What To Do When Home Insurance Denies a Claim

A claim denial can be frustrating; but it doesn’t have to be the last step

Insurers have to show a level of judgement when deciding whether a claim is legitimate. Fraudulent claims are common, as well as misunderstanding of what a policy covers. But knowing some common reasons for claim denial may not only shed light on the situation, but can offer steps to take to try and remedy the situation:

Common Reasons for Denial:

1. Coverage Exclusions: Read your policy closely: policies often have specific exclusions, such as damage from floods, earthquakes, or neglect.
2. Lack of Documentation: If you don’t provide sufficient evidence or documentation for your claim, it may be denied. Your agent can help you find the right documentation.
3. Policy Limits: If the damage exceeds the coverage limits of your policy, the claim could be partially or fully denied.
4. Late Reporting: Insurance companies require timely reporting of claims. Delays can lead to denials.
5. Pre-existing Conditions: Damage that existed before the policy was in effect or that is due to maintenance issues can be denied.
6. Fraud or Misrepresentation: If the insurer suspects fraud or that you misrepresented information on your application, they may deny the claim.

Steps to Take After a Denial:

1. Call your Agent or Customer Service Contact: Your agent isn’t responsible for approving or denying claims
2. Review the Denial Letter: Understand the reasons for the denial and the specific policy provisions cited.
3. Gather Evidence: Collect any supporting documentation, such as photos, repair estimates, and witness statements.
4. Contact Your Insurer: Reach out to your insurance company for clarification and discuss the denial.
5. File an Appeal: If you believe the claim was wrongly denied, you can formally appeal the decision. Check your policy for the appeals process.
6. Consult a Professional: If needed, consider seeking advice from a public adjuster or attorney who specializes in insurance claims.
7. Shop Around: If you consistently face issues with your current insurer, it might be worth comparing policies and providers.

Let Our Agents Help

Understanding your policy and being prepared can help you navigate the claims process more effectively – and talking to an insurance agent is the best way to keep yourself informed. Shoot us an email or call today!