What to Do If an Insurance Company Denies Your Claim in California 2025

Many California residents rely on their insurance company if an issue arises and they need help. It’s frustrating when you make a claim, and it’s denied. After years of making insurance payments, you might wonder what to do if an insurance company denies your claim in California.

It is critical to know about your available options if your insurance claim has been unfairly denied. Luckily, your recovery doesn’t have to stop with a claim denial. There are some important steps to take when fighting an insurance claim denial in California.

To start, it’s useful to review the denial letter, gather documentation, and consider reaching out to the California Department of Insurance or a trusted personal injury attorney.

Review the Denial Letter

It’s critical to understand why your claim was denied. You can review the correspondence from the insurance company to understand their reasons for your claim denial.

Denial letters typically discuss the specific policy language that’s the basis for a denial. Insurance companies in California must give specific reasons when they deny a claim. Some reasons that are commonly provided are a lack of coverage, unnecessary medical care, or procedural errors.

Re-read your specific insurance policy to review your coverage, any exclusions, and any specific rules or conditions that might apply to your claim. Check if there are any sections about denied insurance claims to see if the denial determination aligns with your specific policy.

Gather Relevant Documentation

You can bolster your position by gathering documentation relevant to your claim. You can collect:

• Photos
• Medical records
• Accident reports
• Witness statements
• Repair estimates
• Other relevant documentation specific to your insurance claim

At this point, you could contact your insurance company to discuss a possible claim resolution. They may be willing to review the documents you’ve gathered, and they might reach a new claim decision.

If you speak with someone, ask for any other documents related to your claim, and request a full denial explanation. Also, document as many details as possible about your conversation (who you talked to, the day/time of the conversation, and what was said).

File an Appeal If Necessary

You may need to exhaust your insurance company’s internal process for an appeal. Make sure you’ve followed their internal procedure. Once you have, you typically can move forward with further challenging their denial.

Review your insurance policy to read the specific guidelines for submitting your appeal. Typically, you need to appeal a denial in writing. It’s important to include information about why you think their denial was unjustified. Provide all relevant evidence you’ve gathered, and make sure you file your appeal before any carrier-specific deadlines to give your appeal a fair chance.

Consider Third-Party Assistance

If your formal written appeal is denied, you may want to contact the California Department of Insurance (CDI) to file a complaint. They can provide the necessary forms and general information. The CDI reviews cases impartially, which may lead to the CDI reversing your insurance carrier’s claim denial.

If the CDI can’t resolve your insurance issue, consider speaking with a trusted attorney who is familiar with insurance claim disputes. They can provide reliable advice about your legal options and explore the potential for legal action. You could recover compensation if the insurance company acted in bad faith, or you might have a claim for breach of contract.

An attorney can provide guidance so you can make an informed decision about how to proceed with your case. They can also zealously advocate on your behalf, and a seasoned attorney can often maximize your recovery through the legal process.

FAQs

What Are the Odds in California of Winning an Insurance Claim Appeal?

In California, a high number of claims are usually denied. Specific to healthcare claims, in 2022, Blue Shield reported the number of in-network claims was 1,269,858, with 250,000 denials. However, about half of these denials are usually overturned, indicating a significant chance of reversing a denial.

The reason(s) cited for the refusal and the specific supporting information provided usually impact whether your appeal is successful. With documentation and an attorney’s assistance, you can potentially reverse your decision.

Can I File a Complaint Against My California Insurance Company?

Yes, you can file a complaint. Contact the California Department of Insurance (CDI), which can provide complaint forms and additional information. The CDI impartially reviews complaints and can often help with an insurance company’s denial of a claim.

If the CDI can’t do anything, consider speaking with an experienced attorney. They can typically increase your likelihood of having your claim denial reversed.

Can I Sue an Insurance Company in California for Denying My Claim?

Yes, you can sue an insurance company if they’ve denied your claim. You have the legal right to file a claim, especially if they denied your claim in bad faith. You should first complete your carrier’s internal procedure for an appeal. Then, speak with an attorney who can evaluate your case’s strength.

An attorney can answer your questions and represent your interests throughout the litigation process.

What Type of Attorney Can Help If My Insurance Claim Is Denied?

If your insurance claim was denied, you can consult an attorney who is familiar with insurance and bad faith cases. Someone with experience in filing cases against insurance companies can prove extremely beneficial.

An attorney can explain your insurance policy, gather compelling evidence, and navigate the complex appeals process. They can maximize your recovery and provide trustworthy advice.

Schedule a Consultation With Corrales Law Group

If your insurance claim was unfairly denied, don’t fight them alone. An attorney from Corrales Law Group can pursue the compensation to which you’re entitled. We can discuss your case and explore all available options.

Our firm is familiar with the complex nature of insurance law, and we routinely go up against big insurance companies. We can explain your insurance policy, its coverage, and the reason(s) for the denial of your claim.

We are a bilingual law office and have worked hard for our clients since 2012. Contact Corrales Law Group right away to schedule your consultation with an experienced attorney.