Dealing with property damage or loss can be stressful enough, but if your homes insurance claim is rejected after being submitted to your insurance provider, that stress can be increased. Due to negligence, a lack of coverage, a missed filing date, or a lack of supporting documents, a claim may be rejected. For house insurance claims and settlement denials, homeowners are fortunate to have options. Knowing that you can appeal an insurance claim denial may help you settle the situation if you ever find yourself in it. Below are five methods that Bankrate recommends for disputing an insurance claim.
1. Examine your coverage and claim
To reduce the chance of an insurance coverage gap, it is ideal to examine your policy before a claim ever arises. You can better prepare financially for what might need to be paid out of pocket if you are aware of the types of damage or events that are covered by your policy. When examining your insurance, consider what situations and items are covered, look for any exclusions, consider your deductible, and consider the procedure for filing claims.
Verifying the data you provided to the insurer regarding the claim is crucial in a claim situation. Check to see if you provided sufficient documentation and supporting evidence. You must thoroughly comprehend the information you provided if you still believe the insurance underestimated your claim in order to be ready for a follow-up conversation.
Hints for checking your insurance
You might find it useful to incorporate the following phases into your initial review process as you are examining your policy.
- As you read the policy, make a list of all the questions you have.
- As much evidence as you can, including pictures, witness accounts, recordings, and any other data you deem important, should be gathered.
2. Submit a protest
When you are certain that you comprehend the policy’s language, you can call the insurance provider and ask for a new review of your claim or a new examination based on updated facts. It’s possible that an adjuster erred the first time around. Your claims adjuster can assist in providing answers to any queries you may have regarding the scope of your policy’s coverage.
Having the appropriate documentation is helpful when filing an appeal. This can include dates and information about the incident, as well as, if appropriate, images, videos, and witness accounts.
Advice for submitting an appeal
The following advice can be useful if you intend to appeal:
- Request one more home visit.
- Gather as much evidence and documentation as you can.
- In a letter that is written in straightforward terms, explain the basis for your appeal.
3. Obtain a second professional judgment.
It might be time for a second professional opinion if your request for a re-examination of your claim was rejected or produced the same refusal. You have the right to work with a public insurance adjuster or an independent appraiser as a consumer. An independent public insurance adjuster might be hired on your behalf to assist in the settlement of a claim.
Checking references and recommendations is a wise move when choosing a professional. This might assist in confirming that the adjuster is duly licensed in the state where the claim is being made. You can also get the record of the adjuster verified by calling your state’s insurance department. While a public adjuster or independent assessor might be able to help, their services are not free. There are no assurances the claim will be settled, and independent adjusters may charge up to 15% of the settlement sum.
Employing a third party might either support the insurance company’s initial denial of your claim or show support for the claim you are making. You can think about getting in touch with your insurance provider and asking to talk to the claims manager if the public insurance adjuster’s opinion supports your claim. You could then ask for another evaluation of the claim at that point.
Advice on reaching out to another insurance professional
If you decide to use an independent insurance adjuster, bear the following hiring advice in mind:
- Inquire of friends or family members who have dealt with the process of having a claim rejected and seeking outside assistance for recommendations of public insurance adjusters.
- Request references from the public adjuster, and think about looking into their complaint history and how they may have handled previous insurance claim disputes with the Better Business Bureau and your state’s Department of Insurance.
- After a disaster, stay away from hiring a public insurance adjuster who knocks on doors to ask for business.
4. Complain to the insurance department in your state.
You could file a complaint with the state insurance department if you engaged a third party but the claim was still rejected or the settlement amount was too low. This choice can be the best if you believe your insurer wrongfully refused your claim and want your state insurance department to look into the matter to make sure your insurance policy and applicable state insurance regulations were correctly followed. You can learn about other resources you were unaware of when you phone the insurance agency. The Department of Insurance for each state is listed by the National Association of Insurance Commissioners (NAIC), which should contain information on how to make a complaint in your state.
Advice for making a complaint
Take into account the following before filing a complaint:
- Check with the state insurance office to see if there are any resources you can use to speak with the insurance company about your claim.
- The time frame for carriers to react to a claim is often set by the state insurance department. You can find out if the insurance company reacted right away.
- To see if the insurer has been the subject of any other complaints, use the NAIC’s consumer resources.
5. Work with a lawyer
A different choice is to hire a lawyer, however this option will cost more money. The costs can mount up rapidly because attorneys often charge a consultation fee and an hourly rate for legal services. To decide if the process is worthwhile for you, you must weigh the expense of hiring an attorney against the likelihood that your claim will be approved — or, conversely, denied again.
Terms to understand while contesting the denial or settlement of a home insurance claim
A few terminology that are used in the filing and processing of claims are worth being aware of in advance.
| Term | Meaning |
|---|---|
| Appraisal | An appraisal is a detailed assessment of either the property or property damage. An appraisal is written by an adjuster to estimate the amount of damage from a loss. The initial appraisal is usually provided at no charge from the insurance carrier. |
| Mediation | Mediation is a meeting between a representative for the insurance carrier and the policyholder. A mediator will facilitate the meeting and both parties will present information regarding the claim. The goal is to find a solution for both parties. |
| Adjuster | This is a professional hired to evaluate property damage. The adjuster will determine how much damage has occurred to the property. The adjuster will also recommend the amount to be paid out for the damages. |
Causes for why your home insurance claim can be rejected
Even though a homeowners insurance policy is intended to offer financial security in the event that a covered event causes damage, there are some situations when a claim may be rejected, including:
- Lack of coverage – Not all events or causes of damage are covered by homeowners insurance. Exclusions in policies mean that certain risks are not covered if they cause damage to your home. For instance, basic homeowners insurance does not cover flood damage.
- Missed filing deadline – You have a certain amount of time to file a claim. This deadline is typically one year from the date of the incident, but it might differ by insurer and state. In order to prevent missing vital dates, it is crucial to submit a claim as soon as the harm occurs and it is safe to do so.
- Not enough supporting evidence – Your claim may be rejected if you didn’t provide enough supporting evidence, such as pictures, videos, or witness statements. The more supporting data there is, the better-informed a judgment the insurance adjuster can make since they must consider as many details as possible.
- Negligence – It is your duty to maintain your home, which includes doing routine upkeep and repairs. If it is determined that your failure to maintain your home and make necessary repairs contributed to the loss, your appeal may be rejected.
Your claim might occasionally not be bluntly rejected by your insurance. Instead, a settlement can be less than anticipated. If this is the case, a home insurance claim settlement offer could be contested using the same procedure of analyzing all pertinent data, requesting an additional examination, and commissioning an independent third-party investigation. Before accepting a settlement offer, you could also consult with a lawyer.
A lot of people have questions
How do house insurance adjusters work?
For the insurance provider or policyholder, a home insurance adjuster manages claims. Their duties include examining the loss, confirming damages, and estimating repair costs after verifying the claim’s specifics. A public insurance adjuster is a third party that either party may hire to do an impartial claim estimate while a home insurance adjuster often works for an insurance company.
How can I appeal the denial of a renters insurance claim?
Renters insurance claim denials can be contested similarly to homeowners insurance claim denials. Examine the claim and coverage specifics, file an appeal, get a second expert opinion, file a complaint with the state’s insurance department, and retain legal counsel before proceeding. You might not need to follow all the steps to contest a renters insurance claims denial, depending on your circumstances and the specifics of the claim denial.
