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how to dispute home insurance claim denial

How To Dispute A Homeowners Insurance Claim

how to dispute home insurance claim denial

It’s difficult to know what to do when your homeowners insurance company won’t pay. Each insurance company is different and they all deny insurance claims for a variety of different reasons. Most homeowners become furious at the concept that their insurance carrier would dare to deny their claim after all the money that they pay for their policies and with what they feel may be legitimate claims. You want your claims paid with no hassle. Homeowners can dispute the insurance company denial effectively gaining the money that you need to bring your home back to the way it should be.

Insurance carrier and policyholder disputes take place fairly often. Insurance companies want to do their best to pay out as little in claims as possible in order for their businesses to thrive, while the insured expects the insurance carrier to pay their claims timely as a measure of faith after high premiums are paid consistently each year allowing that claims are paid with little to no disruption. That doesn’t mean that there is never a positive agreement between the carrier and the insured. You have the right to dispute any denial and it may come out to your benefit, but research is needed on your part.

Steps To appeal A Home Insurance Claim Decision

There are steps that you need to take to dispute a claim denial from your insurance carrier in order to be successful in having the denial overturned with reviewing your policy being first and foremost to make sure all guidelines have been met.

Review

It is critical that you review your policy to make sure you understand the amount of coverage that you have and the exclusions that are on the plan, e.g. flood and earthquake are generally not a part of a standard homeowner’s insurance policy. These are separate plans that you need to purchase. It may come to your attention that you have All Cash Value as opposed to Replacement Value for the damage in which case there will be monetary limits to the amount of coverage that you will be due. There are also going to be deadlines for filing that, if not met, the carrier will be able to deny the filing.

If you review your policy and see there is no obvious reason for a denial, you should be able to proceed with a dispute for the denial. The denial letter that you receive from the home insurance carrier will indicate an outline with the reason for their denying the claim. If they are citing an exclusion as their reasoning, call the carrier and have them clarify exactly what part of your policy notes this type of exclusion has been included.

Document

It will be essential for you to document each time that you are in contact with the insurance carrier as well as the claims adjuster once you have made the decision that you will go forward with a dispute of the denied claim. Keeping the conversations exclusive to email is a good way to leave a paper trail but, if you need to have a conversation over the phone, take good notes along with the date, time, and who you spoke with. After the call, email the party with a summary of the conversation. Follow the same pattern if the meeting happens in person. 

Taking an inventory of all of your personal possessions before any type of destructive event, e.g. fire, natural disaster, or theft, takes place is crucial. Make sure to add to the inventory any type of big purchase and keep this list in a safety deposit box. Also, take pictures or perhaps a video of your property to keep online and with your insurance provider’s office. This will give them and your proof of the way that the property appeared prior to any type of loss that you may be making claim for. It’s also imperative to take pictures immediately after the loss takes place. If you are displaced, you will need to save any receipts from the place where you stay as well as things that you may have needed in order to make sure your home was safe from intruders, e.g. if windows were broken and you needed to board them up.

Appeal

Appeal home insurance decision that was made initially by the claims adjuster. When you file your appeal, be sure to include all of the documentation with your photos, inventory, and all evidence that will support your case. This would be a good time to provide witness feedback and records indicating that there was regular maintenance done with your home. Insurance companies cite negligence in certain instances with denials of claims. Proof that negligence was not a factor showing that regular servicing was part of your routine with your home, e.g. smoke detectors or perhaps a security system, will support your case in an appeal insurer’s decision.

Agree

There are times when the adjuster and the contractor don’t agree on the amount of damage that has been done to the home. The adjuster makes their inspection and determines what the sum should be to repair the loss, while the contractor’s estimate is much more and his vision of the damage is more extensive. At this point, it would be reasonable to have the claims adjuster come back to the property and meet with other professionals whose estimates contrast so vastly. This may be enough to alter the adjuster’s estimate.

Appraisal

If you’re in a position where you don’t know what to do when your insurance company won’t pay and the claims adjuster won’t change their mind after the meeting with the professionals, it may be time to request a written appraisal with your insurance company. The insurer has the right to do this as well. It isn’t important who makes the inquiry first, each party will choose their appraiser and pay for that person. The appraisers for each of you will decide on a third party who will mediate. After the appraisers decide on an appropriate settlement, the insurer is responsible for paying that amount. If they can’t agree, the mediator will review the differences between the two and make a decision as to which she agrees with. Based on that decision, the insurer will pay whichever amount the mediator decides is more suitable. 

What To Do When Your Homeowner’s Insurance Company Won’t Pay

What to do when your home insurance company won’t pay after you have exhausted all of your efforts with what you feel is a valid claim, you can file a complaint with the state’s Department of Insurance. They are set to investigate insured complaints against their carriers. They will also look over your policy to see if the claim is something that was supposed to be covered. If the state insurance department finds that you have a case with your claim, they can assist you in negotiating with the insurance provider. 

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