When An Insurance Company Denies Your Claim Without Explanation
Posted September 09, 2025 in Personal Injury
Filing an insurance claim can already feel overwhelming. Whether it’s for a car accident, property damage, or an injury, you trust your insurance company will handle your claim fairly. But sometimes, you get a letter or email that simply says your claim is denied — with little or no explanation.
If that’s happened to you, you’re not alone. And in many cases, you still have options. Below, our friends from Mickey Keenan P.A. provide this guide that will walk you through why this happens, what your rights are, and what to do next.
Why Insurance Companies Deny Claims
While there are many valid reasons for an insurance denial, companies are required to tell you why your claim was rejected. When they don’t, it raises questions — and potential legal concerns.
Some common reasons claims are denied include:
- Policy exclusions – Your policy may not cover the type of loss you claimed.
- Lapsed coverage – Your policy expired due to non-payment or cancellation.
- Insufficient documentation – The insurer says you didn’t provide enough proof of your loss or damages.
- Disputed fault – In accident claims, they may believe you were at fault or share responsibility.
- Pre-existing conditions – In injury cases, they may argue your condition wasn’t caused by the incident.
Even if one of these applies, insurers are generally obligated to explain their decision.
Your Right To An Explanation
In most states, insurance companies must:
- Provide a written explanation for claim denials.
- Cite the specific policy language they’re relying on.
- Give you information on how to appeal or dispute the decision.
If they fail to do so, it could be a sign of bad faith, meaning they’re not acting honestly or fairly as your insurer.
What Is Insurance Bad Faith?
Bad faith occurs when an insurance company acts unreasonably or dishonestly in handling a claim. Examples include:
- Denying a claim without investigating
- Refusing to explain a denial
- Delaying payment without a valid reason
- Offering an unreasonably low settlement
If you can show that your insurer acted in bad faith, you may be entitled to damages beyond the value of your original claim.
Steps To Take After An Unexplained Denial
If your claim has been denied without explanation, here’s what to do:
Request a Written Explanation
Contact your insurer and ask for a detailed written explanation citing the specific policy provisions used to deny your claim.
Review Your Policy
Compare the denial reason with your policy’s terms. Look for coverage definitions, exclusions, and deadlines.
Gather Documentation
Collect all evidence related to your claim — photos, receipts, witness statements, medical records, or police reports.
File An Internal Appeal
Most insurers have an appeals process. Follow their steps carefully and meet all deadlines.
Contact Your State’s Department of Insurance
If the insurer refuses to cooperate, your state’s insurance regulator can investigate.
Consult an Attorney
A personal injury or insurance lawyer can review your case, communicate with the insurer, and determine if a bad faith lawsuit is appropriate.
Real-Life Example
Imagine your home suffers significant water damage from a burst pipe. You file a claim with your homeowner’s insurance. Weeks later, you receive a one-line email: “Your claim has been denied.” No reason. No instructions.
You request details, and the insurer still won’t provide them. This refusal to explain, combined with ignoring your requests, could be considered bad faith. A pedestrian accident lawyer could step in, demand the insurer’s file, and potentially seek damages for the denial and the delay.
When Denial Becomes Delay
Sometimes an insurance company doesn’t outright deny your claim — they just keep delaying. They may repeatedly ask for more documents, reassign your claim, or “lose” paperwork. This is another tactic that can fall under bad faith if it’s being used to avoid paying.
Document every interaction and keep records of all calls, emails, and letters.
How An Attorney Can Help
An attorney experienced in insurance disputes can:
- Review your policy for coverage terms and exclusions
- Demand a full explanation and documentation from the insurer
- Negotiate on your behalf for a fair settlement
- File a lawsuit for bad faith if the insurer acted improperly
In some states, if you win a bad faith case, the insurer may have to pay your attorney’s fees and additional damages.
Protecting Yourself Before You Need To File A Claim
While you can’t prevent every dispute, you can make things easier if you ever have to fight a denial:
- Keep a copy of your policy and any updates from the insurer.
- Document everything — from the moment the loss occurs.
- Communicate in writing as much as possible.
- Know your deadlines for reporting a claim and filing an appeal.
An unexplained insurance denial is frustrating, but it’s not the end of the road. You have the right to know why your claim was denied — and to challenge that decision.
If your insurer won’t give you answers or is dragging their feet, don’t wait. Reach out to an attorney who understands insurance bad faith laws in your state. They can help you get the answers, and the compensation, you deserve!