’s PIP insurance requires medical care within 14 days).

4. Disputes Over Fault

In liability-based claims, the insurer may deny coverage by claiming:

• The policyholder was at fault and not eligible for compensation.
• The injuries or damages were caused by something other than the accident.

5. Insufficient Evidence

If the insurance company believes there is not enough proof of injuries, damages, or liability, they may deny the claim. This is why gathering strong evidence, such as medical records, photos, and witness statements, is essential.

6. Bad Faith Denials

Some insurers deny claims without a legitimate reason. This is known as insurance bad faith, and it is illegal. Signs of bad faith include:

• Unreasonable delays in processing claims.
• Failure to provide a clear explanation for denial.
• Pressuring claimants into accepting lowball settlements.

Steps to Take After an Insurance Claim Denial

A claim denial does not mean you have no options. Taking the right steps can help you fight back and recover the compensation you deserve.

1. Review the Denial Letter

Carefully read the insurance company’s denial letter to understand the reason for the decision. Look for:

• The specific policy provisions cited as reasons for denial.
• Any deadlines for appealing the decision.

2. Gather Additional Evidence

If the denial was based on lack of evidence, collect:

• Medical records and bills to support your injury claim.
• Accident reports and witness statements.
• Photos and videos of injuries and property damage.
• Correspondence with the insurance company, including emails and claim forms.

3. File an Appeal with the Insurance Company

Many insurers allow policyholders to appeal a denial by submitting additional evidence and a written request for reconsideration. In your appeal:

• Address the reason for the denial and provide supporting documents.
• Cite specific policy language that supports your claim.

4. File a Complaint with the Florida Department of Financial Services

If the insurance company fails to respond fairly, you can file a complaint with the Florida Division of Consumer Services, which oversees insurance disputes. This can prompt the insurer to re-evaluate your claim.

5. Consider Filing a Lawsuit

If the insurance company refuses to pay a valid claim, you may need to file a bad faith insurance lawsuit or a personal injury lawsuit to recover compensation.

When to Hire a Personal Injury Attorney

If an insurance company unfairly denies your claim, an experienced attorney can help you:

• Review your policy and identify coverage that applies.
• Gather and submit strong evidence to support your claim.
• Negotiate with the insurer to secure a fair settlement.
• File a lawsuit if necessary to recover damages.

At Bonderud Law, we have extensive experience handling insurance disputes and fighting for accident victims. If your insurance claim has been denied, contact us today for a free consultation.

Conclusion

Insurance companies deny claims for many reasons, but a denial does not mean you are out of options. By understanding why claims are denied, gathering additional evidence, and working with an attorney, you can fight back and pursue the compensation you deserve.

If your insurance company has denied your claim or is delaying payment, seeking legal help can increase your chances of a successful appeal or lawsuit.