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  • Writer's pictureMaria Shalack

Home Insurance Claim Denied? Seek Expert Assistance!

If your claim is denied, you should immediately seek a licensed Florida Public Adjuster to determine the validity of the denial.

An experienced Public Adjuster can analyze the denial letter, review your policy, and assess whether the claim can be reopened.

Furthermore, a Public Adjuster can prepare an estimate of the damages, arrange a meeting with the insurance company for reinspection, and facilitate the payment process.

Litigation might be the next appropriate step if the insurance company still refuses to pay.

Having a Public Adjuster in place before resorting to litigation has its advantages. They can witness your claim, demonstrate that you made efforts to obtain payment, evaluate the damages, and help you find the right attorney to represent your case. The Public Adjuster will also compile the necessary information and write the estimate required for the attorney to fight against the insurance company effectively.

Home Insurance Claim Denied
Home Insurance Claim Denied

Why Would a Home Insurance Claim be Denied?

There could be several claim denial reasons for homeowners insurance:

  • Non-Covered Peril: The reason for the damage might not be covered under your policy. Home insurance policies generally cover specific perils such as fire, theft, or certain types of water damage. However, they often do not cover damage due to earthquakes, floods, or normal wear and tear.

  • Late Reporting: Insurance companies require that incidents be reported promptly. If you wait too long to report the damage, the insurance company may deny your claim.

  • Insufficient Documentation: If you fail to adequately document the damage (with photographs, receipts, etc.) or fail to keep accurate records, the insurer may reject your claim.

  • Policy Lapse: If your policy lapsed due to non-payment of premiums at the time the damage occurred, the insurance company will deny your claim.

  • Fraud or Misrepresentation: If the insurance company finds any evidence of fraudulent activity or if you have misrepresented information related to the claim, they can deny your claim. This could be anything from intentionally causing damage to lying about the extent or cause of the damage.

  • Negligence: If the damage is due to negligence or poor maintenance on your part, the insurer might deny your claim. For example, if a leaky roof that hasn't been maintained causes water damage, the insurer may refuse to cover the damage.

  • Exclusions: Every insurance policy has exclusions. The policy will not provide coverage in these specific situations or circumstances. It will be denied if your claim falls under any of these exclusions.

It is important to have a professional such as a licensed Public Adjuster or property insurance attorney review your denial letter to see if it is valid. The policy language is often ambiguous, and we can reopen the claim to get you paid.

If a claim is determined to be under your deductible or if the damages are not sufficient to cover that amount, then it is not a denial. The insurance has actually admitted coverage and usually written an estimate of what they think should be covered. Usually, homeowners think this type of coverage determination is a denial.

In many cases, we can reopen this type of claim, properly estimate the loss, and get you paid by requesting a reinspection, negotiating with the insurance, going to appraisal, or sometimes through litigation.

For example, in a water damage claim from a broken pipe under the kitchen sink, the insurance might want to pay just to fix the bottom cabinet and determine it is under the deductible. But the kitchen cabinets cannot be repaired and cannot be matched. Therefore, we would represent you to get paid for all the cabinets.

It's always a good idea to thoroughly review your insurance policy and understand its terms, conditions, coverage limits, and exclusions. If you have any doubts or your claim is denied, or an insurance company reduced your payment through unfair claim settlement practices, you might seek advice from a professional public adjuster specializing in home insurance claims.

How to Dispute an Insurance Claim Denial

Disputing a home insurance claim denial usually refers to the initial process of challenging the insurance company's decision to deny your home damage claim. This often involves contacting your insurance company, presenting additional evidence, clarifying misunderstandings, or explaining why you believe the denial is unjust based on the terms of your policy.

If your insurance claim is denied and you believe the decision is unjust, you can consult Maria Shalack at A&H to assist you before disputing the denial. This process can be tedious, and it requires a professional familiar with insurance policies and estimating the loss. Learn more about how the process works in the following step-by-step guide:

  • Understand the Denial: Read the denial letter carefully to understand why the claim was denied. The insurer is legally obliged to provide a reason.

  • Review Your Insurance Policy: Go through your insurance policy thoroughly to understand its terms, conditions, and exceptions. Make sure that your claim should indeed be covered as per the terms of your policy.

  • Gather Evidence: Compile all necessary documents that support your claim. This could include photos of the damage, repair estimates, receipts, police reports, and any other relevant documents.

