You send in your premiums. You do what you’re supposed to. You rely on your insurance company to cover you when things turn sour—be it a car crash, a hurricane, or slip and fall. But then, out of nowhere, they deliver the one thing that everyone dislikes to receive: Claim Denied.
If you’re here because that recently happened to you, let me say this first—you’re not alone. I’ve had hundreds of clients in South Florida who were caught off guard by a denial letter, didn’t know what to do next, and tired of the system. And I get it. It’s maddening. But there is something you can do. Let me walk you through it step by step.
Step 1: Don’t Panic. Denial Does Not Mean It’s Over.
It might feel like the end of the road, but it is not. Insurance companies deny claims for all kinds of reasons—and not all of them are valid. Some are technical reasons. Some are based on interpretations that can simply be challenged. Sometimes it’s just bad faith.
Your assignment right now is to breathe deeply, take it slow, and get informed. It’s not a slam in your face. It’s a fork in the road. You just have to stay on the good path from here.
Step 2: Read the Denial Letter Carefully
That denial letter may be loaded with gobbledygook, but down at the core of it is the reason—or reasons—why they’re denying you. It might contain phrases such as:
- “Coverage not available under policy terms”
- “Failure to provide requested documentation”
- “Claim is in excess of policy limits”
- “Pre-existing condition” (in health claims)
- “Late reporting” or “failure to aid in the investigation”
Each of these has a clear game plan for fighting back. But first, we must understand just what the insurance company is charging.
Pro tip: If the letter doesn’t tell you clearly why they denied the claim, that’s a red flag in and of itself. You deserve a clear explanation. If you have no clue what it’s saying, call me. I’ll read it to you—no fee, no strings.
Step 3: Collect and Read Your Policy
Now’s the time to dust off your insurance policy. Look at what’s actually covered—and what’s excluded. Policies are often dozens of pages long, but the devil is in the details.
Focus on:
- The Declarations Page (this lists your coverage amounts and limits)
- The Insuring Agreement (this explains what is covered)
- The Exclusions section (what isn’t covered)
- The Conditions section (what you’re required to do, like timely notice)
This is where we’re going to contrast what they’re saying with what you actually enrolled in. I’ve done hundreds of cases where companies use made-up rules or interpretations that crumble when the actual policy is examined.
Step 4: Gather Evidence in Support of Your Claim
If the denial is based on incomplete information, alleged contradictions, or dispute of the facts, you’ll have to make sure you have:
- Photographs of the injury or damage
- Police reports or incident reports
- Medical records or bills
- Repair estimates
- Witness statements
- Any correspondence you’ve had with the insurer
The more organized and detailed you are here, the better your case will be if we choose to fight on.
Step 5: File an Internal Appeal
Most insurance providers do have an internal appeals process. This is your first shot at reversing the denial without going to court. But don’t be casual about it. You’re only allowed one shot at getting it right.
Here’s how to do it:
- Reply by the deadline indicated in your denial letter
- Attach a written statement explaining why you believe the denial is wrong
- Back it up with evidence (photos, records, expert opinions, etc.)
- Be clear, concise, and professional
It ain’t always easy to do this, especially when emotions are running high. If you’d like me to help you write it or review your appeal letter before your sending it, I’m here.
Step 6: File a Complaint with Florida’s Insurance Regulator
If the insurer is not being transparent or is stalling, you can make a complaint to the Florida Office of Insurance Regulation (OIR). This will put a bit of pressure on the company and make it very clear that you’re not afraid to take it further.
You can make a complaint online at: https://www.myfloridacfo.com/division/consumers
Once your complaint is on file, the state will consider it and force the insurer to reply. This doesn’t always result in getting your claim paid, but it sends a signal—and it can tip the balance in your direction, particularly if the insurer knows they’ve made a mess of your file.
Step 7: Speak with a Personal Injury Attorney (That’s Me)
If none of the above is an option—or you just don’t want to endure it on your own—then you need someone in your corner who knows how to fight.
I have handled thousands of claim denials, and I have witnessed the games that these firms play in an attempt to wear people down. They expect you to give up. But when you have an experienced attorney in your corner, the game changes. Suddenly, they stop playing games.
We can:
- Renegotiate your claim and policy for free
- Send them a notice letter putting them on notice
- Sue them in bad faith if they acted wrongly
- Negotiate a fair settlement—or go all the way to trial if you want
And here’s the good news: You don’t pay me a cent upfront. If we take your case, I only get paid if you win. That’s how confident I am of what we do.
Real Talk: Why Do Insurance Companies Deny Valid Claims?
I wish I could say it’s rare. But it’s not.
Sometimes it’s to make money. Sometimes it’s just incompetence. Claims get lost, paperwork disappears, adjusters are overworked and under-trained. And then there are the bad faith denials—where they know your claim is worth paying but don’t anticipate you’ll fight.
Here in South Florida, I’ve seen it happen after hurricanes, car wrecks, and slip-and-falls. One client came to me after their car insurance company denied a claim stating they weren’t “at fault”—even though there was a police report saying they were. We got them a full payout, and penalties.
The moral is: Don’t quit after one “no.” Because with the right strategy, it can be a “yes.”
Final Thoughts
Insurance companies may have clout, but they don’t have the final word. If your claim was denied, don’t walk away angry and without a solution. Let’s make that denial a fight worth having.
You’re not a case number—you’re a human being. You’re owed answers. You’re owed action. You’re owed an attorney who cares about you—not a case number.
Call Jaime “Mr. 786Abogado” Suarez today to Get You Paid!
