The Short Answer:
If an insurance company denies your claim, your first step should be to contact a qualified personal injury lawyer who can review your case and guide you through the appeals process. An attorney can help you understand the denial letter, gather supporting evidence, and file a timely appeal. If the internal appeal is unsuccessful, a lawyer can also escalate the matter to your state’s insurance regulators and pursue further legal action if necessary.
At Lowry Law, we help injury victims across Maine stand up to insurance companies that put profits before people. If your personal injury claim was denied, read on to learn what you can do next.
Key Takeaways
- We review your denial in detail: Our team examines the insurer’s explanation, looking for errors, inconsistencies, or unfair reasoning.
- We gather and present strong evidence: We collect medical records, bills, accident reports, and witness statements to support your appeal.
- We handle appeals and deadlines: We prepare and file timely internal appeals with all necessary documentation.
- We escalate when needed: If an insurer won’t play fair, we can request an external review or file a complaint with Maine’s Bureau of Insurance.
- We fight bad faith tactics: With more than 50 years of combined experience, we know how to challenge insurers who deny legitimate claims.
Common Reasons Why Insurance Claims Are Denied
Insurance companies are skilled at finding reasons to deny claims, even when the injuries and damages are very real. Some denials are based on legitimate policy terms, but many are rooted in technicalities or strategies designed to save the insurer money. If you’ve ever wondered “why would an insurance company deny a claim?” the truth is that denials often stem from issues with documentation, deadlines, or policy interpretations. By understanding the most common reasons for denial, you’ll be better prepared to challenge the insurer’s decision and protect your right to compensation.
- Delays in medical treatment: If you didn’t seek immediate medical attention after your accident, the insurer may argue your injuries aren’t as serious or that they were caused by something else.
- Lack of proof: Insufficient evidence, such as missing medical records, photos, or accident reports, can make it easier for insurers to question your claim.
- Incorrect or incomplete information: Simple mistakes on claim forms or missing details in your report may give insurers an excuse to delay or deny payment.
- Failure to mitigate damages: If you ignore your doctor’s instructions or take actions that make your injuries worse, insurers may use that as a reason to reduce or deny your payout.
- Policy exclusions: Some types of accidents, conditions, or treatments may not be covered under your policy’s fine print.
- Bad faith practices: Sometimes insurers deny valid claims without a legitimate reason, delay payment unnecessarily, or misrepresent policy terms. This is known as acting in bad faith, and it may give you the right to pursue additional legal action against the insurance company.
While these are some of the most common reasons why insurance claims are denied, that doesn’t mean the insurer is always right. Many denials can be overturned with the right documentation, medical evidence, or legal advocacy. With the help of an experienced personal injury lawyer in Maine, you can identify weak points in the insurer’s reasoning and take action to pursue the compensation you may be owed.
Why Insurance Companies Deny Legitimate Claims
Many insurers deny claims hoping you’ll give up rather than fight back. Common tactics include:
- Downplaying your injuries.
- Claiming pre-existing conditions caused your medical issues.
- Using vague policy exclusions.
- Delaying responses until deadlines pass.
Insurance companies often deny claims to protect their profits, not because your case is without merit. If you’re facing an injury claim denial, don’t lose hope–you have the right to push back.
What to Do When an Insurance Claim Is Denied
If your personal injury claim is denied, you don’t have to face the insurer alone. Here’s a clear roadmap for what to do next and how Lowry Law can help every step of the way:
1. Contact a Personal Injury Lawyer
The most important first step is speaking with a qualified attorney. At Lowry Law, we:
- Review your denial letter and policy language.
- Identify errors, unfair reasoning, or bad faith tactics.
- Handle communications and negotiations with the insurer on your behalf.
- Fight for full and fair compensation for your injuries.
2. Review and Understand the Denial
With your lawyer’s help, carefully examine the denial letter to:
- Understand the insurer’s stated reason for denial.
- Compare it with your policy to check if the reason aligns with coverage.
- Identify any mistakes in billing codes, dates, or documentation.
3. Gather Evidence to Strengthen Your Case
A strong case often changes the outcome. We can help you:
- Collect all medical records, bills, and accident-related documents.
- Obtain police reports, photos, or witness statements if relevant.
- Keep all correspondence with the insurer organized.
