San Diego Denied Insurance Claim Lawyer

Having an insurance claim denied can be an incredibly frustrating and stressful experience. You likely filed the claim expecting your insurance company to help you during a difficult time, only to have them refuse coverage. This leaves you to deal with mounting bills, lost income, and general life disruption without the critical financial assistance you counted on. Fortunately, you have options if your insurance claim gets denied in San Diego.

An experienced denied insurance claim lawyer can evaluate your situation, pinpoint why your claim was denied, and develop a legal strategy to fight for the coverage you deserve. With the right legal help, many denied claims can be successfully appealed, overturned, or settled for a satisfactory amount.

This guide explains why insurance claims get denied, how a denied claim lawyer can help, what to expect from the appeal process, and tips on finding the best legal representation. For sound advice on your particular situation, please don’t hesitate to call us at the Hamparyan Law Firm. Your consultation is free. We’re eager to provide assistance, whether it’s regarding auto insurance, property damage, homeowner’s insurance, or other policy types.

Assistance in San Diego Insurance Bad Faith Denied Claims

If you believe you may have fallen victim to San Diego bad faith insurance via denied claims, call Robert Hamparyan today at (619) 550-1355 for dedicated legal representation and a free consultation regarding your potential claim.

Why Insurance Claims Get Denied

Insurance companies deny claims for a wide variety of reasons. Some of these reasons are justifiable, but many denials happen due to unfair practices and technicalities that aim to increase insurance company profits at the expense of the policyholder. Some of the most common reasons insurance claims get denied include:

Pre-Existing Conditions

Most insurance policies have clauses excluding coverage for health conditions you already had when you purchased the policy. If your treatment or disability relates to a pre-existing condition, the insurance company will likely deny coverage.

Errors or Misrepresentations on Your Application

When applying for insurance, any misstatement or omission made on your application can give grounds for a claim denial. Even minor mistakes can trigger a rejection.

Lack of Medical Necessity

Insurers will sometimes deny claims they feel are not “medically necessary,” even if your doctor disagrees. This often happens with experimental treatments, alternative therapies, and care deemed excessive given your condition.

Disputes Over What Caused Your Loss

When the cause of your loss is unclear, insurance companies may deny your claim by stating that your policy excludes that particular loss cause. For example, they may claim damage was due to flood rather than storm surge if the former is excluded from your policy.

Post-Loss Underwriting

In some cases, insurance companies will scrutinize your background more closely AFTER you file a claim in hopes of finding a reason to deny you. This illegal practice is called post-loss underwriting.

Expired Statute of Limitations

Insurance policies and state laws limit how long you have to file a claim after a loss occurs. Submitting a claim past the allowed time period will lead to denial in most cases.

If your claim gets denied for what seems like an unjust reason, don’t simply accept the insurance company’s decision. An experienced lawyer can help determine if the denial is legitimate or if legal options exist to appeal and regain coverage.

How a Denied Insurance Claim Lawyer Can Help

Dealing with claim denials and appeals is tricky without legal expertise on insurance contracts and claims investigations. A qualified denied claim lawyer knows insurance policies inside and out. They can use their specialized knowledge to build a strong case for overturning the denial. A lawyer experienced with denied insurance claims may be able to help in the following ways:

Identify Unfair Denial Reasons

Insurers don’t always provide the true or full reasons for denying a claim. Skilled lawyers know which explanations are valid and which indicate unfair denial practices. If the denial lacks legal merits, they can initiate the appeals process.

Negotiate Claim Settlements

Even if a denial seems technically valid, there still may be room for a settlement. An attorney familiar with insurance claim negotiations can leverage their skills to work out a claims settlement that reimburses at least part of your costs.

File Bad Faith Lawsuits

Many Californians have a valid claim for insurance benefits but get unreasonably rejected. If an insurance company handles your claim in a negligent or dishonest manner, this constitutes “bad faith.” A lawyer can sue the insurer on your behalf for acting in bad faith, helping maximize the financial damages you recover.

Help Navigate Complex Appeals

Appealing a claim denial involves completing specific forms, meeting rigid deadlines, and arguing your case before an insurance board. A proficient attorney makes sure no detail falls through the cracks so your appeal has the best possible chance of succeeding.

To speak with a denied claim attorney about your legal options, call the Hamparyan Law Firm at (619) 550-1355. Our firm has helped many clients in the San Diego area overturn wrongful claim denials through settlements and litigation. Let our experience work for you.

What to Expect from the Insurance Claim Appeals Process

The exact appeals process differs slightly depending on your insurer and policy type. But in general, filing an appeal involves the following steps:

Step 1: Review the Denial Carefully.

Read your claim denial notification closely, underlining the exact reasons given for rejecting coverage. This specifies what aspects you must refute, provide additional documentation for, or clarify when filing your appeal.

Step 2: Gather Supporting Documents.

