How to contest an insurance company’s final settlement offer after an injury

Quick summary: If you disagree with a final settlement offer from an insurer in New York, you have several options: gather documentation, make a written demand, use the insurer’s appeal process, file a complaint with the New York Department of Financial Services, pursue dispute resolution (mediation or arbitration), or file a lawsuit before the applicable statute of limitations runs. Act promptly and preserve all records. This article explains each step and links to relevant New York laws and resources.

Detailed answer — step-by-step guidance

1. Pause and preserve evidence

Do not sign a full release or cash a settlement check labeled “final” until you understand what you are giving up. A signed release typically prevents later claims for the same injury. Preserve all evidence: medical records, medical bills, photos of injury or accident scene, lost-wage documentation, repair estimates (if property damage), correspondence with the insurer, and any recorded statements you gave.

2. Review the offer, policy, and explanation

Carefully review the insurer’s written offer and any Explanation of Benefits (EOB). Compare the offer to the coverage limits and terms in your insurance policy. Note whether the insurer addresses:

• Medical bills and future treatment costs
• Lost wages and diminished earning capacity
• Pain and suffering, emotional distress, and other non-economic damages
• Liens from health insurers, Medicare/Medicaid or medical providers

3. Send a written demand and supporting documentation

If the offer is too low, prepare a concise written demand that explains why the value should be higher. Include or reference:

• A summary of how the injury occurred
• Current medical diagnoses, treatment already received, and recommended future care
• Total billed and paid medical expenses, including itemized bills
• Lost-wage documentation (pay stubs, employer statements)
• Photographs and other corroborating evidence
• If available, an expert opinion or physician letter about prognosis and costs

Ask for a written explanation if the insurer denies coverage, reduces benefits, or claims the offer is final. Keep a record of dates and names of insurer representatives you speak with.

4. Use the insurer’s internal appeal or dispute resolution process

Many insurance policies and companies offer an internal appeals process or will participate in mediation or appraisal for certain claims. Follow the insurer’s written appeal procedures and meet any internal deadlines. For health insurance or disability claims, insurers often have formal internal and external review processes.

5. File a complaint with the New York Department of Financial Services (DFS)

If you believe an insurer acted unfairly, you may file a consumer complaint with New York’s Department of Financial Services. The DFS can investigate claim-handling practices and sometimes help get additional information from an insurer. For consumer complaint information see: NY DFS — File a Complaint.

6. Consider mediation or arbitration

Mediation is a voluntary process in which a neutral mediator helps the parties try to reach an agreement. Arbitration is usually binding and may be required by contract. Both can be faster and cheaper than litigation. Ask the insurer whether it will agree to mediation, or review your policy to see if arbitration is required.

7. Evaluate small claims court or litigation

If the amount in dispute is modest, small claims court may be an option. Each county has different limits and procedures; New York State information and local court resources are available here: NY Courts — Small Claims.

For larger claims, you may file a civil lawsuit. Important time limits apply:

• Personal injury claims generally must be started within three years from the date of the injury. See CPLR § 214 for the statutory rule: CPLR § 214.
• Breach of contract claims (such as a dispute over an insurer’s contractual obligations) generally have a six-year limitation period. See CPLR § 213: CPLR § 213.

Filing a lawsuit preserves your right to litigate but involves court fees, deadlines, discovery, and potential trial. If you are near the statute of limitations deadline, consult an attorney immediately to avoid losing the right to sue.

8. Understand potential liens and subrogation

If another insurer or a public program (for example, Medicare or Medicaid) paid any of your medical bills, they may have a right to repayment from any settlement. Ask the insurer for a complete accounting of liens and consult counsel if liens will reduce your recovery.

9. Get legal advice before signing anything

An attorney who handles injury claims can evaluate the offer, estimate the fair value of your case (including future medical costs and non-economic damages), handle negotiations, identify lien obligations, and explain your options. Most injury lawyers in New York work on contingency, meaning they advance costs and get paid from the recovery.

When to act quickly

• If the insurer labels the offer as “final” and the release would bar future claims.
• If the statute of limitations is about to expire — file suit or ask an attorney about tolling options.
• If you received conflicting information from the insurer or notice that benefits were denied without explanation.

Helpful hints

• Do not sign a broad release without knowing the full extent of current and future medical needs.
• Get a written explanation for any denial or reduced payment.
• Keep a detailed record of all communications with the insurer (dates, names, and what was said).
• Ask for a full copy of your insurer’s file and any recorded statements.
• Preserve medical records and invoices — your ability to prove damages depends on documentation.
• If in doubt, consult a personal injury attorney before accepting a final offer — attorneys can often identify hidden value and lien exposure.
• If you suspect unfair claim handling, file a complaint with the NY Department of Financial Services: DFS Consumer Complaints.
• Check local small claims limits and rules before choosing that route: NY Courts — Small Claims.

Bottom line: You can contest a final insurance offer in New York by documenting your damages, using insurer appeal and dispute-resolution procedures, filing a complaint with the NY Department of Financial Services, or pursuing mediation or litigation. Act quickly to preserve rights and watch the statute of limitations (see CPLR § 214 and § 213).

Disclaimer: This article is for general informational purposes only and is not legal advice. It does not create an attorney-client relationship. For advice about your specific situation, consult a licensed New York attorney.