How to contest denials and settlements of home insurance claims


Dealing with damage or loss to your property can be quite stressful, but if your home insurance claim is denied after being filed with your insurance company, it can add another layer of stress. Fortunately, consumers have options for home insurance claims and settlement denials. If you find yourself in this situation, understanding the avenues of action available to you to contest a home insurance claim denial could help you resolve the issue. Bankrate describes four steps you can take below.

1. Review your claim and coverage

You should consider your claim and coverage as a first step before contacting your insurer. This is important because you may not be able to remember all of the key details of your policy, including the type of damage or event included in your coverage. When reviewing your policy, review the events and assets included, check for exclusions, and review the claim submission process.

When verifying the information you initially submitted to the insurer, consider whether the claim was submitted correctly and with adequate supporting evidence. If you still believe the insurer has misjudged your claim, you should fully understand the details you submitted to prepare for a follow-up conversation.

Once you are sure you understand how the policy is worded, you can call the insurance company and request that your claim be reconsidered or request a new review based on new evidence. It is possible that an error was made by an expert the first time.

Tips when reviewing your coverage

As you review your policy, you may find it helpful to include the following steps during your initial review process.

  • Write down any questions you have as you read the policy.
  • Gather as much documentation as possible, including photos, eyewitness statements, videos, and any other information you feel is vital.

2. Get another professional opinion

If you have requested a reconsideration of your request and the request was denied or resulted in the same denial, it may be time to seek another professional opinion. As a consumer, you have the right to hire an independent appraiser or a public claims adjuster. A public adjuster is not affiliated with any particular carrier and can be hired on your behalf to help you settle a claim.

When hiring a professional, be sure to check references and recommendations. You will want to make sure that the insurance adjuster is licensed in the state where you are filing the claim. You should also call your state insurance department to confirm the claims adjuster’s record. While an independent appraiser or public claims adjuster can provide useful assistance, hiring one comes at an additional cost. Independent adjusters may charge up to 15% of the settlement claim and there can be no assurance that the claim will be resolved.

Hiring an independent party will show support for the insurance company’s initial denial or provide support for your claim. If the recommendation made by the public insurance adjuster supports your claim, you may consider contacting your insurer and asking to speak to the claims manager. At this point, you can request that the request be reviewed again.

Tips for contacting another insurance professional

If you are using an independent claims adjuster, keep these tips in mind when hiring:

  • Seek referrals from public adjusters of friends or family who have gone through the claim denial process and have sought the help of a third party.
  • Avoid using a public adjuster who goes door-to-door to solicit clients after a disaster.

3. File a complaint with your state’s insurance department.

If you have hired a third party and the claim is still denied or offered at too low a price, you can file a complaint with the state insurance department. This option may be the best if you think your insurer has unfairly denied your claim and you want your state insurance department to investigate the situation to make sure your insurance contract and the laws. on state insurance were properly observed. When you call the insurance office, you may also be made aware of additional resources that you didn’t realize were an option.

4. Hire a lawyer

Another option is to hire a lawyer, although this route will have to be paid for out of pocket. Lawyers typically charge a consultation fee and an hourly rate for legal advice, which means the expenses can add up quickly. You’ll need to balance the cost of a lawyer with the end result of having a claim approved – or potentially denied again – and determine if the process is worth it for you.

Tips for filing a complaint

When making a complaint, consider the following:

  • Ask the state’s insurance department if there are resources available to contact the insurance company directly and discuss your claim.
  • The state insurance department usually imposes a deadline on carriers to respond to a claim. You can ask if the insurance company responded in a timely manner.

Terms to know when contesting a refusal or settlement of a home insurance claim

There are a few terms used in filing and handling complaints that you might want to know up front.

Term Sense
Evaluation An appraisal is a detailed appraisal of property or property damage. An appraisal is written by an insurance adjuster to estimate the amount of damage caused by a loss. The initial assessment is usually provided free of charge by the insurance company.
Mediation Mediation is a meeting between a representative of the insurer and the policyholder. A mediator will facilitate the meeting and both parties will present information regarding the complaint. The goal is to find a solution for both parties.
Adjuster This is a professional hired to assess property damage. The expert will determine the extent of the damage caused to the property. The expert will also recommend the amount to be paid for the damage.

Reasons Your Home Insurance Claim May Be Denied

While a home insurance policy is designed to provide financial protection in the event of damage caused by a covered event, there are certain circumstances in which a claim may be denied, including:

  • Lack of coverage – Home insurance policies do not cover all types of events or causes of damage. Each policy will have certain risks covered and your claim may fall under an excluded event.
  • Deposit deadline not respected – Insurance companies set time limits within which you can file a claim. This is why it is important to file a claim as soon as the damage occurs so as not to miss any critical deadline.
  • Not enough documentation – If you do not submit enough documents, such as photos, videos or witness statements, it could result in the denial of your claim. Claims adjusters rely on as much detail as possible to make a decision. Therefore, the more supporting evidence there is, the more the expert can make an informed decision.

Sometimes your insurer may not deny your claim straight away. Instead, a settlement could come lower than expected. If so, the same process of reviewing all related documentation, requesting another review, and hiring an independent third party could be used to challenge an offer to settle an insurance claim. dwelling. You can also seek the advice of a lawyer before accepting a settlement amount.

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