What to Do if You Have an Insurance Claim Denied

You’re not the first to have your homeowners’ insurance claim denied. Insurance companies deny claims every single day — sometimes for legitimate reasons, sometimes in error, and sometimes for reasons no one understands. However, there are steps you can take to challenge your homeowners’ insurance claim denial.

What follows are a few tips for when you have a homeowners insurance claim denied when you have suffered property damage.

Common Reasons an Insurance Claim Can be Denied

There are many reasons why a homeowners insurance claim can be denied. Some common reasons for denied claims include:

• Exclusions in Coverage: Most basic homeowners insurance policies have specific exclusions that are not covered by the policy. This may include damage from floods, earthquakes, or war. If the loss is excluded from coverage, the claim will likely be denied.
• Lack of Maintenance: Homeowners are often required to maintain their property and keep it in good condition. If a loss occurs due to lack of maintenance, such as a leaky roof, the insurance company may deny the claim on the grounds that the homeowner was at fault.
• Improper Filing of Claims: Claims must be filed properly and within the time limits specified by the insurance company. If a claim is not filed in a timely manner, it may be denied.
• Fraud: Insurance fraud is a serious issue and insurance companies have measures in place to detect and prevent it. If an insurance company suspects fraud, it may deny the claim.
• Insufficient Proof of Loss: To support a claim, homeowners must provide adequate proof of loss. This includes a detailed description of the damage, photographs, and estimates for repair costs or replacement costs. If the homeowner does not provide enough proof of loss, the claim may be denied.
• Exceeding Coverage Limits: Most homeowners insurance policies have dollar limits on the amount that can be paid for a loss. If the cost of repairs exceeds the policy limits, the insurance company may only pay up to the policy limit, and the homeowner will be responsible for the remainder.
• Pre-existing Damage: Homeowners insurance typically covers losses that occur during the policy period. If the damage was pre-existing, the insurance company may deny the claim.
• Natural Wear and Tear: Homeowners’ insurance policies typically do not cover losses due to normal wear and tear. This includes items that have reached the end of their useful life, such as appliances or HVAC systems.

By understanding these common reasons for denied claims, homeowners can take steps to prevent them from happening. This may include purchasing additional coverage, keeping their property in good condition, and properly filing claims in a timely manner.

Understanding Your Homeowners Insurance Policy and Why Your Claim Was Denied

Be aware of what your insurance policy covers. You should receive a formal denial letter rejecting your claim. This letter usually explains the reason for your claim denial. It will explain the specific language in your policy that justifies why your claim was denied. Read the letter carefully, and compare their explanation to your understanding of your policy. If there is a legitimate reason for denying your claim, i.e., the premium wasn’t paid, the type of loss is explicitly excluded from your coverage, or additional coverages weren’t in your policy, there is nothing more you can do.

However, if after comparing their explanation to your understanding, you still believe your property damage should be covered, immediately contact your insurance company’s claims adjuster and your insurance representative. Persuading an insurance adjuster to reverse a claim denial is difficult, but if the insurance coverage was promised in your homeowners’ policy, you have a case to fight.

File An Appeal With Your Insurance Provider

Arguing your case with insurance carriers and claims adjusters could be like fighting with a brick wall. You will need to file a formal appeal. Time is limited, however, and the clock starts ticking when your claim is denied. This period varies according to state law; for example, it’s 15 days in the state of Texas (via Forbes). The appeals process should be outlined in your homeowners policy.

Filing a formal appeal triggers a review of your denied claim. It’s up to you to provide as much evidence and documentation as you can to support your position. The more organized, the better.

