What to Do If the Insurance Company Denies Your Claim

Don’t Panic — You Still Have Rights and Options

Getting a letter or phone call from the insurance company saying your claim has been denied can feel discouraging.
But here’s the truth: a denial doesn’t mean the end of your case.
Insurance companies deny claims all the time — even valid ones — hoping that injured people will simply give up.

At Anderson Franco Law, we help people throughout San Francisco and the Bay Area fight unfair insurance denials.
Whether your claim involves a personal injury accident or workers’ compensation, you still have legal options to get the money you deserve.

Why Insurance Companies Deny Claims

Understanding why your claim was denied is the first step to turning things around.
Sometimes denials happen because of missing information — but often, insurance companies are protecting their own bottom line.

Common Reasons for Denials

• They claim you caused the accident.
• They say your injuries aren’t serious or weren’t caused by the incident.
• They argue that you filed the claim too late.
• In work injury cases, they allege you weren’t working or weren’t performing job duties when hurt.
• They claim there’s not enough medical evidence.
• Or they use delay tactics hoping you’ll give up.

Whatever their excuse, you have the right to appeal and present additional proof.

If Your Personal Injury Claim Was Denied

If your personal injury claim — such as a car accident, slip and fall, or dog bite — was denied, follow these steps immediately:

1. Ask for a Written Explanation

Request a denial letter explaining the exact reason your claim was rejected.
You have a right to know how the decision was made.

2. Review Your Insurance Policy

Sometimes the insurer misunderstands the coverage.
A personal injury attorney can review the policy and determine whether their reason for denial is valid.

3. Gather Strong Evidence

Collect every piece of evidence that supports your case:

• Police or incident reports
• Photos and videos of the scene
• Medical records and bills
• Witness statements
• Proof of missed work or lost income

The stronger your documentation, the harder it is for an insurer to deny your claim.

4. Avoid Speaking Directly With the Adjuster

Remember — insurance adjusters work for the company, not for you.
Anything you say can be twisted to weaken your case.
Don’t give recorded statements or sign any forms without legal advice.

5. Contact a Personal Injury Lawyer

At Anderson Franco Law, we review your denial for free and identify what went wrong.
With the right evidence and strategy, we can often get insurance companies to reverse their decision and pay what’s fair.

If Your Workers’ Compensation Claim Was Denied

If your workers’ compensation claim was denied, don’t lose hope.
California law gives you the right to appeal and request a judge’s review.

1. Review the Denial Letter

You should receive a written explanation detailing the reason for denial — for example, “injury not work-related” or “claim not filed on time.”

2. File an Application for Adjudication of Claim

This form is submitted to the California Division of Workers’ Compensation (DWC) to formally open your case.
It allows a judge to review the insurer’s decision.

3. Request a Hearing

You or your attorney can request a hearing before a workers’ compensation judge.
At this stage, evidence such as medical reports and witness testimony can be presented.

4. Get an Independent Medical Evaluation

If the insurance company relied on their own doctor, you have the right to a Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME).
This independent opinion can completely change the outcome of your claim.

5. Don’t Give Up

Even if your claim was denied, you still have rights under California law.
A skilled lawyer can help force the insurer to accept liability and pay back benefits.

Personal Injury vs. Workers’ Compensation — What’s the Difference?

Although both involve injuries, these claims work very differently:

Regardless of which applies to you, a denial does not mean you’re out of options.
A lawyer can review your denial, collect new evidence, and fight to reopen your case.

Common Mistakes After a Denial

Avoid these errors, which can hurt your case:

1. Accepting the denial as final.
   Most denials can be appealed. Never assume the insurer’s word is final.
2. Waiting too long.
   In California, deadlines are strict — workers’ comp appeals must be filed within 20 days of receiving the denial.
3. Continuing to speak with the insurance company without a lawyer.
   Anything you say may be used against you.
4. Skipping medical treatment.
   Insurers will claim you’re fully recovered or that your injuries weren’t serious.
5. Failing to save records.
   Keep all emails, letters, medical bills, and photos related to your claim.

How Anderson Franco Law Can Help

At Anderson Franco Law, we represent people across San Francisco and the Bay Area who have had their claims unfairly denied.
Our team provides free consultations and handles cases on a contingency basis, meaning you don’t pay unless we win.

We help clients by:

• Reviewing denial letters and identifying errors
• Gathering additional medical or witness evidence
• Filing appeals and representing you before judges
• Negotiating directly with insurers
• Fighting for the maximum compensation you deserve

We’ve successfully helped clients overturn denials for both personal injury and workers’ comp cases — and we can help you too.

Examples of Denied Cases We’ve Helped With

• Car accidents where insurers claimed “shared fault.”
• Slip and fall incidents where the company said “no dangerous condition existed.”
• Workplace injuries denied because the employer said it happened “off duty.”
• Medical evidence disputes where we helped clients get new evaluations and win appeals.

Every case is different — but the goal is always the same: to get justice.

When to Contact an Attorney

You should contact an attorney as soon as you receive a denial.
The clock starts ticking immediately, especially for workers’ comp cases with short deadlines.

At Anderson Franco Law:

• We review your denial for free.
• We explain your legal options clearly.
• We help you appeal quickly and effectively.

The sooner you act, the better your chances of success.

We Fight for You — Not the Insurance Company

Insurance companies have adjusters, investigators, and lawyers on their side.
You deserve someone on your side who knows how to fight back.

At Anderson Franco Law, we work on a no-win, no-fee basis — meaning you pay nothing upfront.
Our mission is to level the playing field and make sure you get the justice you deserve.

Contact Anderson Franco Law Today

If your personal injury or workers’ compensation claim has been denied, don’t give up. We can help you appeal and fight for the benefits you’re entitled to.