Founding Attorney · Former Licensed Claims Adjuster
Getting a denial letter feels final. It isn't. In my years evaluating claims for carriers, I saw plenty of denials that were really just opening positions — the insurer's hope that you'd accept 'no' and go away. Many are reversed once someone pushes back the right way.
First, understand exactly why
Every denial must cite a reason. Read the letter and your policy side by side. The stated basis tells you precisely what to attack — and whether the insurer is on solid ground or reaching.
Common (and beatable) denial reasons
- "Not covered" — often a strained reading of an exclusion that doesn't actually apply.
- "Insufficient documentation" — usually fixable by supplying the right records.
- "Missed deadline" — check the dates; carriers sometimes miscalculate.
- "Pre-existing / unrelated" — a causation argument that evidence can rebut.
A denial isn't a verdict. It's the carrier's opening bid — and openings can be beaten.
Your next moves
- Keep every letter, email, and call log — dates and names matter.
- Don't give a recorded statement or sign anything without understanding it.
- Request the full claim file and the specific policy language relied on.
- Have someone who knows carrier valuation review the denial before you respond.
Denied, delayed, or underpaid on a claim? I read policies the way carriers do — and I represent policyholders, never insurers.
See how I handle insurance disputes→Think this applies to your situation?
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