Few experiences are as frustrating as faithfully paying your insurance premiums, only to have your claim denied when you need coverage the most. It’s a moment that leaves many feeling betrayed and powerless—especially when it seems the insurance company has all the resources and leverage.
Ellis Riccobono Trial Lawyers work tirelessly to level the playing field for everyday people who feel overshadowed by large insurers, corporations, and powerful interests. Armed with knowledge and support, you can face the insurance giants head-on and pursue the full value of the compensation you’re entitled to.
Common Reasons for Claim Denials
- Policy Exclusions or Limitations
Insurance policies are often filled with technical language outlining what is and isn’t covered. A denial might stem from a clause that specifically excludes the type of loss or event you’re facing—such as flooding, certain storm damage, or mold. It could also be a limitation on coverage that caps the amount payable or restricts the scope of benefits. Carefully reviewing your policy’s fine print is key to understanding whether the insurer is legitimately applying an exclusion or simply using it as a pretext to underpay or deny your claim. - Alleged Misrepresentation or Non-Disclosure
Insurance companies sometimes argue that you provided inaccurate or incomplete information during the application process or failed to update critical details that might affect coverage (e.g., significant renovations, occupancy changes, or undisclosed risks). If the insurer believes these omissions or discrepancies are significant, they may deny the claim outright. Often, the so-called misrepresentation is minor or unrelated to the damage at hand, and a thorough legal review is needed to challenge these grounds effectively. - Disputed Liability or Damages
Even if the cause of the damage seems clear—like a hurricane, fire, or burst pipe—insurers may argue that your losses are exaggerated or weren’t directly linked to the event. They might blame improper maintenance or pre-existing wear and tear. In many cases, these disputes come down to the insurer minimizing payouts—highlighting the need for strong evidence (e.g., inspection reports, photos) and, often, legal representation to present a compelling case. - Administrative or Filing Errors
Sometimes, a claim is denied simply due to missed deadlines, incomplete forms, or other paperwork oversights. While it may feel like a minor technicality, insurance companies often rely on strict procedural rules to sidestep valid claims. Even small errors can become major obstacles if not corrected promptly. Seeking guidance early—either from an insurance professional or an attorney—can prevent or remedy administrative snags before they result in a final denial.
First Steps After Receiving a Denial
- Review the Denial Letter Thoroughly
The denial letter should specify why the claim was rejected or underpaid. Familiarize yourself with the exact policy clauses the insurer references.
Compare the stated reason with your insurance policy; sometimes, insurers invoke exclusions or conditions improperly. - Gather All Documentation
Assemble all relevant paperwork—policies, medical reports, accident photos, estimates, invoices, and correspondence with the insurer. Consider obtaining additional statements from medical professionals, contractors, or other experts who can substantiate the validity of your claim. - Note Deadlines for Appeals
Insurance policies and state laws often have strict time frames for filing an internal appeal or initiating legal action. Missing these deadlines can jeopardize your entire case.
Follow the insurer’s internal process carefully, ensuring all forms are accurately completed and submitted within the specified time. Keep copies of everything you send. - When to Seek Legal Assistance
Insurance claims can be complex, and a denial or underpayment is not always straightforward. While some policyholders can successfully navigate minor disputes through an internal appeal, there are key moments when seeking legal help is not only advisable but necessary.
Below are common signs it may be time to consult with an attorney:
- Repeated Delays or Lack of Communication – If you’ve been submitting documentation and follow-up requests, yet the insurer keeps stalling or remains unresponsive, it could be an intentional tactic to frustrate you into accepting a lower settlement—or giving up altogether. An attorney can pressure the insurer to provide answers and move the claim forward.
- Complex or Conflicting Policy Language – Insurance policies often contain dense legal language and policy exclusions that may be open to interpretation. If you find discrepancies between what the insurer cites as a reason for denial and what your policy actually says, a lawyer can help clarify coverage terms and ensure the insurer isn’t unfairly leveraging ambiguous language.
- Suspicion of Bad Faith Practices – Insurers have a legal duty to handle claims fairly and in good faith. If you experience unwarranted or arbitrary denials, misleading statements, or lowball offers that disregard documented losses, you may have grounds for a bad faith claim. A skilled trial lawyer can gather the evidence to show the insurer is acting unreasonably or dishonestly.
- High-Stakes or Catastrophic Losses – When your losses involve significant property damage, serious personal injuries, or long-term disability, the cost of a denial can be enormous. In these scenarios, legal expertise becomes critical, as insurers have more incentive to dispute large claims.
The Ellis Riccobono Difference
At Ellis Riccobono Trial Lawyers, our commitment goes beyond standard legal representation. We handle every case with determination, empathy, and the resources needed to go toe-to-toe with major insurance companies. Our track record of winning awards and being recognized by the legal community demonstrates our firm’s ability to uphold your rights effectively.
By consulting an experienced attorney early, you improve your chances of a successful outcome—and send a clear message to the insurer that you will not accept anything less than a fair resolution.
If you feel trapped by a powerful insurance company or suspect bad faith tactics, Ellis Riccobono Trial Lawyers is here to champion your case and restore balance to an often-unbalanced system.