Can I challenge an insurance company's denial of my injury claim?

Start by Finding Out Exactly Why the Claim Was Denied

An insurance company may use the word “denied” for several different situations. Before responding, you need to know whether the carrier is disputing fault, the connection between the accident and your injuries, the amount of your losses, insurance coverage, or its responsibility for handling the claim.

Ask the adjuster to provide the denial in writing and identify the facts, policy provisions, or legal rules on which the company relied. N.C. Gen. Stat. § 58-63-15 identifies failure to promptly provide a reasonable explanation for a claim denial, based on the policy and the relevant facts or law, as an unfair claim settlement practice. This statute does not mean every disputed denial creates a separate claim, but it supports asking for a clear explanation rather than accepting a vague statement.

A useful written request should ask:

• Whether the denial concerns liability, contributory negligence, medical causation, damages, coverage, or another issue.
• Which facts the carrier believes support its decision.
• Whether any records or information are missing.
• Whether the carrier contends that a different insurer should receive the claim.
• Whether the company’s investigation is complete or it will review additional evidence.

Common Reasons North Carolina Injury Claims Are Denied

Disputed fault

The insurer may claim its insured did nothing wrong or that the available evidence does not establish negligence. Police reports, photographs, video, witness information, physical evidence, and statements from the people involved can affect that decision.

Contributory negligence

North Carolina allows contributory negligence as a defense. If the defense proves that the injured person’s own negligence helped cause the injury, it can create serious problems for the claim. Under N.C. Gen. Stat. § 1-139, the party raising contributory negligence generally has the burden of proving it.

When fault is disputed, evidence should address both what the other person did wrong and why the injured person acted reasonably. Avoid guessing about distances, speed, timing, or other details when communicating with an adjuster.

Disputed medical connection or incomplete documentation

A carrier may argue that the records do not connect the reported injuries to the incident, that there was a delay in care, or that prior medical issues explain the symptoms. A response may require complete and accurate medical records, bills, visit summaries, and a clear incident timeline. Document symptoms accurately and follow the instructions of your medical providers.

Coverage or carrier problems

The carrier may deny the claim because it believes the person or vehicle was not insured under its policy on the incident date. It may also say that another insurer has primary responsibility for handling the loss. Coverage questions can depend on the policy language, the people and vehicles involved, the reason a vehicle was being used, and other facts.

A coverage denial is different from a decision that the insured person was not at fault. Request the precise coverage reason and preserve every policy-related letter. If another carrier may be responsible, obtain that company’s name, claim number, adjuster information, and any written explanation of why the claim should be redirected.

Ways to Challenge the Denial

There is not always a formal appeal process for a liability claim against another person’s insurer. Depending on the reason for denial, a challenge may involve one or more of these steps:

1. Request the complete reason in writing. A short phone statement may not reveal whether the dispute involves fault, coverage, medical proof, or the amount demanded.
2. Compare the denial with the evidence. Identify inaccurate assumptions, missing records, overlooked witnesses, or documents the carrier may not have reviewed.
3. Submit a focused response. Address each stated reason and provide supporting materials rather than simply asking the adjuster to change the decision.
4. Identify the proper carrier. If another insurer may handle the claim, promptly give that carrier notice and send the appropriate documentation. Keep proof of when and where the materials were delivered.
5. Preserve the legal claim. If the carrier will not reconsider, the injured person may need to evaluate a lawsuit against the legally responsible party. The proper defendant and available insurance are related issues, but they are not always the same issue.

Do not sign a release or other settlement document without understanding what rights it would resolve. Likewise, do not assume the insurer’s denial determines what a court would decide.

Documents to Gather Before Requesting Reconsideration

A well-organized file can help clarify what happened and why the carrier denied the claim. Preserve or gather:

• The written denial and all letters, emails, and text messages from adjusters.
• Claim numbers, policy information, adjuster names, and contact details for every potentially involved carrier.
• Incident or crash reports, photographs, video, diagrams, and witness information.
• Medical records, bills, visit summaries, and documentation of symptoms.
• Employment records supporting claimed time away from work or lost income.
• Receipts for injury-related out-of-pocket expenses.
• A copy of the injury demand and proof showing when the carrier received it.
• Any letter stating that another insurance company should handle the claim.

Keep original files when possible. A simple timeline listing the incident date, medical visits, insurer communications, demand submission, and denial date may also reveal missing information or approaching deadlines.

Do Not Let Reconsideration Cause a Missed Deadline

For many North Carolina personal injury actions, N.C. Gen. Stat. § 1-52 provides a three-year filing period. Different deadlines or procedural rules may apply depending on the type of case, the defendant, and other circumstances.

Insurance negotiations, an adjuster’s continuing investigation, or a request for reconsideration generally do not automatically stop or extend the filing period. Sending the demand to the wrong carrier may also consume valuable time. The applicable deadline should therefore be evaluated separately from the insurance company’s internal claim process.

How This Applies When Another Carrier May Be Responsible

Here, the first step is to obtain the current carrier’s actual reason for denial. If the carrier is denying fault or medical causation, the response should address that issue with supporting evidence. If it is denying responsibility because another carrier should handle the claim, the focus shifts to confirming the correct insurer and delivering the injury demand and supporting records to that company.

The attorney can ask the denying carrier to identify the coverage issue in writing, preserve all communications, and contact the other potentially responsible carrier without assuming that the first company will transfer the file. If responsibility remains unclear, providing prompt notice to each potentially involved carrier may help preserve a record of the claim while the coverage question is investigated.