Denied insurance claim: what to do next
A denial letter feels final, but it's the start of a process, not the end. Insurers reverse their own decisions every day — when the appeal gives them a documented reason to. Here's the sequence that works.
Want this checked on your own policy? Use the Claim Appeal Helper — it reads your policy and denial letter and drafts a structured appeal that answers each denial reason with your own policy wording.
Step 1: Decode the denial letter
Every denial cites a reason — an exclusion, a missed deadline, a documentation gap, or a dispute over what caused the loss. Find the exact sentence and the policy section it references. Your entire appeal targets that sentence. Vague replies to the claim in general go nowhere; a precise rebuttal of the stated reason has a real chance.
Step 2: Check the deadline — before anything else
Appeal windows are real and they expire. Health plans typically allow 180 days for an internal appeal under federal rules. Auto and home policies set their own timelines, sometimes 60 days. The clock is usually in the denial letter itself. If it's close, submit a short written notice that you intend to appeal to preserve your rights, then build the full case.
Step 3: Gather evidence the adjuster didn't have
- Two independent repair or replacement estimates on letterhead.
- Dated photos or videos — phone metadata counts.
- Official records: NOAA weather data, police reports, fire department reports.
- Receipts, bank statements, or appraisals proving value and pre-loss condition.
- Statements from witnesses, contractors, or treating professionals.
New evidence is the strongest lever you have. It lets the insurer reverse course without admitting the original denial was wrong — which is exactly the outcome you want.
Worked example (illustrative figures)
A water-damage denial, overturned in 19 days
| Item | Before | After |
|---|---|---|
| Claim filed | Burst pipe, kitchen | — |
| Denial reason | "Gradual leak" exclusion | — |
| New evidence | None | Plumber's report + NOAA freeze data |
| Policy clause cited | None | "Sudden & accidental discharge" |
| Outcome | $0 | $11,400 paid |
The denial rested on one word: "gradual." A licensed plumber's report stating the pipe failed suddenly during a hard freeze, plus that night's temperature records, converted the claim from excluded to covered. Illustrative example; every policy's wording differs.
Step 4: Write the appeal letter
- Claim number, policy number, date of the denial letter.
- One sentence stating the outcome you want.
- Quote the denial reason back, word for word.
- Cite the clause in your policy that covers the loss — section number and exact wording.
- List the new evidence as numbered exhibits.
- Set a response deadline (14 days is reasonable).
- Note your right to escalate to your state's Department of Insurance.
Keep it factual. Every paragraph should quote the policy, present evidence, or make a specific request. Anger reads as noise; precision reads as a file that will escalate well.
Step 5: Escalate — for free
If the internal appeal fails, file a complaint with your state Department of Insurance. It's free, it takes minutes online, and the insurer must formally respond to the regulator. Many disputes resolve here. For health claims, you also have a right to an external review by an independent organization. Only after those options does hiring an attorney or a public adjuster make sense.
Check your own documents
it reads your policy and denial letter and drafts a structured appeal that answers each denial reason with your own policy wording.