Insurance Claim Denied

Common Reasons Claims Get Denied

Receiving a claim denial letter is frustrating and confusing. Understanding why your claim was denied is the first step toward getting the decision reversed.

Policy Exclusions

The most common denial reason is that your damage falls under a policy exclusion. However, exclusions are often misapplied. Insurance companies will cite exclusions that don't actually apply to your situation.

Insufficient Documentation

Claims get denied when policyholders don't provide adequate evidence of damage, causation, or loss value. These denials are often reversible if you can provide the missing documentation in an appeal.

Late Filing

Most policies require you to report claims within a certain timeframe. If you miss this deadline, your claim can be denied regardless of whether the damage is covered.

Pre-Existing Damage

Insurance companies will deny claims by arguing the damage existed before the covered event. These denials require you to prove the damage was caused by the specific event you're claiming.

How to Challenge a Denial

Review the Denial Letter

Understand exactly why your claim was denied and what policy provisions were cited

Check Appeal Deadlines

Mark the deadline immediately and work backward to ensure timely submission

Gather Supporting Evidence

Provide documentation that directly addresses the denial reason

Address Policy Language

Explain why the insurance company's interpretation is wrong

Document Everything

Create a clear timeline showing what you submitted and when

Be Professional

Methodically address each denial reason with facts and evidence

How Claim Navigator Helps With Denials

Specialized tools for challenging claim denials and building strong appeals.

Denial Analysis — Upload your denial letter and get a breakdown of the stated reasons
Policy Review — Analyze whether the cited policy provisions actually support the denial
Appeal Builder — Generate professional appeals with proper legal citations
Evidence Checklists — Know exactly what documentation to include
Deadline Tracking — Never miss critical appeal deadlines
Escalation Guidance — Understand when and how to escalate beyond the initial appeal

Frequently Asked Questions

What percentage of denied claims get approved on appeal?

Industry data suggests 30-50% of appeals result in some form of claim approval or increased payment. The success rate is much higher when appeals include proper documentation.

How long does the appeal process take?

Most insurance companies must respond to appeals within 30-60 days, depending on state regulations. Complex appeals may take longer.

Can I appeal more than once?

Yes. Most insurance companies have multiple levels of appeal. If your first appeal is denied, you can typically appeal to a higher level.

Should I hire an attorney for my appeal?

Not necessarily. Many appeals can be handled successfully without an attorney if you have proper guidance and tools.

What if my appeal is denied?

If your appeal is denied, you have several options: file a complaint with your state insurance department, request external review, or consult with an attorney.