Partner at Charbonnet Law Firm LLC
Practice Areas: Car Accident, Personal Injury
Insurance claims are meant to provide support during stressful situations. Yet many people are surprised to learn that claims can still be denied even when they believe they did everything right. A denied claim does not always mean the end of the process. It simply means you may need to understand the reason behind the denial, gather stronger proof, or take additional steps to challenge the decision.
This guide explains why insurance claims get denied, how insurers evaluate coverage, and what you can do next. It also highlights key Louisiana rules, your policyholder rights, and how to respond when a denial letter arrives.
Insurance companies follow specific steps to decide whether a claim meets the policy terms. Denials often happen when key information is missing or when the incident does not fit the coverage rules. Understanding these reasons helps you respond more effectively.
Common causes include:
Sometimes the denial is connected to state reporting rules, deadlines, or misunderstandings about what the policy actually covers.
Under Louisiana law (La. R.S. 22:1892), insurers must pay claims within specific timeframes after receiving satisfactory proof of loss.
Any accident involving injury, death, or property damage over 500 dollars must be reported to law enforcement under La. R.S. 32:398.
A claim may also be denied if documentation is incomplete. Crash reports, photos, repair estimates, and medical records play an important role in showing the insurer what happened. Without these details, the company may claim there is not enough information to approve the request.
Insurers evaluate both the details of the incident and the terms of the policy. They review evidence, statements, and reports to determine if the claim falls within the coverage purchased. Fault also matters, especially in accidents. Louisiana uses a comparative fault system.
Louisiana follows a comparative fault system (La. Civ. Code Art. 2323), meaning a claimant’s compensation may be reduced based on their percentage of fault.
If an insurer believes you contributed to the accident, it may reduce coverage or question the claim. This does not always mean the claim is invalid. It simply means the insurer is interpreting the situation based on its own internal review.
Medical documentation, witness statements, and photos often help resolve disagreements. These records show the impact of the incident, the timeline of events, and any factors that may have influenced the outcome.
A denial letter should explain the specific reason the claim was rejected. This letter is important because it outlines the next steps you can take if you want to challenge the decision.
The first step is reviewing the explanation. Look for:
After reviewing the letter, gather any additional proof that supports your claim. This may include updated repair estimates, medical records, witness information, or photos from the scene. In many cases, supplementing a claim strengthens it enough for reconsideration.
It also helps to request clarification from the insurer if the denial is unclear. Understanding the exact issue gives you a clearer direction on what to fix. Many denials are reversed once more complete information is provided.
Disputing a denied insurance claim is a structured process. Insurers must consider any new or corrected information you submit. A disagreement does not automatically mean the insurer acted improperly, but Louisiana law does outline rules they must follow.
The dispute process often includes:
Under Louisiana’s bad faith rules (La. R.S. 22:1973), insurers must treat policyholders fairly and handle claims honestly. If the insurer ignores information or delays the review without valid reasons, these actions may be considered improper under state law.
Sometimes, independent evaluations help clarify damages. Examples include expert assessments, detailed repair inspections, or medical reviews that explain the nature of the injuries.
Many people do not realize how much information is inside an insurance policy. These documents outline coverage limits, exclusions, deadlines, and responsibilities. A denial often makes more sense once the policy language is reviewed.
Important sections to understand include:
Policyholder rights are also important. You have the right to receive explanations, request reconsideration, and provide additional information. You can also ask for clarification if the policy wording seems unclear.
Good documentation habits help prevent future denials. Keeping copies of receipts, medical records, and communication logs makes resolving disputes easier and provides a clear timeline of events.
They deny claims due to missing evidence, unclear policy terms, reporting delays, or coverage disputes based on their evaluation.
Yes. You can request clarification, submit additional documents, or file an internal appeal with the insurer for reconsideration.
State law sets specific timelines for reviewing and paying claims once satisfactory proof of loss is submitted.
Photos, medical records, repair estimates, bills, crash reports, and written statements often help clarify details.
Yes. Under Louisiana’s comparative fault rules, compensation may change depending on each party’s degree of responsibility.
A denied insurance claim can feel frustrating, but it does not always mean the process is over. Understanding why the denial happened, reviewing your policy, and gathering clear documentation can make a meaningful difference. Louisiana law offers important protections for policyholders, and many disputes are resolved once stronger evidence is submitted or missing details are clarified.
If your claim has been denied and you want guidance on the next steps, the New Orleans personal injury lawyers at Charbonnet Law Firm, LLC can help you understand your options and review the details of your situation. Our firm offers a free consultation to discuss your concerns and help you move forward with clarity.
With over 50 years of legal experience serving families in the New Orleans area and surrounding Louisiana communities, our firm takes pride in providing clients with personalized legal services tailored to individual needs.
