After you have been injured and are trying to heal, you would think that your insurance would step in to help. Sometimes, those claims are denied.
In Montana, accidents can happen on rural highways, icy sidewalks, and busy job sites, and this scenario is unfortunately common.
But a denial does not have to be the end of your story. You can often challenge the decision and protect your right to compensation. Here is what to do when your claim is denied so you can take those steps to resolve coverage disputes.
Read the Denial Letter Carefully
As frustrating as it feels, you do not want to toss that denial letter in a drawer. Make sure to read it front to back. It should list the specific reasons for the denial and cite your policy or the adjuster’s findings.
Some of the most common denial reasons in Montana personal injury cases include:
- The insurer claims you were partially at fault under Montana’s modified comparative negligence rule.
- Lack of documentation of medical treatment or lost wages.
- Missed deadlines for filing the claim or providing notice.
- Disputes over whether your injuries were caused by the accident or by a pre-existing condition.
When you know why the claim was denied, you will have a map of how to challenge it.
Contact the Adjuster
Before filing a formal appeal, you want to call the adjuster or claims representative. Sometimes, denials happen because of misunderstandings like a missing medical record, an incomplete wage-loss statement, or a billing code error.
You want to be polite but firm. Ask for clarification on what is missing or why they believe coverage does not apply. Remember to take notes on:
- Who you spoke with
- The date and time
- Any promises or explanations
If it is a minor issue, correcting it may lead to a quick reversal. But sometimes, you may need the assistance of a Montana personal injury lawyer.
From the moment you receive the denial, you want to create a file, either on paper or digitally, for every correspondence. Make sure to save:
- Letters and emails from the insurer
- Notes from phone calls
- Copies of your medical bills, wage-loss records, and accident reports
Good documentation is not only necessary for appeals; it can also be vital evidence if you end up in court or file a bad faith claim.
Get Professional Legal Help Early
Personal injury claims have high stakes, especially if you are facing medical bills, lost wages, or long-term injuries. You may want to have someone on your side to help with an insurance denial. A Montana insurance dispute lawyer can:
- Review your policy and the denial letter
- Collect evidence and build a strong appeal
- Negotiate directly with the insurer
- File a lawsuit if necessary for bad faith or to recover damages
When someone speaks the insurer’s language, that can often even the playing field and help resolve issues with your claim.
Build a Strong Written Appeal
Whether you work with an attorney or not, it is time to put things in writing. Your appeal should:
- State that you are appealing the denial
- Reference the claim number, date of loss, and any policy numbers
- Explain why the denial is incorrect
- Attach evidence, such as medical records, accident reports, wage statements, photos, or witness statements
- Quote the specific policy provisions or Montana law that supports your claim
You want to keep it factual and organized. This should not be about venting frustration. Focus on making it easy for a new reviewer to see why the denial should be overturned.
Also, keep in mind any impending deadlines. Insurance policies may impose shorter deadlines for notifying the company or appealing denials. Unfortunately, when you miss these dates, that can permanently bar your claim, no matter the strength of your case.
Know Montana’s Bad Faith Protections
Montana has some of the strongest bad faith laws regarding insurance in the country. Under the Montana Unfair Trade Practices Act, insurers must handle claims immediately, fairly, and in good faith.
If they unreasonably deny or delay your claim, they can be held liable for damages that extend beyond the policy limits, including paying for your attorney’s fees and possible punitive damages in extreme cases.
If you suspect your insurer is overstepping the line, document everything and consult with an attorney to determine the next steps.
Get Legal Help for Denied Insurance Claims
A denied insurance claim can feel like a punch in the gut, especially when you are physically and financially hurting. But in Montana, you have tools and protections on your side.
You paid for coverage. You deserve fair treatment. Now that you know the steps to resolve coverage claims in Montana, you know what to do when your claim is denied. At AFJ Law Firm PLLC, we can assist.
At AFJ Law Firm PLLC – Personal Injury, Car Accident, and Insurance Law., we are here to help you through the entire claims process, including proving fault in these accidents. Click here to visit our Montana Personal Injury Frequently Asked Questions page. Click here to visit our Commercial Trucking and Semi-Truck Accident practice area page. Contact us if you still have questions about your Montana trucking accident case.