Filing an insurance claim after a disaster or property damage should be a straightforward process, but for many homeowners and business owners, it can quickly turn into a frustrating battle. Insurance companies are in the business of minimizing their payouts, and even legitimate insurance claims can sometimes be denied. If you find yourself in this unfortunate situation, it’s important to understand why insurers deny claims and how you can fight back to ensure you receive the compensation you deserve.
At A H Neaman Company, we are experienced public adjusters in Pennsylvania, West Virginia, and Maryland, and we specialize in helping policyholders navigate denied claims. In this blog post, we’ll explain the common reasons insurance companies deny legitimate claims and offer tips on how to effectively challenge those denials.
Common Reasons Insurance Companies Deny Claims
While it may seem unfair, insurance companies often find ways to deny claims, even when they are legitimate. Below are some common reasons for denial:
1. Policy Exclusions
Insurance policies contain specific exclusions that outline the types of damage or events that are not covered. For example, some policies may exclude damage caused by flooding or certain types of natural disasters. If the cause of damage falls under one of these exclusions, an insurer may deny your claim outright.
How to Fight Back:
Review your insurance policy carefully to ensure that the damage you’re claiming isn’t explicitly excluded. If your damage falls within the policy’s coverage, but the insurer claims it’s excluded, you may need to hire a public adjuster to help interpret the policy and present a more compelling case to the insurance company.
2. Insufficient Documentation
Insurance companies rely heavily on documentation to determine the extent of the damage and the corresponding payout. If you fail to provide enough evidence or the right kind of documentation, your insurer may deny your claim, citing a lack of proof.
How to Fight Back:
To ensure you have strong documentation, take clear photographs and videos of the damage. Collect repair estimates from professionals, maintain an updated inventory of property, and keep all receipts and records of your possessions. If your claim is denied due to insufficient documentation, a public adjuster can assist in gathering and presenting the necessary proof.
3. Failure to Meet Deadlines
Every insurance policy has a timeline in which a claim must be filed after the damage occurs. If you miss this deadline, even by a small amount, the insurance company may deny your claim, citing a violation of the policy’s terms.
How to Fight Back:
It’s essential to be aware of the deadlines specified in your policy and file your claim as quickly as possible. If your claim is denied because of a missed deadline, your public adjuster can investigate whether the insurer has improperly applied the deadline or if there were extenuating circumstances that delayed your claim.
4. Claiming Damage from Pre-existing Conditions
Insurance companies may deny claims if they believe the damage was caused by a pre-existing condition or lack of maintenance. For example, if your roof is old and you claim storm damage, the insurer may argue that the roof’s age or poor maintenance was the real cause of the damage, not the storm itself.
How to Fight Back:
In these cases, it’s crucial to demonstrate that the damage was caused by a specific event (such as a storm, fire, or theft) and not a pre-existing issue. A public adjuster can help gather independent assessments from contractors or specialists to establish the actual cause of the damage and provide you with a better chance of winning your claim.
5. Underinsurance
Sometimes, insurers deny claims because the coverage is not enough to fully cover the damage. If you have a policy with a low coverage limit or one that doesn’t properly reflect the value of your property, your insurer may deny or reduce your claim amount, stating that it exceeds the policy’s limits.
How to Fight Back:
If you suspect underinsurance, it’s important to have a public adjuster review your policy and the damages. Public adjusters are skilled at assessing property values and ensuring that the policy limits are adequate. If the insurance company has underpaid or undervalued your claim, your public adjuster can help negotiate a fair settlement or even file an appeal.
Steps to Take When Your Claim Is Denied
If your insurance claim is denied, it’s important not to accept the denial without further investigation. Follow these steps to fight back:
1. Request a Detailed Explanation
When an insurance company denies a claim, it is legally required to provide a written explanation outlining the reasons for the denial. Make sure you fully understand the reasons before taking further action. If the reason for denial is unclear, ask for clarification.
2. Review Your Policy
Re-read your insurance policy to ensure that the damage is covered. Understand any exclusions, limits, or conditions that might affect your claim. If necessary, seek help from an experienced public adjuster to interpret complex policy language.
3. Gather Additional Documentation
If your claim was denied due to insufficient documentation, gather more evidence, such as photographs, repair estimates, and expert assessments. This is crucial for building a stronger case. A public adjuster can help identify any gaps in your documentation and assist in collecting additional proof.
4. File an Appeal
If your insurance company refuses to pay out or denies your claim outright, you have the right to appeal the decision. This process involves submitting a formal appeal letter and presenting your case to the insurer with additional evidence. A public adjuster can help you craft a compelling appeal.
5. Consider Legal Action
If your appeal is unsuccessful, you may want to consider taking legal action. Some cases may require litigation, especially if bad faith is suspected. Working with a lawyer who specializes in insurance disputes can help you navigate this process.
How a Public Adjuster Can Help
Fighting a denied insurance claim can be overwhelming, but a public adjuster can help level the playing field. A public adjuster is an independent, licensed professional who works on your behalf, not the insurance company’s. They assist in interpreting your policy, gathering evidence, and negotiating with your insurer. In Pennsylvania, West Virginia, and Maryland, A H Neaman Company has a proven track record of successfully helping clients fight denied claims and secure the compensation they deserve.
Our team of experienced public adjusters understands the nuances of insurance policies and the tactics that insurance companies use to deny legitimate claims. We work with homeowners and business owners to ensure that their claims are handled professionally and fairly.
Conclusion
Dealing with a denied insurance claim can be frustrating and confusing, but you don’t have to face it alone. If your insurance company has denied your claim, consider consulting with a public adjuster to review your case and fight for the compensation you deserve. At A H Neaman Company, we specialize in advocating for policyholders in Pennsylvania, West Virginia, and Maryland. Let us help you navigate the claims process and ensure that your legitimate claim is paid out in full. Contact us today for a consultation and start fighting back against unjust claim denials.
