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. A denial is common enough that both states regulate how insurers handle claims.

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. Bad faith, in the Legal Information Institute at Cornell Law School’s definition, is dishonesty in a transaction — here, an insurer refusing to deal fairly with a claim. 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 bad faith and claims-handling laws in Georgia and South Carolina, including whom each one protects.

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. A common denial ground. 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. In Georgia an insurer must put a denial in writing and, if its policyholder asks in writing, explain the basis for it (O.C.G.A. § 33-6-34(10)). No statute gives a claimant against another driver’s insurer that right in either state, so ask for the reasons in writing regardless. 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
• Any deadline the letter sets for a response or for 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 — Ask for Reconsideration in Writing

There is no formal appeal of a liability insurer’s denial in Georgia or South Carolina: you are not a party to the at-fault driver’s policy, so a reconsideration letter is a request, not a procedure. Its force is the evidence it carries and the lawsuit it precedes. 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 reconsideration 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 deadline for the insurer to respond — in Georgia motor-vehicle cases an attorney-prepared pre-suit offer must allow at least 30 days to accept (O.C.G.A. § 9-11-67.1); South Carolina sets no fixed period

Having an attorney draft or review the letter sends a clear message to the insurance company that you are serious about pursuing the claim.

If the insurer will not reconsider, 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 violate the state’s claims-handling laws. Georgia (O.C.G.A. § 33-6-34) and South Carolina (S.C. Code § 38-59-20) both prohibit unfair claim practices, and both states have regulatory agencies that accept consumer complaints.

In Georgia, you can file a complaint with the Office of the Commissioner of Insurance and Safety Fire. In South Carolina, complaints go to the South Carolina Department of Insurance. These agencies require the insurer to answer the complaint in writing, can make it investigate thoroughly, and can take enforcement action — in South Carolina, cease-and-desist orders and penalties (S.C. Code § 38-59-30) — when claims-handling laws are broken. They do not decide what your claim is worth or order the insurer to pay it.

A regulatory complaint also puts the insurer’s conduct on record. Regulators act on patterns — South Carolina’s statute reaches practices carried out often enough to be a general business practice — so a complaint that joins others can bring enforcement your own case never would. It does not create a bad-faith claim for you against the other driver’s insurer.

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 reconsideration 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. If the denial came from your own insurer — an uninsured or underinsured motorist claim, for example — you may also have a bad-faith claim against it. You cannot sue the other driver’s insurer for bad faith in either state (Mills v. Allstate; Kleckley); when that insurer wrongly refuses to settle within its limits, the claim belongs to its own policyholder, who can assign it to you.

Filing a lawsuit does not necessarily mean going to trial. According to the Bureau of Justice Statistics, only about 4 percent of tort cases in a 2005 national sample of state courts ended in a trial; the rest ended by settlement, dismissal or other disposition. 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, discovery lets your attorney depose the at-fault party and witnesses, subpoena records, and test the facts the insurer relied on. A denial built on a thin file has to hold up under that scrutiny, which is often what moves the case toward settlement.

In medical malpractice cases and premises liability claims, the disputes are usually about duty and causation, which are decided on evidence a lawsuit can develop.

Bad Faith Denial Laws in Georgia

Georgia’s bad-faith statute is a policyholder’s remedy against their own insurer — on a denied med-pay claim, for example — not an injured person’s remedy against the other driver’s carrier. Under O.C.G.A. § 33-4-6, when an insurer refuses to pay a covered claim in bad faith and the insured is forced to litigate, it owes a penalty of up to 50% of the loss or $5,000, whichever is greater, plus reasonable attorney’s fees.

To trigger bad faith penalties under O.C.G.A. § 33-4-6, the policyholder must send a written demand for payment to the insurer at least 60 days before filing suit. If the insurer still refuses and the refusal is found to be in bad faith, the penalties apply on top of the underlying claim amount. On uninsured motorist claims the parallel rule is O.C.G.A. § 33-7-11(j): a 60-day demand and a penalty of up to 25% or $25,000, whichever is greater, plus fees.

Georgia courts define bad faith as a frivolous and unfounded refusal to pay (Taylor v. Government Employees Ins. Co., 350 Ga. App. 734 (2019)); an insurer with a reasonable basis for its position does not owe the penalty even if it loses. Refusing to pay without a reasonable investigation is separately an unfair claims settlement practice the Commissioner can act on (O.C.G.A. § 33-6-34(6)).

Workers’ compensation claims follow their own rules. In Georgia the insurer must start income benefits or file a notice to controvert within 21 days of learning of the injury (O.C.G.A. § 34-9-221); late benefits carry a 15 percent penalty, and an insurer that starts paying has 60 days from the first payment’s due date to controvert. The State Board can assess attorney’s fees against an insurer that defends without reasonable grounds (O.C.G.A. § 34-9-108), and there is no separate bad-faith lawsuit for a delayed comp claim.

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 lists improper claim practices, including failing to acknowledge and act promptly on claims, failing to adopt reasonable standards for investigating claims, and not attempting in good faith to settle claims where liability is reasonably clear. The list expressly covers third-party liability claims, but it is enforced by the Director of Insurance against practices frequent enough to be a general business practice, and it gives no one a private claim.

South Carolina gives policyholders two remedies of their own. An insurer that refuses to pay its policyholder’s claim for 90 days after a demand, without reasonable cause or in bad faith, owes attorney’s fees capped at one-third of the judgment (S.C. Code § 38-59-40). And 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.

Because the Nichols remedy is a tort claim, a policyholder’s recovery is measured by the harm the denial caused rather than by a percentage of the claim. Punitive damages are available for willful or reckless conduct, capped at the greater of three times compensatory damages or $500,000, a floor indexed each year — $739,245 for 2026 (S.C. Code § 15-32-530).

This is an important consideration in pedestrian accident claims and motorcycle accident cases in South Carolina when the at-fault driver is uninsured or underinsured: the denied claim is then the UM/UIM claim against the injured person’s own insurer, which is the claim Nichols protects.

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. 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 requests for reconsideration.

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 a jury finds 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 reconsideration 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

Graeham C. Gillin

Partner, COO