Collect any documents that show why your claim should be paid, such as medical records, police reports, financial statements, or contractor repair estimates. Also gather evidence to disprove the denial reasons cited by the insurance company. At this stage, an insurance denial attorney can already help you by compiling evidence in a way that targets the insurer’s reason for rejection.

Step 3: File the Appeal.

Submit the appeal within the deadline stated in your policy, which is usually 60 days from the claim denial. Follow the proper procedures outlined in your policy documents for completing appeal forms, attaching documentation, and confirming receipt.

Step 4: Participate in the Review Process.

The insurance company reviews the materials you submit and assesses if they adequately address the original denial’s concerns. You may need to provide additional information upon request and directly address any lingering issues.

Step 5: Receive Appeal Determination.

After finishing the review, the insurance company will either overturn the claim denial and pay your policy benefits or uphold their original rejection. Make sure to meet any further deadlines if you need to escalate your appeal to higher internal reviewers.

Having an attorney assist with this complicated process helps ensure you are being strategic, building an appeal that’s most compelling for the insurer to pay your claim.

Tips for Finding the Best Insurance Lawyer in San Diego

The insurance appeals process is complex and maze-like, and you’ll need a specialized attorney to assist you. It takes real-world experience, legal skills, and extensive knowledge to successfully handle denied insurance claims cases. When researching legal help, keep the following tips in mind:

Look for Substantial Insurance Law Experience.

Find lawyers who have specifically handled denied insurance claims and have years of relevant experience under their belt. Check that they have a proven record of favorable settlements and case outcomes.

Verify Strong Insurance Dispute Competence.

Make sure your prospective lawyers thoroughly understand all types of insurance policies, industry claims regulations, and the appeals procedures for major insurers. This nuanced knowledge is vital for navigating denials.

Assess Lawyer’s Trial Ability.

Insurers know which lawyers simply file appeals versus those willing to take cases to court if needed. Prioritize attorneys who have demonstrated that they can litigate insurance denials when warranted. Their willingness to go to trial gives them more leverage.

Check Attorney and Law Firm Disciplinary History.

Use your state bar association website to confirm that the lawyer carries an active license in good standing. Look out for any past disciplinary complaints or malpractice issues that raise ethical red flags.

When you’re trying to choose the right claim attorney to assist you, take time to thoroughly vet their legal skills, insurance insights, and case history. The insurance denial attorneys at the Hamparyan Law Firm have all the qualifications to competently handle your appeal. For a case evaluation from our accomplished denied claim attorney serving San Diego, call (619) 550-1355 today.

Denied Claim Attorney: Frequently Asked Questions

What key details should I gather to help my lawyer appeal my denied claim?

Compile any documents related to your insurance policy, your claimed incident, and the denial itself to support your appeal. This includes your policy declaration page listing coverage types and limits, police reports if applicable, all medical records and bills, repair estimates or contractor invoices, income loss documentation, and the insurance company’s official denial letter.

Also track down any proof that refutes the denial rationales cited by the insurer. Supplying thorough background materials helps your lawyer highlight irregularities and build arguments to overturn the rejected claim.

Can a lawyer help if my claim was denied because I missed the filing deadline?

If an insurance company denies your claim due to missing the policy’s deadline, appealing the decision becomes difficult but not always impossible. An attorney who’s experienced in denied claim negotiations may still be able to convince the insurer to pay a partial settlement, especially if you missed the deadline due to extenuating circumstances. 

There also might be legal precedents for compelling payment in certain late-claim situations. A seasoned lawyer can provide guidance if any options exist to regain at least some coverage following a missed deadline denial.

What if I already tried appealing my denied claim on my own without success?

Just because an initial self-directed denied claim appeal gets rejected doesn’t mean the case is necessarily closed. Insurance policies often have multiple levels of internal appeals, so a new escalated request filed by a lawyer can potentially prompt reconsideration.

Also, if the insurer exhibited any hints of acting in “bad faith” along the way, your attorney can potentially file a lawsuit to recoup damages related to wrongful denial conduct. Through this lawsuit, you may still possibly secure payment of the original policy benefits. So while challenging an already-denied appeal is more difficult, a skilled denied claim lawyer may identify aspects worth leveraging for another attempt.

Need a San Diego Insurance Lawyer? Let the Hamparyan Law Firm Help with Your Denied Coverage or Bad Faith Insurance Claim

If you have had an insurance claim denied in the San Diego area, the experienced attorneys at the Hamparyan Law Firm can help. Our lead attorney Robert Hamparyan has prior experience working on the insurance defense side, and we now leverage his insider insight to build strong appeals on behalf of our clients.

We have a proven track record of negotiating favorable settlements and taking insurers to court for bad faith practices when needed. Our combination of insurance insights and relentless legal advocacy provides denied claim clients the best possible chances of overturning wrongful denials. Call the Hamparyan Law Firm at (619) 550-1355 for a free consultation if your insurance company has denied coverage you deserve.