Has Your Insurance Denied Your Claim?
Here at Tetzel Law we know how difficult it can be when the insurance company denies your claim. You think you’re covered because you have insurance but after months of delays and stall tactics you slowly realize you’ll have to fight them. This is where we come in.
We know how to fight insurance companies and know all the loopholes they try to hide behind. Let us beat the insurance companies for you.
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Navigating and disputing homeowner’s insurance denials can be complex without the proper legal training. Locating an insurance dispute attorney can help you to gain the financial support you deserve during your crisis.
When an insurance dispute attorney sits down with you, they will be able to guide you through the necessary steps in a calm and professional manner. In most cases, they will be helping you with one of eight types of claim denials: surface water, seepage, water back-up, fire, theft, power disruption, intentional acts, and anti-concurrent claims. Identifying and forming a strategy to combat a denial from your insurance company should always be left to a professional but if you’ve filed a claim chances are it’s one of the 8 issues below.
1. Fire Claim Denied
This can be one of the most emotionally tolling denial situations to navigate. In addition to the general property damages, you will also need to have all valuables in your home properly documented to ensure full recovery for your loss. You and your family will have already lost numerous irreplaceable items, so it is of utmost importance that you receive the insurance money you deserve.
With the building costs it requires to construct an entirely new home on a damaged lot, you will need every penny you can get. Cleaning up the ash and debris from the newly burned down resident will also be very costly. Sitting down with an insurance dispute attorney to locate every possible source of claim money will help you raise the proper funds.
Understanding how much you can receive from such a claim is important when first agreeing to an insurance policy. Although denials are much less frequent in the case of fires, many disputes arise regarding the amount of damage and the property covered under the applicable policy.
In addition, fire losses include thorough investigations, which can require legal representation. For example, the local police and fire department will investigate for evidence of arson, detect the cause of origin of the fire and complete criminal background checks on all related parties.
2. Surface Water
Nearly any situation where a property is damaged by water will end up causing an insurance company to deny the claim. Most insurance contracts have sections that detail what constitutes as “floods” and what is considered “surface water.” Although both occurrences derive from natural causes, insurance companies will use the same denial grounds when the loss results from an artificial or man-made structure.
You might be accused of having damages that occurred from surface water. For example if you allowed rainwater from a storm to remain on top of your house for a long period. Additionally, if an underground pipe were to break and cause water damage, an insurance company may try to include the incident under a surface water exclusion.
Insurance companies write contracts to keep definitions ambiguous. Courts have interpreted the specific definitions of surface water damage included in an insurance contracts. An insurance dispute attorney will allow you to determine if you should argue against a claim denial in these situations, and in the event you have a valid claim, advocate on your behalf.
Keeping your property properly maintained and inspected can help you to avoid these legal situations. Always check for potential areas of water build up after experiencing any severe weather conditions or local flooding. Meticulous documentation of conditions on the property can also be useful in the dispute procedures.
Damages that occur from seepage and leakage issues happen gradually, as opposed to the sudden and accidental damages that occur from flooding and pipe ruptures. As a result, insurance companies view these losses as maintenance-oriented and do not include coverage in policies.
Yearly inspections of your home’s pipes system is a prudent practice and will be useful in any insurance disputes involving seepage and leakage. Further, home owners should constantly monitor sprinklers and ensure water is not pooling around the home’s foundation. Another cause of seepage can be sloping landscapes which cause water to be directed towards the foundation.
With the amount of pipes in your home, there are several key areas to check for damage or potential seepage. Bathroom areas, laundry machines and dishwashers are common seepage heavy areas. When hiring someone to inspect your property, always make sure they pay special attention to these areas.
Once again, you should seek the help of an insurance dispute attorney before taking action on a denial claim. This situation may not be as complex as surface water claim disputes, but is still dependent on a thorough understanding of insurance law.
4. Water Back-Up
In the legal sense, a water back-up is defined as the accumulation of water caused by a reversal or stoppage in its intended flow. This is commonly confused with instances of water overflow and discharge, as the back-up can frequently cause this type of damage.