4. File an Internal Appeal
Your lawyer will prepare and submit a formal appeal that:
- Explains why the denial is incorrect.
- Cites specific policy provisions in your favor.
- Includes medical evidence and supporting documentation.
- Meets all required deadlines so your rights are preserved.
5. Seek External Review or File a Complaint
If an internal appeal doesn’t succeed, you may still have options. In Maine:
- Some health insurance denials qualify for independent external review.
- You can also file a complaint with the Bureau of Insurance, which can investigate unfair claim practices.
How to Appeal a Denied Insurance Claim in Maine
If your insurance company denies your claim, you don’t have to accept their decision as final. In Maine, policyholders have the right to challenge unfair or incorrect denials. Unlike your initial claim, an appeal requires you to present stronger documentation, a clear argument, and often, professional support. Here’s how to move forward with an appeal:
1. Contact an Attorney
Before diving into the appeals process, consider speaking with a lawyer who understands insurance disputes. A personal injury attorney can:
- Review your policy and denial letter.
- Spot errors, missing details, or bad faith tactics.
- Handle communication with the insurer on your behalf.
- Strengthen your case with evidence and expert testimony if needed.
2. Understand Your Appeal Rights
Every denial letter should explain whether you can appeal, what deadlines apply, and what documents are required. Insurers in Maine are legally obligated to provide clear reasons for the denial and instructions for the appeal process.
3. Strengthen Your Case With Evidence
An appeal is your chance to prove the insurer wrong. This may involve submitting:
- Updated or more detailed medical records.
- Expert opinions from doctors or specialists.
- Accident reports, photographs, or witness statements.
- Written clarification from providers if billing codes or paperwork were incorrect.
4. Write a Strong Appeal Letter
Your appeal letter should:
- Clearly state that you are appealing the denial.
- Reference the insurer’s stated reason for the denial.
- Point to specific policy language that supports coverage.
- Include all supporting documentation as attachments.
5. File the Appeal Within Deadlines
Insurance companies often allow 30 to 60 days for appeals, but deadlines vary. Missing this window can eliminate your right to contest the decision, so act quickly.
Will Appealing a Denial Make a Difference?
Yes, appealing a denial can absolutely make a difference. Many claims are denied because of missing paperwork, coding errors, or misinterpretations of policy language—all issues that can often be corrected through an appeal. By providing additional evidence, clarifying details, or challenging an insurer’s reasoning, you increase your chances of overturning the denial. In fact, many valid claims are approved only after policyholders push back with a strong appeal or get help from an attorney.
How Our Attorneys Help Mainers With Injury Claim Denials
At Lowry Law, we’ve seen firsthand how frustrating it is when an insurance company rejects a legitimate claim. Our team helps clients across Maine by:
- Evaluating denial letters to identify weaknesses in the insurer’s reasoning.
- Gathering evidence that supports your case.
- Filing strong appeals on your behalf.
- Taking insurers to court if necessary to pursue justice.
You don’t have to face powerful insurance companies alone. With Lowry Law on your side, you have a team committed to protecting your rights.
Why Choose Lowry Law for Your Denied Claim?
When your insurance company denies your claim, experience matters. Our attorneys bring more than 50 years of combined experience fighting for injury victims across Maine. Since 1971, our firm has been dedicated to standing up to insurers that put profits over people.
Choosing Lowry Law means you benefit from:
- Proven experience: Decades of results in personal injury and insurance disputes.
- Local insight: As a Maine-based firm, we know the state’s insurance laws, courts, and regulators.
- Personalized service: We treat every client with respect, offering straightforward advice and clear communication.
- No upfront costs: We provide free case reviews and work on a contingency fee basis—meaning you pay nothing unless we win for you.
With our team on your side, you won’t have to face powerful insurance companies alone. We fight to turn denied claims into fair compensation for the people of Maine.
The Next Step After a Denial Starts Here
If your insurance claim has been denied in Maine, it doesn’t mean your fight for compensation is over. With the right strategy and the right legal team, you can challenge the insurer’s decision, file a strong appeal, and protect your financial future.
At Lowry Law, we’ve been advocating for Mainers since 1971. From handling appeals to pursuing bad faith cases in court, we know what it takes to hold insurers accountable.
Schedule your free case review today. You pay nothing upfront.
