Claim Denied

Your Claim is Denied. What now?

It’s not a good feeling when the insurance company denies your claim. While it’s hard to get them to reverse a denial, it’s not impossible. Here are a few pointers on what to do if your claim is denied.

When a company denies your claim, they are required to tell you the reason for denial in writing and where in your policy the basis for the denial is. When you’ve received the denial notification, read it carefully and then check your policy to determine whether their denial is warranted. Then go over your initial claim and see if there is anything either you or the insurance company adjuster missed.

The biggest reason for denial is that the cause of loss is not covered. For instance, many people don’t realize that sump pump failure is not covered on a standard policy (you need an endorsement for it). If you have a sump pump failure claim but don’t have the endorsement, you’ll get denied and there’s not much you can do about it. But occasionally you can attribute a cause to something that is covered. For instance, the wild fires in California caused mudslides. Mudslides are generally not covered. However, since these mudslides were caused by fires burning trees and creating conditions for mudslides, there is an argument that the cause of loss was fire, not mudslides.

Consult with contractors to determine the true cause, don’t just guess. We had a client who guessed what was causing a leak under his kitchen sink. It turned out he was wrong, but before we were involved, he had already told the insurance company what he thought was causing the leak. Once you do that, it’s hard to walk it back. His claim was denied.

Another reason a claim is denied is the company determines the insured was negligent. The terms of your policy require you to take reasonable measures to protect your property from damage. Maybe you left your heat set too low when you went on vacation and the pipes froze. Maybe you waited too long to have your roof repaired and rain damaged the ceilings. If your claim is denied on the basis of negligence and you can prove you were not negligent, for instance by supplying oil or gas receipts proving you did maintain heat, you may be able to get the company to review your claim.

Another basis for denial is wear and tear. Wear and tear is damage that naturally happens at a property due to normal use and aging, for instance, fading paint, worn carpeting, scuffed floors. If your adjuster determines that your damage is a result of normal wear and tear, your claim will be denied. Again, if you can prove otherwise, they might reverse the denial.

The best way to avoid having a claim denied is to do your homework before you submit the claim. Know your policy and make sure the cause of loss you’re claiming is covered. Having a public adjuster in your corner will minimize your chances of denial because the public adjuster will collect all necessary and accurate information and submit the claim from the best possible position.

Robert L. McCormack Public Adjusters, Inc. has more than fifty years in the insurance adjusting field and an A+ rating from the Better Business Bureau. Bob McCormack has adjusted every type of property claim there is: fire, storms, water, robbery, you name it. Licensed in Massachusetts, Rhode Island, Florida, and Texas, Bob can handle your claim from start to finish. Contact us today via email or telephone 508-588-4243.

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