Most insurance policies account for these incidents, but often stipulate that the source of the damage must originate on your actual premises. For example, a washer machine’s pipe back-up and damage would be a covered event. On the other hand, if your neighborhood street system’s pipes were to cause damage to your property as the result of a back-up, then it would not be covered under this provision.
As with the other water-related insurance denials, you can be turned away if damages are determined to happen due to negligence on the insured’s part. The same inspections you would receive for pipe upkeep would help you determine if you are at risks of leakage in any section of your home.
Any loss resulting from theft will require similar investigations from local law enforcement. However, you can also be reimbursed for stolen items through your homeowner’s insurance carrier. Typically, you will have little dispute from the insurance company if the item is low in value. However, each home owner should consider individual endorsements or separate “floater” policies for high value property.
Regardless, complex theft situations can cause significant dispute. Again, keeping a thoroughly documented list of items of value in your home can help streamline the claim process. This can be done by retaining receipts and taking pictures of personal property.
6. Power Disruption
In most cases, power disruption and outages will not provide any major inconvenience for a home owner. However, if an outage or disruption last for several days, it can cause damage to your property. Spoiled food, malfunctioning climate control and other problems may lead to damages that cost you money. Knowing what circumstances are covered in your insurance policy regarding power outages and disruptions is of utmost importance.
Generally speaking, it is much more likely damages will be covered if the outage occurred because of factors on your property. For example, if your property was struck by lightning or a tree of yours fell onto power lines on your property, you will be much more likely to be covered by your insurance policy. On the other hand, if the damages occurred because of a city-wide blackout, your insurance company will be hesitant to cover your damages.
Electronics affected by localized power outages (such as lightning or fallen trees) are usually covered under most insurance policies. This helps to ensure that high value items such as computers and televisions will not be lost to forces of nature. However, if the source causing damage to the electronic device did not originate on your property, it is once again less likely your insurance company will pay out.
If you are covered, insurance companies will often pay for hotels or other accommodation services while you and your family are waiting for your property to receive the proper maintenance. Power outages of lack of power can make a living space dangerous to occupy, so this is always a good quality to look for in insurance policies.
7. Intentional Acts
Insurance providers will deny any coverage to an insured if they are proven to have caused damage intentionally. It is recommended that you contact an insurance attorney immediately if an insurance provider denies you coverage because they claim an incident was intentional.
Understanding the difference between negligent and intentional acts can help you determine whether or not an insurance company might attempt to deny the claim. Negligence occurs when damages happen because of a lack of reasonable care. Lack of maintenance of your homes different systems could be an example of negligent behavior. Intentional acts, on the other hand, occur when the perpetrator purposefully causes the loss.
Since insurance is meant to protect against accidental and unexpected damages, any act proven intentional will be disqualified for insurance coverage.
Further, if you believe your loss was caused by the negligent of a third party (i.e. a neighbor), you should consult an attorney because you could have a right to recover additional funds over and above the proceeds received from your own homeowner’s insurance company.
8. Anti-Concurrent Causes
This is one of the most controversial ways that insurance companies have denied claims in the past. Essentially, an anti-concurrent clause will deny homeowners insurance coverage if damages occur from two separate sources at once even if one of the causes is a covered event. However, the exact wording of this clause can differ significantly from policy to policy. This tricky and frustrating clause has been tucked away in many home insurance policies, so you should always check to see if it is included within your policy.
Making sure this clause is absent from your policy can help save you in dire situations. Tragically, many victims of massive hurricanes such as Katrina, where denied any coverage under this clause. In their cases, insurance companies denied them coverage due to damages occurring from both wind and water at the same time. While legal interpretations of these cases have been questioned, these provisions are a threat to homeowners.
When purchasing your family’s home insurance policy, you should expect only the best. With high monthly premiums, denials should be few and far between. Instead, insurance companies are driven by profit and as a result, are in the business of denying claims. As such, do not take a denial as a final decision and contact a home insurance attorney to fight for your rights.