A serious injury can turn your life upside down, and getting your claim denied just adds to the stress. Many people come to us asking why do insurance companies deny claims, especially when they’ve followed every step. At SSD Law Firm PC: Star Accident Injury and Immigration Law Firm, we’ve seen how these denials can slow recovery and stand in the way of justice. Attorney Sarwinder Dhanjan, a trusted Fresno personal injury lawyer, is here to help you push back.

Common Reasons Why Insurance Companies Deny Claims

Insurance companies may deny your claim for a variety of reasons, many of which are built into the structure of your policy or stem from how the incident is reported. Understanding these reasons can help you better prepare when filing a personal injury claim:

Policy Exclusions and Limitations

If your injury falls under an exclusion clause in your policy, the insurer can legally deny your claim. This includes injuries related to high-risk activities, pre-existing conditions, or treatments deemed experimental. Always review your policy terms thoroughly before filing a claim.

Misrepresentation or Non-Disclosure

Providing inaccurate or incomplete information when purchasing your policy can lead to a denial. For example, not disclosing a pre-existing injury or prior accident history may result in claim rejection.

Missed Premium Payments

Insurance providers may deny coverage if you missed premium payments, even unintentionally. If your policy lapsed during the time of your injury, they’re not obligated to honor your claim.

Insufficient Evidence

If you don’t submit enough documentation, like medical records, police reports, or photographs, the insurer might argue there’s not enough proof of your injury or the circumstances.

Delayed Filing

Timing matters. If you wait too long after the injury to file a claim, it could be automatically denied.

Sarwinder Dhanjan, a trusted personal injury lawyer in Fresno, guides clients through these challenges every day. Our mission is to make sure you’re not unfairly denied because of fine print, delays, or missed details.

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What to Do If Your Insurance Claim Is Denied in California

If your personal injury claim is denied in California, you do have options. According to the National Association of Insurance Commissioners (NAIC), you can pursue both an internal and external appeal.

Here are the steps you should take:

• Request an Internal Appeal: You have up to 180 days from the date of the denial to request a review. This allows your insurer to reconsider your case based on any additional evidence.
• Work with Your Medical Provider: Ask your physician to submit further documentation or clarification that supports your claim.
• Expedited Review for Urgent Cases: If your injury is severe or life-threatening, you can request that the appeal be handled on an urgent basis.

Proper documentation, follow-ups, and persistence can often make the difference between a successful appeal and a second denial.

Can You Dispute a Denied Insurance Claim Without a Lawyer?

Yes, you can—but it’s not always your best option. While California law does allow individuals to handle insurance disputes on their own, doing so can be difficult without understanding the legal language, deadlines, and documentation required.

Here are a few things to consider:

• You’ll face seasoned insurance adjusters whose job is to limit payouts.
• Legal jargon and policy terms can make even straightforward claims confusing.
• You may inadvertently waive rights or miss critical deadlines without legal advice.

If your injuries are minor and the denial was due to a clerical error, self-advocacy might work. However, for more serious injuries, lost income, or long-term damages, you may risk losing the compensation you deserve.

How a Fresno Personal Injury Lawyer Can Help With Denied Insurance Claims

A Fresno personal injury lawyer can level the playing field. Understanding how insurance companies operate and what it takes to successfully challenge a denial is critical when pursuing fair compensation.

Here’s how we can support your case:

• Conduct a thorough policy review to identify coverage and exclusion issues.
• Collect and organize essential evidence such as accident reports, medical records, and witness statements.
• Negotiate with the insurance company using legal strategies that emphasize your rights and the insurer’s obligations.
• Pursue litigation if necessary, especially when the insurer is acting in bad faith.

A denied claim doesn’t mean it’s over. Many Fresno clients are surprised to find it’s still possible to turn things around with the right legal help.

Contact a Fresno Injury Attorney to Seek Justice in Your Personal Injury Case

Insurance denials after an injury can feel like a second blow. If you’re wondering why insurance companies deny claims, we invite you to contact SSD Law Firm PC: Star Accident Injury and Immigration Law Firm today at (559) 342-2000. Schedule a free consultation today.