Short answer: Start by carefully reading the denial, preserve and organize all evidence, follow the insurer’s internal appeal steps, consider filing a consumer complaint with New Mexico’s insurance regulator, and evaluate whether suing in court is necessary. Acting promptly is essential.

Detailed answer — step-by-step guide

This explains what typically happens and what you should do after an insurer refuses to pay an injury claim from a minor accident in New Mexico. The information below is educational and does not constitute legal advice.

1. Read the denial letter carefully

An insurer’s denial letter should explain why the claim was denied, what facts or policy language the company relied on, and whether you have any internal appeal steps or deadlines. Note any dates and requested information.

2. Preserve and collect your evidence

• Keep photos of the vehicles, injuries, scene, and any visible property damage.
• Get copies of all medical records, treatment notes, billing statements, and any diagnostic tests.
• Save police reports, witness contact information, repair estimates, and correspondence with the insurer (emails, letters, notes of phone calls).

Insurers often deny claims for lack of medical proof, late notice, disputed fault, or policy exclusions. Good documentation strengthens an appeal or later lawsuit.

3. Request the insurer’s claim file and full explanation

Ask the insurer to send the complete claims file, including recorded statements, adjuster notes, and any expert reports it relied on. This can reveal weaknesses in the denial and may prompt reconsideration.

4. Use the insurer’s internal appeal process

Most policies and companies offer an internal appeal or reconsideration. Submit a clear written appeal attaching: medical records, a timeline of events, photos, witness statements, and a concise explanation of why the denial is incorrect. Keep copies of everything and send by a trackable method (certified mail or email with read receipt).

5. File a complaint with New Mexico’s insurance regulator

If internal appeals fail or the insurer is unresponsive, you can file a consumer complaint with the New Mexico Office of Superintendent of Insurance (OSI). The OSI handles consumer complaints and can investigate whether the insurer followed New Mexico rules. File online or by phone; include claim numbers and copies of supporting documents. See the OSI consumer information here: New Mexico Office of Superintendent of Insurance.

6. Consider negotiation or mediation

Many denials lead to renewed negotiations once you present stronger evidence. You can propose a demand package summarizing damages and attaching medical records and invoices. For low-dollar disputes, mediation or alternative dispute resolution can be faster and cheaper than litigation.

7. Evaluate a lawsuit in state court

If the insurer refuses to pay and your damages justify legal costs, you may file a civil suit. For minor-amount disputes, New Mexico’s courts offer streamlined forums where you can pursue claims without lengthy formal procedures. Visit the New Mexico Courts website for procedural information: New Mexico Courts. Be aware that court claims are subject to time limits; act promptly to avoid losing the right to sue.

8. Bad-faith considerations

Insurers must follow certain consumer-protection rules and claims-handling standards. If an insurer unreasonably denied a valid claim, you may have claims beyond the underlying injury damage (for example, claims for bad-faith handling). The state regulator (OSI) can investigate unfair practices. For the text of New Mexico laws and the state’s legislative resources, see: New Mexico Legislature – Statutes and Laws.

9. When to consult an attorney

Talk with a personal-injury attorney if:

• Your medical bills or lost wages are substantial relative to legal costs.
• The insurer’s denial is complex or based on disputed facts (fault, preexisting conditions, policy interpretation).
• You suspect the insurer acted in bad faith or violated consumer-protection rules.
• Settlement talks stall or you’re approaching time limits to file suit.

An attorney can evaluate liability, calculate damages, advise on negotiation strategy, and if necessary file suit and handle litigation.

Practical timeline and what to expect

• Immediate (days): gather evidence, obtain medical records, preserve photos and receipts.
• Short term (weeks): submit an internal appeal with supporting documents; request the insurer’s claim file.
• If unresolved (1–3 months): file a complaint with the OSI and continue negotiation or mediation.
• Longer term (months to years): if a lawsuit is necessary, litigation timelines vary; be prepared for discovery, depositions, and court schedules.

Always track deadlines listed by the insurer and any statutory filing deadlines that might apply to your claim.

Helpful Hints

• Act quickly. Delays can reduce evidence quality and may trigger filing deadlines.
• Put everything in writing. Follow up phone calls with written confirmation that summarizes what was discussed.
• Keep a claims notebook. Record dates, times, names of insurers’ representatives, and what they said.
• Don’t sign away rights. Avoid signing broad releases or recorded statements without understanding consequences; ask for legal advice first.
• Request your full medical records and itemized bills early—these are central to proving injury-related damages.
• Use certified or trackable mail for important submissions and retain copies of all documents.
• Filing a complaint with OSI does not automatically create a private right to money damages, but it can prompt regulatory action and sometimes motivates insurers to re-evaluate a claim.
• If your case is small, ask about expedited court procedures or small-claims options through New Mexico Courts to save time and cost.

Disclaimer

This article is for general information only and does not constitute legal advice. It is not a substitute for advice from a licensed attorney who can evaluate your specific facts and the applicable law in New Mexico.