February 17, 2020
Your home has suffered serious damage. Perhaps the cause was a fire, flood, storm, burglary, or vandalism. In any case, you believe you are covered, file your insurance claim, only to have it denied.
Your first instinct probably involves cursing your insurance agent at the very least, and we will not even consider the details of the worst. Our instinct would be the same. However, don’t let your emotions get the better of you. Stifle those urges, stay calm, and address the situation rationally. Let this guide help you through the process.
- Review the Policy – You probably did not go through your homeowner’s policy in detail before filing a claim, but you certainly should have. It is important that you fully understand the coverage.
Typical reasons for denial, aside from failure to pay the policy premiums, are causes (perils) that are not covered, not taking sufficient preventative measures, or insufficient documentation of the damage. It is best to think like an adjuster looking for a reason to deny your claim, and fill out your claim addressing all of those potential questions.
Give the policy another review so you can adequately address the reason for denial. If your copy of the policy was destroyed in the event, you can get a copy from your insurance company.
- Understand the Denial – You should receive a formal letter from your adjuster that specifies why the claim was denied, as well as the section of the policy that backs up that denial. If you did not receive formal notification, follow up with the adjuster. The insurance company is obligated to explain the reason for denial.
Compare this reason with your policy statement. Do you dispute the meaning of a term in the policy? Did the adjuster not fully understand the situation? Were there insufficient photographs or other evidence to back up the damage claims? Does the problem appear to be a filing error?
If the denial is ambiguous, ask for clarification from the adjuster. Document all conversations with dates, times, and names, then send this information to the adjuster while keeping a copy for yourself.
If their denial accurately describes the situation and the policy unambiguously backs up their denial, all you can do is learn from your mistake and perhaps rely on the power of prayer. Here are the steps to take if you still believe you have a valid reason to challenge the denial:
- File an Appeal – You will need to fill out an appeal form with your insurer, but lay out your rebuttal separately before doing so. Ask an impartial but trusted friend to review the case from an adjuster’s point of view. You may have lost perspective by now, and your friend may be able to give you constructive insight that helps you win your appeal.
Ask the insurance company for a resolution date. Do not expect the process to move quickly. Be as patient as circumstances allow you to be, and follow up if the deadline passes without any word about your case.
- Seek Further Action if Necessary – If your appeal is denied and you still dispute the insurance company’s action, you have several avenues of resolution. You can ask to speak to superiors within the insurance company or file a complaint with the regulatory agency in your state (typically an Insurance Commission).
If nothing else works, you can seek an attorney with experience in homeowner’s claims and determine whether you have a case. Keep in mind the value of the loss if you go down this path and whether the loss is worth the time and legal fees to continue.
Preventative measures are always best. Should such an event happen again, remember to thoroughly review your policy, photograph the damage, have supporting documentation ready for the value of possessions, and fill out your claim thoroughly and carefully, leaving a claims adjuster as few judgment calls as possible.
We hope that your case is resolved to your satisfaction so that you can move on to the recovery stage and put the mishap behind you. If not, try to learn from the experience and be as preventative as possible – starting with finding a different insurance company.