What to Do If Your Personal Injury Claim Is Denied

Getting a denial letter from an insurance company after a serious injury feels like a gut punch. You did everything right — reported the accident, sought medical treatment, filed a claim — and the insurer still said no. Unfortunately, claim denials are far more common than most people expect. Insurance companies in both Georgia and South Carolina deny legitimate personal injury claims every day, often counting on injured claimants to give up rather than fight back.

But a denial is not the final word. Under both Georgia and South Carolina law, you have legal rights and concrete steps you can take to challenge an unfair denial. According to the Cornell Law Institute’s overview of insurance bad faith, policyholders and third-party claimants have legal remedies when insurers fail to handle claims in good faith. Whether your claim involves a car accident, a truck wreck, or a slip and fall on someone else’s property, knowing how to respond to a denial can make the difference between walking away empty-handed and recovering the compensation you deserve.

This guide walks through the most common reasons claims get denied, the five steps you should take after receiving a denial, and the specific bad faith insurance laws in Georgia and South Carolina that protect injured people from unfair claim practices.

Common Reasons Insurance Companies Deny Claims

Before you can effectively challenge a denial, you need to understand why it happened. Insurance adjusters rely on a handful of common justifications when denying personal injury claims. Some are legitimate coverage issues. Many are not.

Disputed liability. The insurer claims their policyholder was not at fault, or argues that you share enough blame to reduce or eliminate the claim. In states like Georgia, where the modified comparative fault threshold under O.C.G.A. § 51-12-33 bars recovery at 50% or more fault, adjusters will aggressively push the narrative that you caused the accident.

Lapsed or insufficient coverage. The at-fault driver’s policy may have lapsed before the accident, or the policy limits may not cover the full extent of your injuries. This is especially common in motorcycle accident claims where injuries tend to be severe and medical costs run high.

Pre-existing conditions. One of the most overused denial tactics. The insurer reviews your medical records, finds a prior injury to the same body part, and argues your current pain is simply a flare-up rather than a new injury caused by the accident. Georgia and South Carolina both follow the “eggshell plaintiff” doctrine, meaning a defendant takes the victim as they find them — but that does not stop insurers from trying.

Gaps in medical treatment. If you waited weeks or months before seeing a doctor, or if you missed follow-up appointments, the adjuster will argue that your injuries were not serious enough to warrant compensation. This is a particularly common problem in traumatic brain injury claims, where symptoms like confusion and headaches may not prompt an immediate ER visit.

Missed deadlines. Filing a claim after the policy’s notification deadline or failing to provide requested documentation on time gives the insurer a procedural reason to deny the claim outright.

Recorded statement issues. If you gave a recorded statement to the insurance adjuster without legal counsel, anything you said — even casual, offhand remarks like “I’m doing fine” — may be used to undermine the severity of your injuries.

Step 1 — Request and Review the Denial Letter

The first thing to do after a denial is get the reason in writing. Insurance companies in Georgia and South Carolina are required to provide a written explanation when they deny a claim. If you received a verbal denial over the phone, send a written request demanding the specific reasons for the denial, the policy provisions they relied on, and any documentation they reviewed.

Once you have the denial letter, read it carefully. Pay close attention to:

• The specific reason or reasons cited for the denial
• Any policy exclusions or limitations referenced
• Deadlines for filing an appeal or providing additional information
• The adjuster’s name, claim number, and contact information

The denial letter is the roadmap for your entire response strategy. If the insurer says liability is disputed, you know you need stronger evidence proving fault. If they cite a gap in treatment, you need medical records explaining why. Every denial has a weak point — the letter tells you where to look.

Keep every piece of correspondence. Save emails, photograph letters, and note the date, time, and content of any phone calls. This paper trail becomes critical evidence if the case escalates to a bad faith claim or a lawsuit.

Step 2 — Gather Additional Evidence

Once you understand the basis for the denial, your next move is building a stronger case. The insurer denied your claim because they believe the evidence supports their position. Your job is to prove them wrong.

Medical records and expert opinions. If the denial is based on disputed injuries or pre-existing conditions, get a detailed narrative report from your treating physician explaining the causal connection between the accident and your current condition. For complex injuries — spinal cord damage, internal organ injuries, or traumatic brain injuries — an independent medical examination from a specialist can be particularly persuasive.