Consult a Public Insurance Adjuster

Consulting a public adjuster can be a wise decision if your homeowners’ insurance claim has been denied. Public adjusters are insurance professionals who specialize in representing policyholders in insurance claims by offering an independent appraisal of damages. Here are some reasons why you should consider working with a public adjuster:

• Expertise: Public adjusters have extensive knowledge and experience in the insurance claims process, and can help you navigate the complex procedures and regulations involved.
• Objectivity: Public adjusters work on behalf of policyholders and do not have any ties to insurance companies. This means they can provide an objective assessment of your claim and negotiate a fair settlement on your behalf.
• Increased Settlement Amounts: Public adjusters have the skills and experience to maximize the amount of compensation you receive. They may be able to identify additional damages or coverage options that you may not be aware of, and negotiate a higher settlement amount with the insurance company.
• Reduced Stress: Filing a claim can be a stressful and overwhelming process, especially if the claim is denied. A public adjuster can take the lead in communicating with the insurance company, handling negotiations, and dealing with the paperwork, allowing you to focus on other important matters.
• Time Savings: The process of filing a denied insurance claim can be time-consuming and complex. Public adjusters have the knowledge and experience to handle the process quickly and efficiently, potentially saving you time and hassle.

A public adjuster can verify your coverage, document damage and value your losses, and negotiate the maximum settlement allowed under the terms of your homeowners policy. the sooner you seek their help, the sooner you will begin the process of recovery from property damage and loss.

File A Formal Complaint

The insurance industry is heavily regulated. Courts in every state can overturn bad faith denials and assist in property claims disputes. If the treatment of your claim falls short despite your case to the contrary, you have the option to file a formal complaint with your state’s insurance commissioner.

It is important to understand that the denial of a claim is not necessarily the final decision. Here are some steps to follow when filing a formal complaint:

• Review the Denial Letter: The first step is to carefully review the denial letter from the insurance company. This letter should explain the reason for the denial of the claim and will provide information on the appeal process.
• Gather Supporting Documentation: To support your complaint, it is important to gather all relevant documentation, such as policy documents, photos of the damage, and any estimates or receipts for repairs.
• Write a Complaint Letter: The next step is to write a formal complaint letter to the insurance company. In this letter, you should provide a detailed explanation of the claim, including the date and cause of the loss, and the reasons why you believe the claim was wrongly denied.
• Contact Your State Insurance Department: If the insurance company does not respond to your complaint, you may need to contact your state insurance department. This department can help you understand your rights and options, and may be able to assist with resolving the dispute.
• Hire an Attorney: If you are unable to resolve the dispute with the insurance company, you may consider hiring an attorney. An attorney can help you understand your rights and represent you in court, if necessary.
• Consider Alternative Dispute Resolution: Alternative dispute resolution, such as mediation or arbitration, can be a less formal and less costly way to resolve disputes with insurance companies. This may be a good option if you are unable to resolve the dispute through other means.

When It’s Time To Take Legal Action Against Your Insurance Company

It may be time to hire an insurance lawyer for an insurance claim if you can’t reach an agreement with your insurance company or the insurer seems to be delaying the claim process on purpose.

If your homeowners insurance claim has been denied and you cannot resolve the dispute through other means, it may be time to consider hiring an insurance lawyer. An insurance lawyer is a legal professional who specializes in representing policyholders in insurance claims disputes.

You’ll want to find a specialist familiar with insurance laws. Be sure to get references that show a successful track record settling property insurance claims, not just an understanding of property law. If you can’t find one, you can start a search at the American Bar Association’s list of state bar associations.

Contact Stellar Public Adjusting if You’ve Had a Homeowners Insurance Claim Denied

As mentioned above, public adjusters are an indispensable tool for getting larger claim settlements. If you’re in good standing with your insurance provider and have been making your insurance payments in a timely manner, and feel you are due a payout after a claim denial, we can use our expertise to help you.

Stellar Public Adjusting does not outsource work, so the adjuster you deal with when you file your claim will be the same one assisting you through the claims denial process all the way until you get the money you deserve for the damage in dispute.

Use our web form to contact us today. If you have an urgent problem that requires immediate assistance, call our office at 305-570-3519.