What Happens if the Insurance Company Denies Your Injury Claim?

Denied Injury Claim in New York? Here’s What to Do Next

After an accident, most people feel extremely stressed out. You’re hurting, unsure who to trust, and hoping your insurance company will do the right thing. But when that claim gets denied? The frustration hits hard. You start questioning everything, what went wrong, what to do next, and whether you’ll ever get the help you need.

At Horn Wright, LLP, we understand how overwhelming that denial can feel. Our personal injury attorneys step in when the insurance companies push back. We fight for people across the state who’ve been wrongly denied compensation after car crashes, slip-and-falls, and workplace injuries. When insurers play games, we fight back so you can focus on getting better.

The Initial Shock: Getting a Denial Letter in New York

The moment you get that denial letter in the mail, it knocks the wind out of you. You might expect some back-and-forth, but a flat-out “no” feels like a slap. In New York, insurance companies must send written notice if they deny your injury claim, citing specific reasons. But even when they follow the rulebook, it doesn’t make the news any easier to take.

Most denials follow an earlier accident, maybe a rear-end crash on the BQE or a slip on icy steps outside a Yonkers apartment. You thought you had everything together: the police report, medical records, and maybe even witness names. But suddenly, the insurance company says your claim doesn’t qualify. Now what?

Under New York Law, companies are required to handle claims fairly. That looks good on paper, but it can feel very different in real life. Denials don’t always mean the case is over. Often, they signal that it’s just getting started.

Why Insurance Companies Deny Valid Injury Claims in New York

Insurance companies operate as businesses. The fewer claims they pay, the more profit they keep. In New York, they often reject injury claims based on technical reasons or narrow interpretations of the law.

Here’s what we often see:

• They dispute fault, even when the police report clearly supports your side.
• They challenge injury severity, saying it doesn’t meet the “serious injury” threshold under NY’s no-fault law.
• They argue that injuries came from a pre-existing condition.
• They blame incomplete documentation, missing medical notes or delayed treatment.
• They use surveillance or social media to suggest you’re not as hurt as claimed.
• They cite policy exclusions that may not even apply.

If you were injured in a crash near the FDR Drive, the insurer might argue your neck pain isn’t “serious” because you returned to work two weeks later. Or if you slipped inside a Manhattan office lobby and didn’t go to urgent care that day, they use that delay to minimize your injuries.

These denials don’t always stand up to scrutiny, but they put the burden back on you.

Check the Denial Letter: What It Tells You (and What It Doesn’t)

Start with the denial letter. Read it carefully, line by line. Under New York law, the insurer must clearly explain why it denied your claim. What they say, and what they leave out, both matter.

Look for:

• Direct references to your policy’s limits and coverage
• Explanations based on New York no-fault law
• Medical documentation they claim is missing or insufficient
• Accusations that your injury didn’t result from the incident

Some letters will cite specific policy clauses. Others stay vague, hoping you won’t push back. That’s a red flag. When an insurer uses general language without tying it to real evidence, it raises questions about whether they followed the rules.

In New York, vague denials may violate fair claims handling rules set by the Department of Financial Services. That doesn’t make them illegal outright, but it gives you something to work with.

Gather and Re-Check Your Evidence

Before taking another step, gather everything. Missing or disorganized documents often give insurers room to deny. Even small things, a missing signature or delayed Magnetic Resonance Imaging (MRI) report, can complicate a valid claim.

Recheck:

• The police report from the NYPD or county sheriff’s department
• Emergency room records from hospitals like Mount Sinai or Albany Medical Center
• Follow-up care notes from physical therapy or chiropractic visits
• Bills showing out-of-pocket costs and insurance coverage
• Photos of your injuries or the accident scene

Speak with any witnesses again. Confirm their contact information. If the adjuster said something didn’t match up, figure out where the gaps are.

The more complete your evidence, the stronger your position becomes.

File an Appeal with the Insurance Company

New York allows you to appeal most insurance denials, but the clock starts ticking right away. Depending on your policy, you might have as little as 30 to 45 days to respond.

An appeal isn’t just a disagreement. It’s a formal response where you present your case again, with better documentation or corrected errors. 

In your appeal letter, include:

• A copy of the denial letter
• A detailed explanation of why you believe the denial is incorrect
• New or clarified evidence, such as updated medical reports or witness statements
• References to policy sections or New York law that support your position

Make sure you keep copies of every form, letter, and email. Track when you sent them and who received them. Some cases get resolved at this stage, especially if you clearly show where the insurer made a mistake.

Know When to Involve a New York Injury Lawyer

If the appeal goes nowhere or you suspect the insurance company isn’t dealing with you fairly, it may be time to bring in legal help.

You shouldn’t need an attorney just to get your bills paid. But here’s when one often becomes necessary:

• The insurer refuses to acknowledge liability after a clear-cut accident
• Your injuries require long-term care or involve permanent damage
• The insurer blames your health history or unrelated events
• Your case involves multiple parties, like construction site injuries or multi-car pileups

New York personal injury attorneys know how to subpoena records, challenge insurer tactics, and bring in medical or accident experts. If it’s time to hire a lawyer, they can help you assess your options. They also track whether the insurer violated laws that affect how claims get handled.

Consider Filing a Bad Faith Insurance Claim in New York

Insurers have a duty to act in good faith. When they delay, lowball, or misrepresent terms, they may cross the line into bad faith territory.

In New York, bad faith claims don’t exist as a standalone cause under state law. But injured people can still sue based on:

• Breach of contract
• Unfair settlement practices
• Misrepresentation of coverage terms

If your insurer delays a response for months, despite repeated calls and emails, or offers a settlement far below your documented losses without explanation, those may support a lawsuit. In some cases, you can recover not just what you’re owed, but additional damages as well.

These claims take time and legal strategy. But they send a clear message: you won’t accept stonewalling.

Understand How Denials Affect Lawsuit Timelines in NY

In New York, the statute of limitations for personal injury lawsuits is typically three years. That might seem like plenty of time. But if you spend months fighting with the insurer first, your legal window can start to close fast.

If your injury occurred in late 2022 and the claim gets denied in mid-2023, waiting to act until 2025 leaves little time to build your case. That’s why timing matters. You can pursue insurance appeals and prepare a lawsuit at the same time. Don’t wait for the insurer to run out the clock.

Stay Ahead of Deadlines and Documentation

Even if you’re not ready to sue, staying organized keeps your options open. Make a checklist. Check it often.

• Read the denial letter in full
• Mark down your appeal deadline
• Request a full explanation if the letter is vague
• Save every letter, email, and phone log
• Track how your injuries affect work, family, and health
• Talk with your doctor about long-term care needs

Every piece of documentation helps later. And staying on top of things helps you feel more in control during an uncertain time.

You Can Still Win After a Denial

A denial doesn’t mean your injury claim ends. In New York, it often means the process shifts. With better evidence, stronger appeals, or the right legal support, you still have paths forward.

At Horn Wright, LLP, we help people across New York fight back when insurers try to cut them off. Our team understands the tactics they use, and we don’t back down. Whether your accident happened in Albany, Queens, or anywhere in between, reach out to move forward with strength and clarity.