Is It Worth Appealing a Denied Insurance Claim?

When an accident occurs, most Americans rely on their insurance coverage to help them recover. It doesn't matter if it's a car accident, property damage, or medical expenses; insurance is supposed to help.

What happens, however, if the insurance is denied? Is it worth appealing a denied insurance claim? For many people in Iowa, a denied insurance claim can feel like a dead end. However, in many cases, it is definitely worth appealing.

Insurance companies often deny claims for reasons that can be challenged, and a policyholder has a legal right to dispute those. Below, there is information on when it might be worth appealing an initial denial and how working with an experienced attorney can make a huge difference. They can also explain what to do after a multi-vehicle car accident.

Understanding Why a Claim is Denied

Before you decide if you want to appeal a claim with an insurer, it's important to understand why your claim was denied in the first place. Insurance companies are businesses, and their goal is to protect their bottom line and pay out as little as possible. For instance, if a health insurer doesn't think a claim is supporting a medical necessity, they very well may deny a claim. Common reasons include:

• Missing information or incomplete information – If a claim form lacks required documentation, the insurer may automatically deny it. Some companies have an internal appeal process that scans forms for missing information to automatically deny them.

• Policy exclusions – Some policies exclude certain types of accidents, damages, or medical conditions. A health insurance health plan might have this, and so may an auto insurance plan.

• Lapsed coverage – If premiums weren’t paid on time, the insurer may argue the policy was inactive at the time of the incident, even if you were otherwise fully insured.

• Disputes about fault or liability – Especially in car accidents, insurers may claim that you were partially or fully at fault. An external review and investigation will need to be done, otherwise, from an independent review organization or other resource.

• Failure to seek timely medical care – In personal injury cases, delays in treatment can lead insurers to question whether injuries were accident-related. Claims denial is common in these situations.

Sometimes these reasons are legitimate—but many denials result from errors, misinterpretations, unfair claim-handling practices, or other reasons. That’s why appealing can be worthwhile.

The Importance of Reviewing the Claims Denial Letter

If your insurance claim is denied, the first thing to do is carefully read the denial letter to find out why your claim was rejected and take note of the specific policy provisions they are using to support that. Oftentimes, you will see vague language or unclear justification about the claim denial. According to information from the Iowa Insurance Division and Kaiser Family Foundation, only 1% of patients appeal claim denials. An attorney, such as Tom Fowler from Tom Fowler Law, can look at the letter to find out if you should respond with an appeal letter or start an external appeal process.

When an Appeal Is Worth Pursuing?

Not every denied claim is worth the time or cost to appeal. However, in many cases, it's at least well worth it to look into, especially when the damages are significant or the denial seems odd.

Here are some common situations where appealing a denied insurance claim makes sense:

• The insurance company misinterpreted your policy coverage.

• You provided sufficient evidence and supporting information, but they claim otherwise.

• They denied the claim before conducting a full investigation.

• The denial was based on a minor paperwork issue that can be corrected by you or providers.

• Your injuries or damages clearly fall under your policy’s terms and dates.

For example, if you were injured in a Des Moines car accident caused by another driver and your uninsured/underinsured motorist coverage was denied without a valid reason, appealing could help you recover the funds you’re entitled to.

The Process of Appealing a Denied Claim

Every insurance company has a process they use for appeals, but most of them follow a step by step process. Acting quickly and following the procedure can greatly help your chances of getting the claim approved.

1. Gather All Relevant Documentation

Start by collecting all of the documents related to the denied claim. This might include photos, receipts, medical records from a healthcare provider, repair estimates, witness statements, and any correspondence with the insurer. This is crucial for future approval.

2. Review Your Insurance Policy

Next, you need to review your insurance policy and make sure, to your understanding, that you were covered and determine that you did everything correctly, as far as you are aware.

3. Submit a Written Appeal

Next, you will need to submit a written appeal. It should include an explanation about why you believe the determination was wrong, and that you request an appeal. Include all supporting documents, from bills and medial records to communications from mechanics and service providers. Keep a copy of everything.

4. Follow Up Regularly

It can take several months for an appeal, though you generally have to start the process within four months of the denial. Follow up and keep a record of every type of communication, response, or contact you have.

5. Consider Legal Action if Necessary

If your appeal is denied again, you might need assistance from a lawyer. They can evaluate your claim and identify if you should file a lawsuit for a bad faith insurance claim.

Iowa Law and Bad Faith Insurance Practices

In Iowa, insurance companies have a legal duty to act in good faith when handling claims. This means they must:

• Promptly investigate claims

• Communicate clearly and honestly with policyholders

• Make fair and timely decisions based on available evidence

When an insurer fails to meet these obligations—by ignoring evidence, misrepresenting policy terms, or intentionally delaying payment—they may be liable for bad faith.

Victims of bad faith insurance practices can potentially recover not only the original claim amount but also additional damages for emotional distress, attorney fees, and sometimes punitive damages. For more information, a top-rated car accident lawyer in Des Moines may be able to help.

The Role of an Attorney in Insurance Appeals

Dealing with insurance companies can be overwhelming, especially when recovering from an accident or loss. A skilled Des Moines insurance claim attorney can take over the process and protect your rights every step of the way.

An attorney can:

• Review your denial letter and insurance policy for inconsistencies

• Gather and organize supporting evidence

• Draft a strong written appeal

• Communicate directly with the insurance adjuster or legal department

• File a lawsuit if the insurer continues to act in bad faith

At Tom Fowler Law, the team understands the complexities of these cases and how frustrating it can be when an insurance company fails to uphold its promises. The firm works to hold insurers accountable and ensure that clients receive the coverage they paid for.

When It Might Not Be Worth Appealing

In some cases, appealing a denial may not be practical. For example:

• The amount in dispute is very small.

• The policy clearly excludes the type of claim you filed.

• You missed filing deadlines outlined in your policy.

Even so, consulting with an attorney can help confirm whether it’s worth the effort. A quick legal review may reveal options you didn’t realize were available. They can also advise on questions like is it worth getting a rental car after an accident?

Final Thoughts: Don’t Accept “No” Without a Fight

Insurance companies deny valid claims more often than most people realize. Sometimes they rely on technicalities, vague policy language, or simple mistakes to avoid paying what’s owed. But a denial does not always mean the end of the road. If your claim has been denied, it’s often worth appealing—especially if you’ve suffered serious losses or believe the insurer acted unfairly. With professional legal guidance, you can challenge the decision and pursue the benefits you deserve.

At Tom Fowler Law, the firm stands up for Iowans who’ve been wronged by insurance companies. Whether your claim involves a car accident, personal injury, or property loss, their legal team is ready to review your case, handle the appeal process, and fight for the justice you’re entitled to. Contact the office for a free consultation.