Policyholders facing wrongful claim denials need practical answers about appeal processes, litigation timelines, attorney costs, and available damages before deciding whether challenging insurers makes financial sense.
What should I do immediately after my claim is denied?
First, request your complete claim file from the insurance company including all internal notes, communications, and documents they reviewed when denying your claim. South Carolina law grants policyholders access to these records revealing how insurers actually handled claims. Second, obtain detailed written explanation specifying exact policy provisions supporting denial—vague rejection letters insufficient for meaningful appeal. Third, avoid providing additional recorded statements without attorney consultation as adjusters use these to manufacture inconsistencies supporting denial. Fourth, gather all documentation contradicting the insurer's stated reasons—medical records proving treatment necessity, repair estimates demonstrating damage extent, or expert opinions refuting insurer conclusions. Finally, preserve all correspondence showing how denial affects you financially and emotionally. Contact McGuire Law at (888) 499-5738 within days of denial receipt—appeal deadlines create traps forfeiting reversal opportunities when missed.
Can I appeal an insurance claim denial?
Yes, most insurance policies require internal appeals before policyholders can pursue external remedies. Internal appeals present evidence and arguments to personnel not involved in initial denial decisions. Health insurance denials often have external review options through independent organizations evaluating medical necessity. ERISA-governed employer plans have specific appeal procedures and deadlines that must be followed precisely. We also file Department of Insurance complaints triggering regulatory scrutiny—insurers facing pattern complaints about improper claim handling often reverse denials avoiding state oversight. However, appeal deadlines are strict, typically 60-180 days depending on policy type and state regulations. Missing deadlines forfeits appeal rights, leaving litigation as the only option. Many policyholders attempt appeals themselves, making procedural errors or failing to present compelling evidence that legal counsel would include. Matt McGuire handles appeals professionally, maximizing reversal opportunities while preserving litigation options if appeals fail.
How long does it take to overturn a wrongful denial?
Timeline varies dramatically based on insurance type, appeal complexity, and insurer cooperation. Simple internal appeals might resolve within 30-90 days when insurers recognize denial errors and reverse decisions quickly. Health insurance external reviews typically take 60-90 days as independent physicians evaluate medical necessity. Department of Insurance investigations can take several months as regulators examine claim files and insurer responses. When appeals fail and litigation becomes necessary, cases can take 1-2 years or longer depending on court schedules, discovery disputes, and whether insurers force trials. However, litigation discovery often produces settlements as insurers prefer paying claims over exposing internal documents revealing systematic bad faith practices to juries. We pursue fastest resolution paths while ensuring you receive full benefits owed rather than accepting quick partial payments. Some situations require immediate litigation seeking preliminary injunctions—particularly health insurance denials delaying necessary medical treatment creating irreparable harm.
What damages can I recover beyond the denied claim?
Beyond original policy benefits wrongfully denied, South Carolina law allows recovery of consequential damages caused by improper denial—additional medical expenses incurred while fighting for treatment authorization, lost income when disability claim denials prevented return to work, and emotional distress from financial hardship created by wrongful rejection. Interest accrues on delayed payments from the date benefits should have been provided. Attorney fees required to obtain benefits insurers should have paid voluntarily are recoverable in many cases. When denial conduct demonstrates willful disregard for policyholder rights—systematic claim rejection policies, refusing investigation despite obvious coverage, or maintaining denials after evidence proves they're wrong—punitive damages may be available punishing misconduct and deterring future bad faith. Total damages can substantially exceed original claim value when insurers force litigation rather than honoring obligations. However, ERISA-governed plans limit remedies to policy benefits and attorney fees, making federal law particularly favorable to insurance companies denying employer-provided coverage.
How much does it cost to fight an insurance denial?
Most denial attorneys work on contingency fee basis for bad faith cases, meaning you pay nothing upfront and owe fees only if recovery obtained. We advance all case costs—expert witness fees, medical record costs, court filing fees—without requiring client payment. If we don't recover benefits, you owe nothing. This arrangement allows policyholders to challenge billion-dollar insurance corporations regardless of financial circumstances. Contingency fees typically constitute a percentage of recovery, incentivizing attorneys to maximize results. Some cases—particularly ERISA claims with limited remedy availability—may require hourly fee arrangements, though we offer free consultations evaluating whether cases justify costs. During consultation, we explain fee structure clearly and provide written agreements detailing all terms. Insurance companies count on policyholders lacking resources to challenge denials—contingency representation levels the playing field, ensuring everyone can pursue benefits they're owed under policy terms and South Carolina law.
