My injury claim was denied or underpaid: what can I do about the insurance company?

Insurance disputes are part of the work described on our personal injury page, and most of them start with a letter: a denial, a request for more time, or an offer that does not cover the bills. What you can do depends first on whose insurance company it is. Your own insurer owes you duties under your policy, while the at-fault person's insurer is defending its customer. California's Fair Claims Settlement Practices Regulations, in title 10 of the California Code of Regulations, set timing and fairness rules for both.

How does a disputed injury claim move, step by step?

1. Notice of claim. You report the claim and get a claim number. The Department of Insurance's accident guide says an insurer must acknowledge the claim, begin investigating and provide forms within 15 days of notice, and respond to your communications within 15 days.
2. Proof of claim. You send documents that support the claim and its amount, such as medical bills, records and wage loss. Under 10 CCR 2695.7(b), the insurer then has no more than 40 calendar days to accept or deny the claim, in whole or in part.
3. A written explanation. A denial of a first party claim, such as medical payments or uninsured motorist coverage under your own policy, must be in writing and list every basis for it, with the policy provision or law relied on (section 2695.7(b)(1)). A third party denial, or a dispute over liability or damages, must also be in writing.
4. A request for more time, if needed. If the insurer cannot decide within 40 days, it must say so in writing, explain what it still needs, and repeat that notice every 30 days (section 2695.7(c)(1)).
5. Your response. You or your lawyer answer the stated reasons with records, photos, bills or statements, in writing.
6. Outside review. Every written denial must tell you that you may have the matter reviewed by the Department of Insurance and give the address and phone number of the unit that reviews claims practices (section 2695.7(b)(3)).
7. The legal route. Against your own uninsured motorist coverage, disagreements go to arbitration (Insurance Code section 11580.2(f)). Against the at-fault person, the route is a lawsuit, generally within two years of the injury (Code of Civil Procedure section 335.1). Our page on how long an injury case takes in Los Angeles County covers what happens after filing.

What deadlines apply to the insurer and to me?

The 40-day clock in section 2695.7(b) does not apply to certain disability and mortgage guaranty policies, or to automobile repair bills under collision and comprehensive coverage, though the written explanation rules still do (section 2695.7(b)(4)).

What counts as an unfair offer or denial?

Section 2695.7(g) says no insurer may try to settle a claim with an unreasonably low offer. In deciding whether an offer was unreasonably low, the Insurance Commissioner considers how far the insurer weighed the evidence you submitted, the legal authority and evidence available to it, its own adjuster's view of damages, the likely verdict, and whether a reasonable person who knew the facts would have offered more. Section 2695.7(d) requires a thorough, fair and objective investigation and bars insurers from demanding information that is not reasonably needed.

Insurance Code section 790.03(h) separately lists unfair claims settlement practices when they are done knowingly or so often that they amount to a general business practice. The list includes misrepresenting policy provisions, failing to affirm or deny coverage within a reasonable time, not attempting in good faith to settle promptly and fairly once liability is reasonably clear, failing to give a reasonable explanation for a denial or compromise offer, and directly advising a claimant not to hire an attorney. Whether a particular denial gives you any claim beyond the policy itself is a separate legal question that depends on the facts.

What changes the answer?

Whose insurance company it is

With your own insurer, you are a party to the contract, and the first party rules apply: a written denial listing every basis, notice about subrogation, and arbitration for uninsured motorist disputes. With the other driver's or property owner's insurer, you are a third party claimant. The insurer must still put a denial in writing, but the pressure point is a lawsuit against its insured. A passenger may have more than one policy to look at, as our page on whose insurance pays a passenger explains.

Whether the other driver had enough insurance

Uninsured motorist coverage includes an underinsured vehicle, one insured for less than the uninsured motorist limits on your own vehicle (Insurance Code section 11580.2(p)(2)). That coverage does not apply until the at-fault driver's liability limits are used up by settlement or judgment and proof of payment is given to your insurer (section 11580.2(p)(3)). Our page on how much insurance California drivers must carry explains the minimum limits.

Whether it was a hit and run

For a driver whose identity is unknown, section 11580.2(b) requires that the injury arose from physical contact with the other vehicle, a report to the police, sheriff or CHP within 24 hours, and a statement under oath to your insurer within 30 days. Our guide to hit and run or uninsured driver claims in Los Angeles County walks through those steps.

Whether there is a workers' compensation claim

If you were hurt on the job, section 11580.2(f) says the uninsured motorist arbitrator does not proceed until your physical condition is stationary and ratable, and the arbitration demand must include a sworn statement about any workers' compensation claim.