Accident reconstruction. When liability is disputed, accident reconstruction experts can analyze physical evidence, vehicle damage, road conditions, and witness statements to establish how the collision occurred and who was at fault. This is especially valuable in commercial truck accident cases where multiple parties may share responsibility.

Surveillance and documentation. Dashcam footage, security camera recordings from nearby businesses, and photos taken at the scene can contradict the insurer’s version of events. Witness statements from people who were not involved in the accident carry significant weight as well.

Financial documentation. Gather every receipt, bill, and statement related to your injuries. Medical bills, pharmacy records, physical therapy invoices, lost wage documentation from your employer, and receipts for out-of-pocket expenses all strengthen the damages portion of your claim.

Step 3 — File a Formal Appeal

Most insurance policies include an internal appeals process. Filing a formal appeal forces the insurer to re-examine your claim, often with a different adjuster or supervisor reviewing the file. This is your chance to submit all the new evidence you have gathered and directly address each reason cited in the denial letter.

A strong appeal letter should:

• Reference the claim number, denial date, and specific denial reasons
• Present new or additional evidence that contradicts the denial
• Cite the relevant policy language that supports coverage
• Include supporting documentation — medical records, expert reports, witness statements
• Set a reasonable deadline for the insurer to respond (typically 30 days)

Having an attorney draft or review the appeal letter sends a clear message to the insurance company that you are serious about pursuing the claim. Insurers know that represented claimants are far more likely to follow through with litigation if the appeal is denied.

If the internal appeal is unsuccessful, the next steps involve taking the fight outside the insurance company’s walls.

Step 4 — File a Bad Faith Insurance Complaint

When an insurance company denies a valid claim without a reasonable basis, or fails to properly investigate before issuing a denial, that conduct may rise to the level of bad faith. Both Georgia and South Carolina have laws prohibiting insurers from handling claims in bad faith, and both states have regulatory agencies that accept consumer complaints.

In Georgia, you can file a complaint with the Georgia Office of Insurance and Safety Fire Commissioner. In South Carolina, complaints go to the South Carolina Department of Insurance. These agencies can investigate the insurer’s conduct, impose fines, and in some cases compel the insurer to re-open and properly evaluate the claim.

Filing a regulatory complaint also creates an official record of the insurer’s conduct. If the case later goes to trial, evidence that you reported the insurer’s behavior to state regulators can support a bad faith claim and demonstrate a pattern of unreasonable denial practices.

This step is particularly relevant in cases involving wrongful death claims, where families are grieving and insurance companies sometimes exploit the emotional burden to push lowball offers or outright denials.

Step 5 — File a Personal Injury Lawsuit

If the appeal fails and the insurer refuses to offer fair compensation, filing a lawsuit may be the only remaining option. In both Georgia and South Carolina, you have the right to pursue a civil claim against the at-fault party — and in some cases, directly against the insurer for bad faith conduct.

Filing a lawsuit does not necessarily mean going to trial. In fact, the vast majority of personal injury cases settle after a lawsuit is filed but before trial begins. The act of filing signals to the insurance company that you are prepared to let a jury decide the case, which often prompts more serious settlement discussions.

Once a lawsuit is filed, the discovery process gives your attorney the ability to subpoena the insurer’s claim file, depose the adjusters who handled your case, and obtain internal communications that may reveal whether the denial was made in bad faith. This kind of evidence is often the catalyst for a favorable settlement.

Lawsuits are especially common in medical malpractice cases and premises liability claims, where insurers routinely dispute the nature and extent of injuries or argue that the property owner had no duty to prevent the hazard.

Bad Faith Denial Laws in Georgia

Georgia takes insurance bad faith seriously. Under O.C.G.A. § 33-4-6, when an insurer refuses to pay a claim in bad faith and the insured is forced to litigate, the court may award penalties of up to 50% of the claim amount plus reasonable attorney’s fees. This statute gives Georgia policyholders a powerful weapon against insurers that deny or delay valid claims without justification.

To trigger bad faith penalties under O.C.G.A. § 33-4-6, the claimant must send a written demand to the insurer at least 60 days before filing suit. The demand must specify the claim amount and give the insurer an opportunity to pay. If the insurer still refuses and the court later finds the refusal was in bad faith, the penalties apply on top of the underlying claim amount.