What if my denial was based on a policy exclusion?
Policy exclusions must be clearly written, unambiguous, and actually apply to your specific situation under South Carolina law. Courts interpret insurance policies from the policyholder's perspective, construing ambiguous language against insurers who drafted contracts. Exclusions must be conspicuous—buried exclusions in fine print may not be enforceable. Many denials cite exclusions that don't actually bar coverage when policy language is read properly. For example, health insurers cite experimental treatment exclusions for FDA-approved procedures, or auto insurers cite business use exclusions for incidental work-related driving clearly within personal coverage. We analyze whether exclusions invoked actually apply to your loss, whether insurers properly highlighted exclusions when selling coverage, and whether exclusion language is ambiguous enough to be interpreted in your favor. Even when exclusions technically apply, insurers must prove all exclusion elements—burden of proof that often fails under scrutiny. Don't accept exclusion-based denials without attorney review confirming they're legally supportable.
Can I sue my insurance company for denying my claim?
Yes, wrongful claim denials create grounds for breach of contract and bad faith lawsuits in South Carolina. Breach of contract claims seek policy benefits plus interest and attorney fees. Bad faith claims—available when insurers lack reasonable basis for denial and knew or recklessly disregarded that unreasonableness—allow recovery of consequential damages, emotional distress, and punitive damages beyond policy limits. However, ERISA-governed employer plans severely restrict available remedies, making federal litigation particularly challenging. Before suing, you typically must exhaust internal appeals and potentially external review processes. Litigation involves comprehensive discovery obtaining claim files, adjuster communications, and corporate policies revealing systematic denial practices. Depositions of claims personnel expose improper handling. Expert testimony establishes industry standards for reasonable claims processing. Many cases settle during discovery as insurers prefer paying claims over jury trials exposing bad faith conduct. Matt McGuire has extensive litigation experience forcing insurers to honor contractual obligations through settlement negotiations or trial verdicts.
What if my health insurance denied necessary treatment?
Health insurance denials for medically necessary treatment create immediate crises requiring urgent response. First, obtain detailed written explanation specifying medical criteria supporting denial. Second, gather documentation from treating physicians explaining why treatment is medically necessary, not experimental, and appropriate for your condition. Third, file internal appeal immediately—most policies require appeals within 180 days. Fourth, request external review through independent physicians evaluating medical necessity if internal appeal fails. Fifth, file Department of Insurance complaint triggering regulatory scrutiny of improper denial. When treatment can't wait for appeals—cancer surgeries, cardiac procedures, or other urgent care—we pursue preliminary injunctions forcing coverage pending final resolution. Some physicians will proceed with treatment while awaiting appeal outcomes, others won't. We work with medical providers coordinating care while fighting denials. ERISA plans governing employer coverage have particularly strict appeal procedures that must be followed precisely—procedural errors forfeit external review rights. Matt McGuire has extensive experience with health insurance denials and the medical evidence needed to prove treatment necessity.
Why do insurance companies wrongfully deny legitimate claims?
Insurance companies profit by collecting premiums and minimizing claim payments. Corporate performance metrics reward claims personnel for reducing payouts rather than honoring obligations. Systematic denial policies bet that most policyholders will accept decisions rather than appealing or litigating—statistically correct assumption given that fewer than 20% of denials get challenged. Adjusters face pressure meeting financial targets encouraging aggressive denial postures. Claims training emphasizes finding reasons to deny rather than reasons to pay. Computer algorithms flag claims for "special handling" based on dollar amounts, creating heightened scrutiny for legitimate high-value losses. Insurers know most policyholders lack insurance law knowledge, can't afford attorneys, and feel intimidated challenging billion-dollar corporations. Every dollar denied is a dollar added to corporate profits and executive bonuses. This systemic problem requires legal intervention forcing insurers to honor contractual promises made to premium-paying policyholders who trusted coverage would be there when needed most.
