Detailed answer — how the appeal process works in West Virginia

This section walks you through the typical steps after an insurance company denies injury benefits for a minor accident. The exact process depends on the type of insurance (auto liability, personal injury protection (PIP), medpay, or your own health insurer) and the reason the company gave for denial.

1. Read the denial carefully

The insurer must state why it denied the claim. Common reasons include: no coverage under the policy, late notice, policy exclusions, insufficient medical causation, or dispute about who was at fault. The denial letter often tells you how to appeal internally and provides a deadline.

2. Internal appeal and rebuttal

Most insurers have an internal review or appeal process. You should:

• Send a written request for reconsideration. Follow any appeal instructions in the denial letter.
• Provide new or clearer evidence: medical records, clear treatment notes tying your injury to the accident, photos of the scene and damage, witness statements, repair estimates, and the police report if any.
• Ask the insurer to explain any medical or investigative basis for denial and request the specific reports, records, or medical reviews used.

3. Administrative complaint with the West Virginia Office of the Insurance Commissioner

If the insurer’s internal appeal fails or you suspect unfair claim-handling, you may file a consumer complaint with the West Virginia Office of the Insurance Commissioner. The Commissioner’s office investigates violations of state insurance law and can compel responses. For information and to submit a complaint, see the Office of the Insurance Commissioner: https://www.wvinsurance.gov/.

4. Evaluate private civil options

If necessary, you can sue the insurer in West Virginia circuit court. Common causes of action include breach of insurance contract and, in some cases, claims under West Virginia’s laws governing unfair claim settlement practices (found in the state insurance statutes). See West Virginia Code, Title 33 (Insurance): https://code.wvlegislature.gov/33/.

5. Time limits and policy deadlines

Deadlines matter. Your insurance policy will include suit-limit provisions (how long you have to sue under the policy). State law also imposes statute-of-limitations rules for personal injury suits. For West Virginia civil procedure and statutes of limitations, see Title 55 of the West Virginia Code: https://code.wvlegislature.gov/55/. If you wait too long, you can permanently lose the right to sue.

6. Settlement, mediation, or trial

Many denials end in negotiation. If you and the insurer can’t agree, possible next steps are mediation or filing a lawsuit. Litigation risks and costs vary with the claim’s size. For minor injuries, a negotiated settlement or small-claims option (if applicable to the claim type) may be the practical route.

7. What an attorney can do

A personal-injury attorney can evaluate the denial, gather medical proof linking your injury to the accident, communicate with the insurer, file an administrative complaint, and, if needed, start a lawsuit. Attorneys also advise whether pursuing a bad-faith or unfair-claims claim is realistic based on the insurer’s conduct and the law in Title 33.

8. Typical timeline

• Immediate (days): preserve evidence, seek medical care, report the claim to your insurer and the other party’s insurer.
• Short term (2–6 weeks): gather medical records, send a written appeal, insurer responds or requests more information.
• Medium term (months): if denied after appeal, file a complaint with the Insurance Commissioner and consider retained counsel.
• Long term (6 months+): if unresolved, litigation may begin; resolution time depends on the court and the case complexity.

9. Practical outcomes you can expect

Possible outcomes include reversal of denial and payment, partial settlement, administrative remedy from the Commissioner’s office, or a court judgment in your favor. If your claim is not compensable under the policy, you may not recover financial damages except by proving the insurer acted improperly under state law.

Helpful Hints

• Preserve everything: keep medical bills, treatment notes, repair receipts, photos, and communications with insurers.
• Get a clear medical link: ask your treating provider to document how your injury relates to the accident in writing.
• Follow your insurer’s procedures exactly: missing a required appeal step can waive claims.
• Note all deadlines in your policy and check West Virginia’s civil deadlines in Title 55: https://code.wvlegislature.gov/55/.
• Use the Insurance Commissioner for help: file a consumer complaint at https://www.wvinsurance.gov/.
• Consider informal negotiation before suing — small claims or settlement can be faster and cheaper for minor injuries.
• If the insurer relies on a medical examiner or independent medical review, request a copy of those reports and the reviewer’s qualifications.
• When in doubt, consult a West Virginia personal injury attorney early to preserve rights and evaluate options.