Claim Denied? Your Guide to Fighting Insurers

A severe injury brings immense physical and financial challenges. You rely on the at-fault party's insurance company to pay for your damages, especially in complex cases. When the insurance company refuses to settle your claim, offers a very low amount, or outright denies it, it can feel devastating and unfair.

Remember, insurance companies are businesses. Their goal is to protect their profits, often by minimizing the amount they pay to accident victims. A denial is usually just the beginning of the fight, not the end. Knowing the professional steps to take next is critical to protecting your future and securing the compensation you need.

If a serious accident has left you with life-altering injuries and the insurance company is refusing to pay, you need qualified legal advocacy immediately. Protect your right to full compensation. Contact Shamberg, Johnson & Bergman for a confidential case review by calling (816) 542-5999 or by using our online contact form.

1. Understand Why the Claim Was Denied

The first professional step is to request a formal written explanation for the denial. Insurance companies cannot simply say "no"; they must provide a reason. Understanding their reasoning is essential because it defines the legal fight ahead.

Common reasons for claim denial or refusal to pay include:

• Disputing Fault: The company argues their client (the person who caused the accident) was not entirely responsible, or they try to blame you for the accident.
• Questioning the Injury: They may argue that your catastrophic injuries were pre-existing or are not as severe as you claim. This is common in TBI and spinal cord injury cases, where symptoms can be difficult to measure.
• Policy Coverage Issues: The insurer may claim that the policy limits are too low or that the type of accident is not covered under the specific policy terms. For instance, in a trucking case, they may dispute which commercial policy applies.
• Failure to Cooperate: They may argue that you missed deadlines or failed to provide necessary medical records or testimony.

A knowledgeable personal injury lawyer in Kansas City, MO, can professionally review this denial letter and immediately counter the insurance company's specific arguments.

2. Compile and Organize All Evidence

A severe injury claim is heavily reliant on documentation. When an insurer refuses to pay, it means your evidence—even if substantial—needs to be stronger and more professionally presented.

Organize your information into clear, distinct categories:

• Medical Records: Collect every record related to your injury, including initial hospital reports, surgery notes, physical therapy records, and reports from specialists. This is vital for showing the severity and long-term consequences of a brain or spinal injury.
• Evidence of Fault: Gather the police report, witness statements, accident scene photos, and any accident reconstruction reports. For a trucking accident, this includes data from the commercial vehicle's "black box."
• Financial Documentation: Collect all bills, receipts, and proof of lost wages from your employer. This substantiates the economic damages discussed in our previous article.

In many catastrophic cases, evidence is complex. Working with a law firm allows you to leverage investigators and experts who can professionally gather the necessary proof.

3. Retain a Professional Personal Injury Lawyer

If the insurance company is already refusing to pay a severe injury claim, you have moved past negotiation and into a serious legal conflict. At this point, the process transitions from a casual claim to formal litigation. This is when legal guidance is non-negotiable.

A lawyer immediately shifts the power dynamic. They take over all communication, forcing the insurer to deal with a professional legal representative, rather than an injured and vulnerable person.

What a lawyer does when an insurer refuses to pay:

• Sends a Formal Demand: They issue a comprehensive, highly detailed legal demand letter supported by robust evidence and expert opinions, such as life care plans.
• Engages in Discovery: They initiate the formal legal process of gathering information, which enables them to request internal insurance documents and policy information in a legally compliant manner.
• Prepares for Trial: By demonstrating a professional, trial-ready commitment, the lawyer creates pressure on the insurance company. This often results in the insurer finally making a fair settlement offer to avoid the risk and cost of a courtroom battle.

4. Pursue Litigation: Filing a Lawsuit

If the insurance company maintains its refusal to pay or offers a significantly insufficient amount, your attorney will recommend filing a formal personal injury lawsuit.

Filing a lawsuit is the official step that moves the case from the insurance company's claims department to the judicial system. This action:

1. Starts the Clock: It triggers legal deadlines for the defendant (the insurance company's client) to respond formally.
2. Forces Negotiation: It brings the insurer's legal team into the process. These professionals understand the risk of a high-value verdict in a severe injury trial and are often more reasonable than the initial claims adjusters.
3. Leads to Trial: While most lawsuits settle out of court, filing the suit is the necessary step that opens the door to a trial if a fair agreement cannot be reached.

In cases involving spinal cord injuries and traumatic brain injuries, the litigation process is often required to secure the substantial compensation necessary for a lifetime of care and support.

Seek Formal Guidance from Shamberg, Johnson & Bergman

A denial from an insurance company for a severe injury claim is a profound obstacle, but it is not the final word. When your financial future depends on a successful outcome, you need a professional legal team to level the playing field.

The team at Shamberg, Johnson & Bergman is prepared to take on insurance companies in pursuit of the full compensation you deserve for your life-altering injuries. Do not face this complex legal battle alone. Contact us today at (816) 542-5999 or complete our online contact form to schedule a comprehensive case evaluation.