Insurance Claim Denied? These Are the Next Steps

After a disaster, some of the worst news is that your insurance claim has been denied or the offer falls short of your expectations. This can be disheartening, especially with the stress you are already handling at the time. There are a number of reasons why your claim is denied, but you can dispute the denial and fight your insurance company to get your claim approved.

Why Are Claims Denied?

Your insurance company should have told you the reason your claim was denied in writing. These are some of the common reasons your claim may have been denied, along with the terminology linked to them in your denial.

Waited too long to file a claim

Insurance companies will give you a window of time after the date of the incident in which to submit your claim. You may also be given documents by your insurance company that are time-sensitive to return. If you do not follow your deadlines for the claim, they can deny it for not complying with their requests.

Below Your Deductible

Your claim may also be unpaid if your insurance determines that the amount of money you are owed is below your deductible for the policy.

Exclusions

Every insurance policy will come with a list of exclusions — things that your policy does not cover. If your claim includes things listed in the exclusions, that portion of your claim will be denied. It is a good idea to go over everything listed in the exclusions when you first obtain your policy, and if need be, see if you can add coverage for any of the exclusions you may need. Denials of this type may be listed as “not a covered peril” or “excluded cause of loss.”

Suspicion or Lack of Documentation

Your insurance company may find something in their investigation into your claim that they find suspicious, which can lead them to deny your claim. As part of this, not having proper documentation for the damages can lead to your claim being denied; either because you did not provide sufficient evidence or because the lack of documentation leads them to find something suspicious.

Disputing Your Claim

If your claim has been denied, you can still fight the decision and possibly get it reversed. Before you decide to file your dispute, take time to go over your entire insurance policy, to make sure you completely understand what your insurance is expected to cover. Then review the claim denial and compare it to all of your documentation. From there, you can get a better idea of where the insurance error may be. You may want to contact a public claims adjuster to help you with this process.

Start your appeal with a letter to your claims adjuster, explaining your point of view and including evidence you have gathered to support your claim. Use certified mail to send your letter so you have a record of when it was sent. If necessary, ask your adjuster for another inspection to get another opinion.

If your letter does not work, you can file a complaint with your state’s department of insurance. This has the potential to give you some powerful leverage for negotiation with your insurance company.

Often insurance companies will bring in an appraiser to determine the amount of the damages, and you or your public adjuster will select another. The two appraisers will review the damages and try to agree upon how much you are owed. If the two become deadlocked, a neutral party, called an “umpire, is brought in to settle things.

Mediation services are sometimes brought in to facilitate negotiations between you and your insurance company to see if you can reach an agreement.

1. Contact a public adjuster, like UCS, to fight for your claim. UCS’ team of experts will visit the site of the loss and gather evidence from the scene to build your case. Our in-house adjusters are highly experienced at successfully presenting appeals to insurance companies and negotiating with them to ensure that you receive the insurance coverage that you deserve.