An insurance denial can feel like a second blow after an accident, especially when you are already dealing with medical treatments, severe pain, time off work, or the loss of a loved one.
McGinity Law Firm has represented Louisiana families for more than 20 years in car accidents, truck and 18-wheeler collisions, motorcycle crashes, wrongful death matters, and insurance claim disputes. An insurance claim denial or underpayment is not always the final word. In some cases, a well-documented appeal or legal action can change the outcome.
When an insurer denies your claim, you have options. We can explain how to appeal an insurance decision and show how Louisiana’s “bad faith” insurance laws can work for you.
Internal Appeal vs. Filing a Lawsuit
An internal appeal means you ask the insurance company to reconsider its decision through its established process. A lawsuit means you ask a court to resolve the dispute and, when appropriate, enforce penalties under Louisiana law. An internal appeal may be possible without giving up the option to file suit, but only if you continue to meet policy requirements and legal filing deadlines.
Internal appeals can be a good first move when:
- The denial appears to be based on missing information or a misunderstanding.
- The insurer has not reviewed key records, such as medical reports or wage documentation.
- The dispute is narrow and correctable, such as coding errors.
A lawsuit may become necessary when:
- The insurer refuses to change course despite clear proof.
- The insurer misrepresents policy terms or ignores evidence.
- There is an unreasonable delay, lowballing, or shifting of explanations.
- Time is running out on legal deadlines.
- The insurer’s conduct suggests bad faith.
If you are unsure which path makes sense, an early legal review from an experienced Louisiana insurance lawyer can help. At McGinity Law Firm, we can assist by identifying deadlines, missing documentation, and whether the insurer’s stated reason for denial matches the policy language.
If you want us to review your denial and explain your options, request a free consultation from McGinity Law Firm today.
Where “Bad Faith” Fits in Under Louisiana Law
Louisiana law allows penalties in certain situations when an insurer unreasonably fails to pay or unreasonably delays handling a claim after receiving satisfactory proof of loss. Depending on the facts, conduct alleged as “bad faith” may include:
- Unreasonable failure to pay after receiving satisfactory proof of loss
- Misrepresenting coverage facts or policy provisions
- Failing to timely communicate, investigate, or make a coverage decision
- Delaying payouts without a legitimate basis
Louisiana has “bad faith” insurance laws that can allow penalties when an insurer unreasonably delays or refuses to pay after receiving satisfactory proof of loss (RS 22:1892 and 22:1973). Not every denial is bad faith, but unreasonable delay or nonpayment can carry consequences.
How To Successfully Appeal an Insurance Denial
Step 1: Identify What Kind of Decision You Are Appealing
If you are asking, “My insurance claim was denied, what next?”, your first step is to get the denial in writing. Make sure it includes the policy language and any evidence the insurer used. This will reveal the true nature of the dispute: are they fighting the facts, the coverage, or the amount of your damages?
You need to determine:
- Whether your claim was denied outright due to liability, coverage, late notice, or a medical expense that wasn’t considered a “medical necessity.”
- Whether they accepted your claim, but the payout is undervalued
- Whether they are delaying with slow responses and repeated document requests, or are still investigating
Step 2: Request the File and Policy Language, Calendar Deadlines, and Preserve Evidence
A verbal explanation is not enough to challenge a decision. Request the reason and the supporting policy provisions in writing. This should include:
- The specific policy provisions they relied on
- The reason for denial or reduction, in writing
- Reports, photos, or evaluations used to justify the decision
At the same time, calendar deadlines from both the policy and Louisiana law ensure an appeal doesn’t cause you to miss a filing deadline. Preserve evidence early before video footage is overwritten or witnesses become hard to find.
Step 3: Build a Clean Appeal Package
An effective appeal clearly shows what happened, cites the relevant policy language, and attaches documents that address the insurer’s stated reason for denial.
Your appeal package typically includes:
- A short cover letter stating the decision you are appealing and the outcome you want
- A timeline of events
- Key documents, such as medical records, wage proof, photos, and police reports
Insurers often deny claims for common reasons, like alleged documentation gaps or by questioning the cause and necessity of your treatment. Your job is to push back with records that connect your treatment directly to the accident timeline.
Be wary of recorded statements. Always check if your policy actually requires one, because anything you say can be twisted later to argue you were at fault or that your injuries aren’t as serious as you claim.
A Tactical Approach: The Three-Layer Strategy
Before a case can be brought to court, most appeals follow this path towards settlement:
- Internal Appeal: Respond point-by-point to the denial rationale with supporting evidence.
- Formal Demand: If the insurer continues to underpay or deny, a demand can state what is owed, why, and when a response is due.
- Escalation: If delays or denials continue, you can file a complaint with the Louisiana Department of Insurance and/or a lawsuit, depending on the claim and deadlines.
Repeated non-responsiveness and rolling document requests can delay reimbursement and can jeopardize a claim if deadlines are missed. When communications stall, escalation may be necessary to obtain a clear coverage decision. Regardless of which layer you are in, small missteps can weaken your position.
Common Mistakes That Weaken Appeals
Many people may not know how to appeal an insurance decision. As a result, their appeals may not be as strong as they could be to ensure favorable outcomes. Some common mistakes can include:
- Appealing without understanding the policy language or the reason behind the denial
- Sending too much unfocused material instead of a clear report that creates a strong case for your claim
- Missing deadlines
- Giving recorded statements without preparation
- A letter labeled “final” may not prevent further appeal or legal action, depending on the policy terms and deadlines.
If any of these issues are already in your file, it does not mean your claim is over, but it may mean you need a tighter strategy. That is often the point at which a legal review by an insurance lawyer in Covington can prevent avoidable damage.
When To Talk to a Lawyer
You shouldn’t have to fight the insurance company alone, especially if liability is disputed, your injuries are serious, a loved one has died, or the adjuster is ignoring your documentation.
Let McGinity Law Firm take a look at your case. With over 20 years of experience in various practice areas of personal injury law, including insurance claims, Douglas McGinity is a Bogalusa insurance lawyer who can help you figure out if an internal appeal is still worth it. If necessary, our team can prepare your case to go to trial to ensure you get fair compensation.
If Your Claim Was Denied, We Can Help You Appeal
If you are trying to figure out how to appeal an insurance claim decision or what to do after a denial, our lawyers at McGinity Law Firm can review the denial, organize the supporting proof, and advise whether an internal appeal, formal demand, or lawsuit is the right next step.
For a free consultation on your insurance claim, contact our Bogalusa or Covington office.
We do not accept an insurer’s first answer at face value. We evaluate the decision against the policy, the evidence, and Louisiana law, and then pursue the available options to obtain just compensation.