Getting a claim denied can feel overwhelming—but a structured appeal can turn the tide. Here’s a step‑by‑step guide that empowers you to challenge denials effectively, with THAgency guiding you every step of the way.
1. Carefully Review the Denial Letter
Every insurer must provide a claim denial in writing. Don’t toss it—this document reveals why your claim was declined. Look for:
Specific policy clauses or exclusions cited
Any missing information or documentation
Stated deadlines for appeal submissions
2. Compare Your Claim to Policy Terms
Match the denial reasons to your actual policy language:
Identify whether the denial is based on a legitimate exclusion
Check if the required deductible applies
Ensure no procedural errors occurred, like missed deadlines or incomplete forms
If something doesn’t align, you may have strong grounds for appeal.
3. Gather Strong Supporting Evidence
A robust appeal hinges on documentation. Compile:
Photos or videos of damage or incidents
Police, repair, or medical reports
Eyewitness or professional statements
Receipts, invoices, and any additional cost estimates
Medical records or doctor’s notes, if relevant
Organize everything clearly, and include a concise cover letter outlining key points.
4. Follow the Insurer’s Appeals Process Precisely
Insurance companies closely follow their own rules. To ensure your appeal is accepted:
Use the dedicated form or format they require
Include all requested attachments
Submit via the proper channel—by mail, email, or online
Respect submission deadlines (typically 30–60 days)
THAgency helps ensure every document is filed correctly and promptly.
5. Submit a Formal Written Appeal
When writing your appeal letter:
Reference claim number, denial date, and policyholder info
State clearly that you are appealing the decision
Quote relevant policy sections
Summarize your evidence and why the claim is valid
Request a prompt reconsideration
Keep your tone balanced: firm and factual, but not confrontational.
6. Escalate Your Appeal if Needed
If the initial appeal fails, move to the next steps:
Send a second-level appeal with new insights or evidence
Request an external review through your state’s insurance department
Consider mediation or arbitration (if allowed) before litigation
THAgency can introduce you to specialist adjusters or legal advocates to strengthen your case.
7. Know When to Seek Legal Help
If the insurer still refuses after every appeal:
A qualified insurance attorney can assess your contract and evidence
Legal recourse may include filing a bad faith lawsuit
THAgency can connect you with trusted legal resources familiar with complex claims
Final Takeaway
Appealing a denied claim takes determination—but with organization, accuracy, and persistence, you significantly improve your chances. Proper documentation, clear communication, and following insurer guidelines are essential. And with THAgency behind you, you’ll have expert guidance to advocate for the settlement you deserve.
Ready to Appeal with Confidence?
Schedule your free appeal consultation with THAgency today. We’ll review your denial, assemble persuasive evidence, and guide your appeal from start to finish—so you get the payout you’re owed.