Whether a deadline is close

Section 2695.7(f) requires an insurer to warn a claimant without a lawyer, in writing, of any time limit it may rely on to deny the claim. That notice does not extend the deadline. Under section 2695.7(i), an insurer may not tell you your rights are at risk unless you sign a form or release by a certain date, except to give notice of an actual time limit.

Whether the dispute is about your car

Vehicle damage follows its own rules on repair estimates and actual cash value, covered in our guide to how a total loss value is decided.

How do I ask the Department of Insurance for help?

The California Department of Insurance takes requests for assistance from consumers who believe an agent, broker or insurer has treated them unfairly, or who are having difficulty opening a claim. Its consumer hotline is 1-800-927-4357 (TDD 1-800-482-4833), and its Los Angeles office is at 300 South Spring Street, South Tower; the Department recommends its electronic complaint forms over paper ones. Section 2695.7(o) bars an insurer from requiring you to withdraw or refrain from a complaint as a condition of settling. The Department's pages do not say that a complaint pauses any legal deadline, so treat every deadline as still running.

A worked example

For example, imagine a hypothetical Glendale driver who is rear-ended by a driver with no insurance. She has uninsured motorist coverage, sends her insurer her medical bills and records, and receives an offer that covers about half of her bills with no explanation. More than 40 days passed after she sent her records, with no written notice that more time was needed.

Several rules apply. She can ask in writing for the bases for the insurer's position, respond with any records it says are missing, and ask the Department of Insurance to review the handling. Because the dispute is with her own uninsured motorist coverage, the policy and section 11580.2(f) send a disagreement to arbitration, and section 11580.2(i) requires her to start it, by certified mail to the insurer, within two years of the crash. As an illustration of the dates, a crash on March 3, 2026 would put that outer date at March 3, 2028. None of this predicts what an arbitrator would award.

Common mistakes when an insurer says no

• Settling with the at-fault driver without your own insurer's consent. Section 11580.2(c)(3) says uninsured motorist coverage does not apply if you settle with, or take to judgment, a person who may be liable without your insurer's written consent.
• Letting the two-year arbitration date pass. Talks with the adjuster do not count as starting arbitration; section 11580.2(i)(1)(C) requires written notice by certified mail, return receipt requested.
• Accepting a phone explanation. The regulations require written denials, and section 2695.7(l) bars a denial based on a phone call or interview that is not documented in the claim file.
• Assuming a complaint stops the clock. File the complaint if it helps, but calendar the legal deadlines separately.
• Signing a release to get a partial payment. Read what the release covers; payment of an accepted amount is due within 30 days under section 2695.7(h).

What to do this week

1. Find every letter and email from the insurer and put them in date order.
2. Mark the date you sent proof of claim and count 40 calendar days forward.
3. Ask in writing for the specific bases of any denial or offer and the policy language relied on.
4. Request a copy of your policy and declarations page if you do not have them.
5. Gather the proof the insurer says is missing, using our list of what to bring to a personal injury consultation.
6. Calendar the two-year dates for a lawsuit and for any uninsured motorist arbitration.
7. Decide whether to file a request for assistance with the Department of Insurance.

Frequently asked questions

Can the adjuster tell me I do not need a lawyer?

Insurance Code section 790.03(h)(14) lists directly advising a claimant not to obtain the services of an attorney as an unfair claims settlement practice. Choosing a lawyer is your decision. Our article on how a personal injury lawyer can help maximize compensation explains what representation involves.

What is proof of claim?

The Department of Insurance describes it as documentation in your possession that provides evidence of the claim and supports its amount. For an injury, that usually means medical records and bills, wage information and any report of the incident. The 40-day clock runs from the insurer's receipt of it.

The insurer keeps asking for more documents. Is that allowed?

It may ask for what it reasonably needs, but section 2695.7(d) bars persisting in seeking information that is not reasonably required for or material to resolving the claim. If it needs more time, it must say what it needs in writing and update you every 30 days. Keep copies of everything you send.

Does the Department of Insurance decide how much my claim is worth?

The Department's pages describe reviewing claims practices and helping consumers who believe they were treated unfairly. They do not describe setting the value of an injury claim. Value disputes are resolved by agreement, arbitration under an uninsured motorist policy, or a court.

What if the at-fault party was a landlord or business?

The same regulations govern its liability insurer's handling of your claim. The legal basis for responsibility is different, as our guide to when a landlord is responsible for an injury explains.

Should I accept a formal settlement offer once a case is filed?

After a lawsuit is filed, a formal statutory offer can shift costs depending on the result. Our page on turning down a 998 settlement offer explains how that works.

How can Glendale Law help?

We read the denial or offer against your policy and the regulations, answer the insurer in writing, track the arbitration and lawsuit deadlines, and take the claim to arbitration or court when that is the next step. Call (818) 244-9000 or request a consultation.