Georgia courts have held that bad faith exists when the insurer had no reasonable basis for denying the claim or when the insurer failed to conduct an adequate investigation. The 50% penalty provision is designed to deter insurers from stonewalling legitimate claims, and Georgia judges do enforce it.

For workers’ compensation claims in Georgia, a separate set of rules applies under O.C.G.A. § 34-9-221, which allows the State Board of Workers’ Compensation to impose penalties when insurers unreasonably deny or delay benefits.

Bad Faith Denial Laws in South Carolina

South Carolina addresses insurance bad faith through both statutory and common law. S.C. Code § 38-59-20 prohibits unfair claims settlement practices, including failing to acknowledge and act promptly on claims, failing to adopt reasonable standards for investigating claims, and refusing to pay claims without conducting a reasonable investigation.

Unlike Georgia’s statutory penalty structure, South Carolina allows injured parties to bring a private cause of action for bad faith denial. In the landmark case Nichols v. State Farm, the South Carolina Supreme Court recognized that insureds can sue their own insurer for bad faith refusal to pay benefits. Successful bad faith claims in South Carolina can result in compensatory damages, consequential damages, and in cases of egregious conduct, punitive damages.

South Carolina’s approach can actually result in larger recoveries than Georgia’s 50% penalty in some cases, because punitive damages in bad faith insurance cases are not capped at a fixed percentage of the claim. If the insurer’s conduct was particularly outrageous — for example, destroying evidence or deliberately misrepresenting policy terms — a jury can award punitive damages that far exceed the original claim value.

This is an important consideration in pedestrian accident claims and motorcycle accident cases in South Carolina, where insurers sometimes attempt to exploit bias against these claimants to justify unreasonably low offers or outright denials.

GA vs. SC Comparison Table

Statute of Limitations — Don’t Wait Too Long

Every personal injury claim is subject to a filing deadline, and a denied insurance claim does not pause or extend that deadline. If you spend months going back and forth with the insurance company and the statute of limitations expires before you file a lawsuit, you lose your right to sue — permanently.

Georgia: 2 years. Under O.C.G.A. § 9-3-33, you have two years from the date of injury to file a personal injury lawsuit in Georgia. This is one of the shorter deadlines in the Southeast, and it can sneak up on claimants who are focused on the insurance process rather than the litigation timeline.

South Carolina: 3 years. Under S.C. Code § 15-3-530, South Carolina allows three years from the date of injury to file suit. While this gives claimants more time, three years passes quickly when you factor in medical treatment, insurance negotiations, and the appeals process.

There are narrow exceptions that may toll (pause) the statute of limitations in certain circumstances — for example, if the injured person is a minor or if the defendant left the state. But relying on exceptions is a dangerous strategy. The safest approach is to consult an attorney well before any deadline approaches.

This is particularly urgent for time-sensitive claims. In car accident cases where the denial comes several months after the accident, you may have less than a year left to file. In wrongful death cases, the Georgia statute of limitations is still two years from the date of death — not from the date of the denial.

The comparative fault rules add another layer of urgency. In Georgia, if the insurer can establish that you were 50% or more at fault under O.C.G.A. § 51-12-33, you recover nothing. In South Carolina, the threshold is 51%. An experienced attorney can assess the liability picture early and build a strategy to counter the insurer’s fault arguments before the clock runs out.

Contact Roden Law — We Fight Denied Claims

A denied personal injury claim does not mean your case is over. It means the insurance company made a business decision — and that decision can be challenged, overturned, or taken before a jury. At Roden Law, we represent injured people across Georgia and South Carolina who have been unfairly denied the compensation they are owed. Our attorneys understand the claims process, the appeal strategies that work, and the bad faith laws that hold insurers accountable when they refuse to do the right thing.

We handle every case on a contingency fee basis. You pay nothing unless we recover money for you. If you have received a denial letter and are not sure what to do next, call us for a free consultation.

Call 1-844-RESULTS or contact us online to speak with an attorney about your denied claim. We have offices in Savannah, Darien, Charleston, Columbia, and Myrtle Beach — and we are ready to fight for you.

About the Author

Eric Roden

Founding Partner, CEO