• 16 Jul 2025

What to Do When Your Insurance Claim Is Denied in North Carolina

If you or a loved one has been bitten by a dog in North Carolina, you’re likely facing more than just physical pain. There are medical bills, questions about legal liability, and uncertainty about what comes next. Fortunately, North Carolina law provides clear steps for how to respond and outlines when a dog owner may be held legally responsible. This guide breaks down everything you need to know—from immediate medical care to potential lawsuit compensation—while keeping you informed of your rights under NC law.

Why Insurance Companies Deny Claims

Insurers often deny claims for one or more of the following:

• Coverage exclusions that weren't fully understood
• Errors or omissions in your documentation
• Delayed filing or response times
• Determination of “non‑medical necessity” (common in health claims)

Knowing the insurer's reason gives you a strong footing for reversing the denial.

How to Appeal an Insurance Denial

Internal Appeals

North Carolina law requires insurers to offer a clear internal appeals process. You must submit your appeal, along with corrected or additional documentation, by the deadline in your denial letter. This is often health insurers following federal mandates via HealthCare.gov guidelines.

External Review & Regulatory Complaints

If the internal appeal fails, certain health and auto claims support independent external review. For other types, NC’s Department of Insurance handles complaints. They investigate patterns of unfair claim handling.

When the Denial Is Unfair or in Bad Faith

North Carolina law lists 14 unfair claim settlement practices under N.C.G.S. § 58‑63‑15(11), including:

• Misrepresenting policy terms
• Failing to acknowledge or follow up timely
• Not investigating claims reasonably
• Delaying or denying valid claims
• Offering unreasonably low settlements to force legal action
• Failing to explain denial reasons clearly

Although this statute doesn’t grant a private right of action, violations like these can still breach consumer protections under N.C.G.S. § 75‑1.1 (Unfair and Deceptive Trade Practices). Courts have confirmed these actions can qualify as unfair trade practices, even without showing a pattern—so long as bad faith or deceptive intent can be proven.

Your Legal Remedies in North Carolina

1. Policy Benefits + Interest

If your appeal succeeds, you’re entitled to the full amount under your policy—potentially with interest for the insurer's delay.

2. Attorney’s Fees

NC law allows recovery of attorney fees under N.C.G.S. § 75‑16.1 when unfair or deceptive practices are proven.

3. Treble (Triple) Damages

Courts may award triple damages if insurer conduct violated N.C.G.S. § 75‑1.1 and caused financial harm.

4. Punitive Damages & Breach of Contract

If your insurer knowingly refused a valid claim or engaged in deliberate deception, you could pursue punitive damages and breach of contract awards under North Carolina common law and statute.

What to Do Immediately After a Denial

1. Review your denial notice and policy wording
2. Submit an internal appeal before the deadline, with complete documentation
3. Identify any statutory violations, especially those listed under § 58‑63‑15(11)(b, f, h, l, n)
4. Log every communication in writing—this builds the case for bad faith
5. File a complaint with NC Department of Insurance (if necessary)
6. Talk to Paul Robinson Law for a no-cost case evaluation

How Paul Robinson Law Builds Your Case

Our team:

• Identifies specific insurance code violations
• Structures appeals with NC law front and center
• Collects key documentation—medical, billing, correspondence
• Prepares to sue for policy benefits, attorney fees, and treble damages
• Handles all negotiation and litigation so you can focus on recovery

Common FAQs

Can I appeal on my own?

Yes, but insurers respond faster—and more fairly—to well-documented, legally backed appeals.

What counts as bad faith in NC?

Repeated delays, misleading statements, refusing valid claims, or offering lowball settlements can all qualify.

How long do I have to sue?

Take the Next Step

A denied claim isn’t the end—it’s a checkpoint. You have legal tools to appeal, hold insurers accountable, and get the compensation you deserve.

Contact Paul Robinson Law now for a free evaluation. No fees unless we win your case and recover for you.