Eleven Reasons Why Your Insurance Claim Might Be Denied

Many reasons exist for insurance companies to deny property damage claims. Some of the most common include:

1. Policy Exclusions: Every policy is unique. Your policy likely has many limitations and exclusions. The insurance company may claim you are seeking compensation for damage that occurred because of an excluded cause.
2. Lack of Coverage: Your policy may not cover some types of damages or losses. For example, if your policy does not include insurance coverage for the contents of your home, you cannot recover money to replace damaged furniture or other personal property.
3. Non-Payment: If you missed paying any premiums, your insurance carrier may say you do not have active insurance coverage.
4. Misrepresentation or Fraud: Insurance adjusters may accuse claimants of misrepresenting information when they purchased their policy or filed their claim.
5. Missed Filing Deadlines: If you fail to file your insurance claim within the timeframe required by your insurance policy, the carrier could deny your claim.
6. Pre-Existing Damage: Your insurance company could claim the damage existed before you purchased the policy or occurred because of a previous event for which you did not file a claim.
7. Failure to Mitigate Loss: If you fail to take reasonable steps to stop further damage following a loss incident, your insurance company may refuse to pay for the additional damage.
8. Insufficient Evidence: One of the most common reasons insurance companies deny property damage claims is inadequate evidence. You may need paperwork, receipts, video, photos, and witness statements to support your claim.
9. Negligence: If the insurance company believes the damage to your property occurred because of your negligence or failure to maintain it, they are unlikely to pay for repairs.
10. Policy Limits: If the repair costs exceed your policy limits, the insurance company may only offer partial coverage or deny your claim.
11. Human Error: A claims adjuster may deny a claim if someone entered invalid information into the application, such as an incorrect or outdated code, or made another input error.

Getting the money you need to complete repairs and replace damaged belongings is key to disaster recovery. If you receive a denial notice for your claim, you should act quickly to determine if it is valid and what options you have to fight it.

First, thoroughly review your policy. Carefully read through the terms, conditions, and exclusions. This will help you understand your coverage and its applicability to your current claim. Then, carefully consider your denial. Read the letter to determine the specific reason your insurance carrier denied the claim. This, paired with your review of your policy, should help you understand whether the reason for denial is valid.

Once you have a solid understanding of what went wrong, you can build an argument and appeal the decision. The most effective way to do this is with help from a law firm that handles insurance bad faith cases.

If you believe you have a valid claim, seek legal advice from an attorney familiar with the insurance appeals process. They can handle the appeal process, explain your rights, outline your next steps, and even file a lawsuit against the insurance carrier if necessary.

In an effort to overturn an insurance claim denial, your lawyer may:

• Gather evidence, including photos and videos, receipts, estimates, paperwork, and other documentation to show the covered damage
• Consult with experts, such as contractors, engineers, appraisers, and others, to help document the cause and extent of your damage
• Contact the insurance adjuster to discuss the denial, which could lead to the insurance carrier recognizing they would rather reconsider the claim than face legal action from your attorney
• Follow the necessary procedures to file an official appeal with the insurance company, which generally requires a written appeal and supporting documentation filed before tight deadlines
• Use mediation or arbitration to resolve the dispute and avoid litigation
• Continue advocating for your rights throughout this process
• Sue the insurance company for bad faith practices (as defined in Florida Statutes § 624.155) and fight for the compensation you deserve, if necessary

All too often, managing an insurance claim is difficult or impossible on your own. Getting a fair settlement or appealing an unfair denial based on a property damage claim requires knowledge of the industry, experience with similar claims, and resources to develop strong support for your claim.

While bad faith insurance cases deal with policyholders disputing coverage with their own insurance carriers, many of the same issues can arise in liability claims based on car accidents, premises liability cases, and other personal injuries.

Working with a lawyer is often the best option for getting fair compensation based on the available insurance coverage. You do not have the time, money, or experience to go toe-to-toe with an insurance company, but your attorney will. They can manage your case while you focus on your career, family, and other priorities.

Ged Lawyers provides case evaluations for those facing unfair insurance denials or inadequate payouts. We can help you with your property damage or personal injury claim and fight for the insurance benefits you need and deserve.

Contact our legal team today to discuss your legal options and next steps. We have someone available to take your call today.