Accidents catch us unaware, derailing best-laid plans and causing untold agony to our loved ones. In these circumstances, many of us find assurance from our insurance policies. While emotional damage takes a long time to heal, we believe we will at least receive financial support.
However, lately, many people in the US are facing claim denials.
Industry reports indicate that almost 60 percent of adults faced troubles with their insurance in 2023. As a result, they struggled to pay bills. They could not focus on recovery and healing during a difficult time. Sadly, the statistics in more recent times have also not been promising.
Let’s identify the best steps to help you tackle this unfortunate situation.
1. List Probable Reasons for Denial
Sometimes, valid reasons may underlie the refusal: reasons you may have overlooked or deemed irrelevant. Taking contradictory action in such circumstances may only cause further financial loss.
A 2025 KFF report found that the leading causes for claims denial among health insurers included administrative reasons and excluded service. Some customers faced denial due to a lack of advance authorization or referral. That said, the analysis also emphasized that the most prevalent reason was “Other.”
In case of road accidents, some policies clearly state that claims may be invalidated if the driver was under the influence of alcohol. You may also face this problem if you performed changes in your vehicle without notifying the insurer.
Nowadays, many companies in this field have begun relying on artificial intelligence for processing claims. They aim to speed up their administrative tasks and reduce ‘wastefulness,’ as evidenced by federal programs like ‘Wasteful and Inappropriate Service Reduction.’
KUOW reports that Washington will be participating in this program, likely weeding out numerous claims.
If you feel this might be the roadblock affecting your case, consider using AI to fight back. Some experts suggest that customers can use AI-based tools to draft appeal letters contesting the denial.
2. Make a Stowers Demand or a Bad Faith Claim
Some US states have legal provisions holding insurers accountable for refusing to settle reasonable claims. For example, the Stowers demand in Texas is an effective option to recover your compensation. If the insurance company refuses this claim, it can be liable for the verdict at trial. They may have to pay far more than the policy’s original limits.
Loewy Law Firm explains how you can proceed:
- Share a formal settlement offer with your insurer.
- The amount must be within the policy’s available coverage limit.
- Ensure your case is concrete and that you have sufficient evidence to prove the validity of the claim.
The Stowers provision is unique to Texas. However, many American states allow you to file bad-faith claims to help you recover your due compensation. For example, California law considers an unreasonable denial of policy benefits as bad faith. In addition to the routine policy benefits, the plaintiffs can recover economic and emotional damages in such cases.
It is ideal to consult an attorney to check whether your state has a similar provision. They can guide you on the safest and most effective course of action.
3. Consider Turning To Social Media
In February 2025, the Guardian published a riveting story about a woman who reversed her health insurance claim denial by tweeting about it. The amount was a staggering $30,000.
The woman in this incident had been hospitalized for endocrine treatments. She had been experiencing distressing symptoms, including chest pain. Her doctors noted a risk of cardiac arrhythmia.
And yet, the insurer stated the procedure was medically unnecessary. Frustrated by the denial and the subsequent delays, she tweeted about it. Her claim was approved; apparently, it had been a mistake.
In recent years, more people have used social media platforms to convey their frustrations with service-sector companies. Such posts manage to grab their followers’ attention and reach the companies involved. Often, the firms decide to take action to avoid a PR crisis that could cost them their reputation.
Still, it is not an infallible plan. It is not even feasible in many cases, such as when the company concerned does not have or maintain a social media account.
Moreover, the social media landscape has become highly fragmented. Pew Research Center highlights that 53 percent of US adults receive their daily news from social media. However, the sources are varied: 35 percent stay updated on YouTube, while 20 percent follow Instagram.
The platforms are numerous, from TikTok and X to Reddit and WhatsApp. In this environment, attention spans are also diluted and scattered.
Another problem is that many people now distrust these platforms. They believe that others sensationalize or outright lie about their experiences. If you choose to use social media to reverse an insurance claim denial, make sure you:
- State the facts lucidly. Resist exaggeration.
- Tag all the relevant stakeholders, especially the insurer (preferably an active account).
- Select a social media platform where you see the most traction. Check that you feel comfortable using it.
- Respond to comments and replies to increase engagement and the likelihood of concrete action.
Having your insurance claim refused can be unsettling. It feels downright harrowing when you are suffering the aftermath of a serious accident. At such times, you may find it tempting to take immediate action against the insurer.
However, consider pausing before you do so and thinking through your best plan. Approaching the scenario methodically, prioritizing investigation into the causes and the possibility of an appeal, can deliver better results.
