What if My Personal Injury Claim Is Denied in Walnut Creek?

Facing a denial after filing a personal injury claim can feel like a dead end. You’ve suffered an injury, possibly through no fault of your own, and now the compensation you were counting on has been rejected. But here’s the truth: a denial is not the final word.

In Walnut Creek and throughout California, there are clear steps you can take if your personal injury claim is denied—legally, ethically, and effectively. This guide breaks it all down so you understand your options, timelines, and the reasons behind most denials.

Why Are Personal Injury Claims Denied?

Understanding the reason for your denial is key to planning your next move. Insurance companies often deny claims for the following reasons:

1. Lack of Medical Evidence

If your medical records are incomplete or don’t clearly connect your injury to the incident, the insurance company may reject your claim. It’s essential to show causation between the accident and your injuries through consistent documentation.

2. Delayed Reporting

California law requires you to act within certain time limits. If you didn’t report the incident quickly enough to the at-fault party or failed to seek medical treatment right away, it may be used against you.

3. Disputed Fault

California follows a comparative negligence model, which means your compensation can be reduced based on your share of fault (California Civil Code §1431.2). However, insurance companies often argue that their insured is not liable at all to avoid paying.

4. Policy Exclusions or Lapses

Your claim might fall outside the scope of the policy—such as being injured during an excluded activity or if coverage lapsed due to non-payment.

5. Pre-Existing Conditions

Insurers sometimes argue that your injury was not caused by the accident but stemmed from a pre-existing issue.

These denials often stem from an effort to reduce or avoid payouts—not because your injuries aren’t valid. Fortunately, a denied claim does not have to be the end.

Step 1: Review the Denial Letter Carefully

Your denial letter should state the reason(s) your claim was rejected. Use this as a roadmap for your next steps.

• Is there a claim that medical evidence was lacking?
• Did the insurer cite missed deadlines?
• Are they disputing fault?

Also, compare the denial with your insurance policy. Policy language can be vague or confusing. Look for unclear terms, exclusions, or coverage limits. California law often favors the insured when policy language is ambiguous, which can be a factor if you proceed to appeal or litigation.

Step 2: Submit an Internal Appeal

Many insurance companies have an internal review or appeal process. This allows you to dispute the denial without immediately going to court.

To do this:

• Write a formal appeal letter explaining why you believe the denial was wrong.
• Include new or missing evidence, like updated medical records, photos, or witness statements.
• Be concise, professional, and factual.

Step 3: Understand the Legal Time Limits in California

In California, personal injury claims must be filed within specific deadlines, known as statutes of limitations.

• General personal injury claims: You have two years from the date of injury to file a lawsuit (California Code of Civil Procedure §335.1).
• Claims against public/government entities: You must file a special administrative claim within 6 months of the injury (Gov. Code §911.2). If denied, you then have 6 months from the denial date to file a lawsuit.

Missing these deadlines typically results in your claim being barred permanently. That’s why it’s essential to act quickly, even if your initial claim was denied.

Step 4: Consider Filing a Lawsuit

If your appeal is unsuccessful, the next step may be to file a personal injury lawsuit.

A formal complaint is submitted to the appropriate court, usually the Contra Costa County Superior Court if your injury occurred in Walnut Creek. The process involves several stages, including:

• Discovery (exchanging evidence)
• Depositions
• Pre-trial motions
• Mediation or settlement negotiations
• Trial

Keep in mind: many cases settle before trial. However, preparing for the full process strengthens your position and may lead to a fairer settlement.

Step 5: Watch for Bad Faith Insurance Practices

California law requires insurers to handle claims fairly and in good faith. If an insurer delays, underpays, or denies your claim without a valid reason, they may be guilty of bad faith.

Common signs of bad faith include:

• Refusing to investigate your claim
• Misrepresenting policy language
• Offering unreasonably low settlements
• Delaying payment with no justification

Under California law, if you can prove bad faith, you may be entitled to additional damages beyond your original claim.

Step 6: Gather Stronger Evidence

Whether you’re appealing, negotiating, or filing a lawsuit, solid documentation is everything. Strengthen your case by:

• Getting detailed medical evaluations from specialists
• Requesting written statements from doctors linking the injury to the accident
• Compiling wage loss documents from your employer
• Retaining video footage, police reports, or witness accounts
• Documenting the emotional and physical toll of your injury (often called “pain and suffering” damages)

You don’t need to figure this all out alone. Many resources, like Brand Peters PC, explain how evidence supports both workers’ comp and personal injury claims.

Step 7: Understand Comparative Fault in California

California follows a pure comparative negligence rule. That means even if you were partly at fault, you can still recover damages—just reduced by your percentage of fault.

For example, if your damages total $100,000 but you were found 30% at fault, you could still recover $70,000. This system benefits claimants but also gives insurers more leeway to shift blame. 

Step 8: When the Claim Involves a Workplace Injury

If your denied personal injury claim involves a work-related incident, it likely falls under workers’ compensation, which follows its own rules.

• File an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board (WCAB)
• You must typically file within 1 year of injury
• If your claim is denied, you may request a hearing with a judge
• Appeals can go to the California Court of Appeal or even the California Supreme Court

For more on this process, see Brand Peters PC’s explanation on denied workers’ comp claims.

Step 9: Know When to Seek Legal Support

While you can handle an appeal on your own, many people find it helpful to consult an attorney after a denial. A skilled personal injury lawyer can:

• Review your denial letter and policy for weaknesses
• Help you gather stronger evidence
• Draft a detailed demand letter
• Represent you in litigation if needed
• Identify if bad faith practices apply to your case

Most personal injury lawyers offer free consultations and work on a contingency fee, meaning you don’t pay unless they recover compensation for you.

Final Thoughts

Having your personal injury claim denied in Walnut Creek doesn’t mean your case is over. In many cases, it’s just the beginning of the next stage.

Has Your Personal Injury Claim Been Denied in Walnut Creek? Don’t Settle for Less Than You Deserve.

At Brand Peters PC, we know how overwhelming a claim denial can be—and we’re here to help. Whether your injury was caused by a car crash, unsafe conditions, or a workplace accident, our attorneys can review your case, explain your options, and help you fight for the compensation you’re owed.

Call us today at (925) 489-0746 or reach out through our website to schedule a free consultation. Let’s take the next step together toward justice and recovery.

Disclaimer: This article is intended for informational purposes only and should not be taken as legal advice. Consult with a qualified attorney to discuss your specific situation.