Life is full of frustrations but one of the more frustrating situations is when your home damage insurance claim is denied. Claim denial happens not infrequently, but there are steps you can take to discover why your claim was denied and to present a well-documented appeal. In some cases, you may have a legal cause of action against the insurer.
There are many reasons why your claim may have been denied:
- The claim was untimely received
- No cause of the damage has been ascertained
- Your own negligence was the cause
- The incident or cause is specifically excluded from coverage
- You did not provide adequate documentation
- Arson or some other deliberate act caused the damage
In some cases, you can remedy this by providing documentation or showing that the limits do cover your damages. In others, you may have to go to more considerable lengths to convince or force the insurer to provide coverage.
The following are some home insurance denial tips:
- Get a copy of your home policy and review it in detail regarding what is covered and what is excluded. For example, if your home was damaged by flooding, was it from a burst pipe in the home or from a storm? If the latter, you would probably need separate flood insurance. Otherwise, does the policy exclude coverage for your own negligence such as a lit cigarette or the presence of certain chemicals that were not supposed to be in your home?
- Is there a maximum coverage amount and did your claimed damages exceed it?
- Review the report from the insurer, if received, of the investigation that documents why the cause of your home damage is excluded. If it is not clear, call your adjuster and have a written explanation sent to you with reference to the applicable provisions of the policy that excludes coverage.
- Begin to note each conversation with your insurance company, including whom you talked to, the date and time, substance of the conversation and outcome. Retain all correspondence between you and the insurer. You may want to confirm in writing any pertinent discussions with the agent or adjuster.
- Talk to an attorney experienced in home insurance claim denial help before you give any recorded or written statements to your insurer.
- If you receive a check that covers only part of your damages or related expenses, carefully review any statements on the check or document that accompanied it that requires your signature. If you have any questions, review it with an attorney as you may be signing away your rights to further payments or to appeal any determination the insurer made regarding your claim.
- Have you adequately documented all your damages? Take extensive photographs of the damage including smoke damage if a fire, broken pipes, furniture, clothes, appliances, computers, television sets, gaming devices and any other property that was damaged.
- If necessary, have an independent investigator review the report from the insurer and conduct another investigation. If the report challenges or contradicts the insurer’s investigation regarding cause and/or your alleged failure to have your home adhere to building codes, present it for its consideration and request that the claim be accepted.
- File a formal appeal with the insurer. You will have to present documented evidence showing why the denial was unfair or in error. You might consider having home insurance claim denial help from an experienced attorney.
- If the insurer does not cooperate with you, delays a decision, gives you inaccurate or misleading information or factual statements, you may have a cause of action for breach of contract or for bad faith.
Fighting insurance companies over anything, especially home insurance claim denials, can be time consuming and expensive. If your claim for damages to your home has been denied, follow the above steps but also consult with Paul Tetzel who can analyze your claim and determine if you have a viable opportunity to challenge the denial and get you the compensation you deserve.