Dealing with an insurance claim is already stressful enough. When that claim gets denied, the frustration can quickly multiply. Whether it’s a medical bill, property damage, or a personal injury claim, a denial can feel like a wall has been thrown up between you and the help you were counting on.
But the good news is that a denied claim doesn’t necessarily mean the end of the road. You have the right to appeal, especially if you suspect bad faith, and often, doing so can make a meaningful difference.
Appealing an insurance denial requires a clear understanding of your policy, good documentation, and persistent follow-through. This process may not be quick, but by taking a step-by-step approach, you can improve your chances of overturning the decision and receiving the benefits you deserve.
Understand Why the Claim Was Denied
Before you can appeal, you need to know exactly why your claim was denied. Insurers are required to provide a written explanation when they reject a claim. You should receive an outline of the specific reasons, whether it’s a lack of coverage, missing documentation, policy exclusions, or errors in the claim submission.
It’s critical to review both the denial letter and your insurance policy. Sometimes, what feels like a denial is actually a request for more information or clarification. Other times, it may involve a misunderstanding of the policy’s language or simply a clerical error.
In any case, understanding the insurer’s rationale gives you the foundation for building a strong appeal.
Gather Documentation and Evidence
Once you know the reason for the denial, start assembling the evidence that supports your case.
This could include original bills, medical records, repair estimates, photos, expert opinions, or other relevant documents. Be sure to organize your materials clearly and keep copies of everything you plan to submit. If your original claim was missing something important, now is your chance to include it.
In some cases, you may want to include a personal statement or letter that explains the situation in plain language.
This can be especially helpful in cases involving health insurance appeals, where showing the necessity of a treatment or procedure may sway the decision.
Here are examples of what to gather:
- A copy of your full insurance policy
- The original claim form and denial notice
- All supporting documentation (invoices, reports, records)
- Notes from conversations with insurance representatives
- A written explanation or appeal letter summarizing your argument
These materials form the core of your appeal and help the insurer reconsider the claim with a fuller understanding of your situation.
Follow the Insurer’s Appeal Process
Every insurance company has its own procedures for handling appeals. Some offer a two-tiered system—starting with an internal review and, if necessary, progressing to an external or independent review. Others may allow for direct escalation if new evidence is introduced.
The appeal process and timeline should be spelled out in the denial letter or in the insurance policy itself. Be sure to follow those instructions exactly. Missing a deadline or skipping a required step could delay the appeal or even result in an automatic rejection.
If you’re unclear about any part of the process, don’t hesitate to contact the insurer’s customer service or claims department for guidance.
Get names, dates, and notes from any conversations in case you need to reference them later.
How Do I Write a Clear Appeal Letter?
Your appeal letter is your opportunity to make a compelling case. Keep it professional, polite, and focused. Outline the facts of your original claim, the reason it was denied, and why you believe that denial was incorrect or unfair. Include a summary of the supporting evidence you’ve attached and reference specific sections of your policy when possible.
Avoid emotional appeals or aggressive language. The goal is to present a reasoned, fact-based argument that invites reconsideration. Stick to the details that matter most to the claim and keep the tone constructive.
Be Persistent, But Patient
After submitting your appeal, it may take several weeks—or longer—for the insurance company to respond. Most insurers have deadlines for reviewing appeals, but follow-up may still be required. Keep a log of your communications and check in periodically to track progress.
If you receive a secondary denial, don’t give up right away. Depending on your policy and jurisdiction, you may have additional levels of appeal available.
Persistence can pay off. In many cases, especially where new documentation or clarity is added, insurers reverse their initial decisions. Some denials result from automation or rushed assessments, so a well-prepared appeal can prompt a more thorough review.
How the Law Offices of Justin R. Boland, PLLC, Can Help
According to a 2024 survey by The Commonwealth Fund, 45% of working-age adults with insurance reported they or a family member received a medical bill or a copayment charge for a service respondents thought should have been free or covered by insurance in the past year.
If your appeal is complex or involves a large financial amount, it may make sense to involve a professional. An attorney, insurance advocate, or healthcare ombudsman can help navigate the appeal process and present your case more effectively. Legal representation is especially helpful in cases that involve long-term disability claims, denied surgeries, or large-scale property damage.
Having an expert by your side can also take some of the emotional weight off your shoulders. These professionals understand how insurers operate and can communicate on your behalf, ensuring the process stays on track.
At the Law Offices of Justin R. Boland, PLLC, we want you to understand that a denied claim doesn’t have to be the final word. By clearly understanding your policy, having solid documentation, and an organized appeal, you have a chance to reverse the decision.
While this process can be slow and frustrating, taking the time to challenge a denial often results in better outcomes, whether it’s reimbursement, approval of a medical procedure, or recovery of lost property. The key is in organization, following the insurer’s procedures, and presenting your case with clarity and confidence.
Appealing isn’t just about persistence—it’s about showing that your claim deserves a second look.
We can help.
