My Claim Was Denied. Is There Anything I Can Do?

Having your claim denied can be very frustrating.  What is insurance for anyhow if it’s not to cover damages to your property when you need help?

First, understand that it may not be the end of the road.  Insurance companies can and often do make mistakes.  They are human after all.  Here are a few tips that may help get the denial of your claim overturned if in fact it is warranted.  But you must be objective and understand that insurance policies do not cover everything.  In general if damages are sudden and accidental, they are likely covered under your policy.  However, if they are long term and occurred over a period of time, whether you knew about it or not, are likely excluded.

  1. Read your policy.  Determine whether or not you have what is known as an All Risk Policy or a Named Peril Policy.  An All Risk Policy covers all types of damages unless they are specifically excluded.  A Named Peril Policy will provide a list of perils that are covered.  Determine whether your type of loss is covered or is it excluded.
  2. If you have not been provided a formal denial letter – demand one.  Explain that you want to know the legal and factual basis for the denial and where in the policy it states that your type of loss is not covered.
  3. Request to speak to a supervisor or claims manager.  It is possible that someone with more experience may see your loss in a different light.  Remain professional and explain where you believe there are errors after you have read through your policy and believe that you do in fact have a covered loss.
  4. Seek the assistance of the Department of Insurance in your state.  Each state has a Department of Insurance that regulates insurance companies.  While they may not provide advice on coverage, they may be able to assist with getting the insurance carrier provide a proper review and response.
  5. Seek the assistance of a Licensed Public Adjuster.  A public adjuster is an insurance expert that understands policy and can assist in getting a wrongful denial overturned.  Public Adjusters work on a contingency basis and their fee varies depending on the state regulations as well as the current status of your claim.  Contact a ClaimAdvisor.com representative who can quickly provide the contact information of a licensed public adjuster in your area.
  6. Seek legal assistance.  Not all attorneys specialize in insurance or bad faith law.  ClaimAdvisor.com has a list of properly experienced attorneys that understand insurance law.  However, most attorneys generally have a higher monetary threshold that they have before they take on a claim as the expenses can be very costly.  Most attorneys work on a contingency basis much like public adjusters.

 

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