  • Write a Dispute Letter: Draft a clear and concise letter outlining why you believe the denial of your claim was incorrect. Include all relevant policy numbers and claims numbers. State your case and back it up with evidence. Request a comprehensive review of your claim and the decision.

  • Contact Your Insurance Company: Send your dispute letter to your insurance company via certified mail with a return receipt requested. This ensures you have a record of your communication. You could also follow up with a phone call, but keep a record of who you speak to and what is said during the call.

  • Get a Second Opinion: Getting a second opinion from an independent adjuster or a professional in the field relevant to your claim could be beneficial. They can provide an unbiased evaluation of the damage and repair costs, which you can use to back up your dispute.

  • Consult a Public Adjuster: If the dispute isn't resolved after these steps, you may want to consult a public adjuster, who might help you reach a solution or guide you to a lawyer who specializes in insurance claims. They can help you understand your rights and may be able to assist in negotiations with the insurance company.

  • File a Complaint: If the issue is still not resolved, a public adjuster might help you file a complaint with your state's insurance department. They may be able to assist you with the dispute process.

Remember, each step you take should be timely and well-documented to ensure your case is as strong as possible. Always be persistent; we highly recommend seeking professional help from a licensed Public Adjuster. Having someone on your side to submit the right documentation is worth it.

Does a Denied Home Insurance Claim Count Against You?

Typically, a denied home insurance claim won't count against you in the same way an approved claim might. However, it's important to understand that the act of filing a claim—whether it's approved or denied—could potentially affect your insurance in several ways:

  • Increased Premiums: Even though insurance premiums are going higher each day in Florida (insurance crisis), whether you file a claim or not, filing a claim, even if it's denied, can potentially result in higher premiums in the future. This is because insurance companies have an underwriting department that looks at your specific situation when renewing the policy, and they may view any claim as an indication of increased risk.

  • Impact on Claims-Free Discount: Some insurance companies offer a discount to homeowners who haven't filed a claim in a certain period. You might lose this discount if you file a claim—even if it's denied.

  • Difficulty Obtaining Coverage: If you have a high number of claims (approved or denied) on your record, it might make it more difficult for you to obtain insurance coverage in the future. Other insurance companies may view you as a high-risk customer and might deny coverage or charge higher premiums.

  • Record on Comprehensive Loss Underwriting Exchange (CLUE) Report: Every home insurance claim you file gets listed on your CLUE report, which insurance companies can check before deciding to give you coverage. This report includes both approved and denied claims.

  • Repairs are needed for any claim submitted: If you file a claim with the insurance company and it is denied. You are still responsible for making the repairs even though the insurance did not pay it.

Remember, the impact of filing a claim can vary depending on your specific insurance company's policies, your history of claims, and other factors. Before filing a claim, discussing these potential impacts and other frequently asked questions (FAQs) with a Florida public adjuster is always a wise move. Their expert advice can help you navigate the process effectively and possibly save you from potential challenges down the line.

What To do if Insurance Denied Roof Claim

Unfortunately, insurance companies often deny roof damage claims, a scenario we at A&H Public Adjusters Corp encounter regularly. The reasons can vary, ranging from when the claim was filed, the event that caused the damage, the age and maintenance of the roof, and the complexities of policy terms and conditions. The denial of a roof damage claim can be a significant setback for homeowners, leading to financial strain and distress.

But remember, a denied claim is not the final word. We have created a comprehensive guide dedicated to helping homeowners understand why roof damage claims are often denied and, more importantly, what you can do about it.

To learn more, call us to give you more actionable advice about this complex issue. Empower yourself with knowledge and take the first step towards a fair settlement today.

A&H Public Adjusters Corp

At A&H Public Adjusters Corp, we know how daunting the insurance claim process can be. Serving Florida with our headquarters in Doral and offices in Port Charlotte, we're well-positioned to support you through every step of your property damage claim. Our licensed Florida public adjusters are on hand in these cities and across Florida's West Coast, including Naples, Ft Myers, North Port, Cape Coral, St Petersburg, as well as the East Coast of Florida.

Don't navigate the complexities of insurance claims alone. We are here to ensure you receive a fair settlement. Learn more about the significant benefits of working with a public adjuster and how we can support you through every step of the claim process. We're committed to standing by your side, fighting for your rights, and reducing your stress during these challenging times.

We invite you to schedule a free consultation with our expert team today. Discover why countless homeowners across Florida have trusted A&H Public Adjusters Corp to protect their interests. Don't let the insurance claim process overwhelm you - we're here to help.


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