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Having your property stolen or damaged is already upsetting, and an insurance carrier denying your claim can make matters even worse.
Insurance providers can deny claims for various reasons — but the initial decision isn’t always final, and you have the right to dispute it.
Here’s what you need to know about why insurance carriers deny claims, and how to dispute them:
- Why home insurance providers deny claims
- How to dispute home insurance claim denials
- Does a denied home insurance claim count against me?
Why home insurance providers deny claims
Two common reasons insurers deny claims include a lapse in coverage due to nonpayment, and waiting too long to file a claim. Here’s a deeper look at eight situations when providers may deny a claim:
The event that caused damage isn’t covered
Homeowners insurance typically provides coverage for theft and damage caused by specific events like fire, smoke, lightning, and hail. Perils — events that may cause damage — you might expect to be included in your policy could actually be excluded from coverage.
For example, flood damage caused by heavy rain or hurricanes typically isn’t covered by a standard homeowners insurance policy — you have to buy a separate flood insurance policy.
Earthquake damage is usually excluded from a homeowners or renters policy as well, but purchasing additional earthquake insurance may be worthwhile if you live in an area prone to earthquakes, like California.
Homeowners insurance may also exclude acts of war and nuclear accidents. However, the U.S. government requires nuclear power plants to hold liability insurance to cover repair costs if a nuclear event causes damage to the area surrounding its power plant.
You didn’t file the claim soon enough
Insurance carriers may require you to file the claim within a certain amount of time in order to approve it. Taking too long to submit your claim could result in a denial, so it’s always a good idea to file your claim as soon as possible. Read your insurance policy terms to find out when the deadline is to file your claim.
You didn’t make temporary repairs after the damage
When a covered event damages your home, the insurance carrier may expect you to make temporary repairs to prevent further damage until there’s a more permanent fix. If you don’t, any additional damage that happens after the event may not be covered.
Say a window breaks in your home, and you don’t cover it with a tarp or piece of wood. You could be held liable for water damage to your home that occurs when the interior is exposed to the elements.
Your insurance claim is incomplete
Insurance providers can deny claims when you don’t have enough evidence to back them up. If your laptop is stolen from your home, and you don’t have receipts or documents to prove you owned it, the insurance carrier may have trouble accepting your claim.
That’s why it’s always a good idea to take photos or videos and get repair estimates before they’re performed as proof of household damage. It’s also wise to create an inventory of all your personal belongings, including their prices. This can help you quickly identify losses in the event of a burglary or natural disaster, and you won’t have to dig through receipts or rely on your memory when filing a claim for damages.
You let your insurance lapse
If you’re behind on premium payments, your insurance could lapse, and you won’t have coverage in an emergency. Paying your insurance premiums on time will keep your insurance policy active at all times in case a disaster happens.
Paying your premium up front or setting up automatic payments could ensure your payments are made on time so your insurance is there when you need it.
The damage is considered normal wear and tear
Your homeowners insurance doesn’t cover normal deterioration of your home over time. If your property, appliances, or other items are old, insurers could attribute damage to wear and tear and deny your claim.
For example, say hail causes damage to your siding. If the insurance carrier determines that your siding is defective or not properly maintained, it could refuse to give you an insurance payout under the wear and tear exclusion. However, you could try to dispute their claim of wear and tear with evidence that you’ve completed maintenance or made updates to your home.
Negligence caused the damage or property loss
If a negligent act results in property damage or theft of property, the insurance provider could decide not to give you a payout. If you leave your aggressive dog unleashed and he bites someone, your insurer likely wouldn’t cover the event. In that situation, you’d have to foot the bill for any legal costs or medical bills yourself.
The insurance provider suspects fraud
Insurance carriers may deny a claim if there’s a concern you could be fabricating or exaggerating loss for financial gain. Fraud could include embellishing timelines and facts about how property damage or theft occurred. Contractors can also commit fraud by overestimating repair costs.
Covering your bases and keeping backup could help you prove that your claim and repair costs are legitimate. This could include calling the police to report a theft, taking notes, pictures, and videos of damage, and getting multiple quotes from contractors.
How to dispute home insurance claim denials
If your insurance provider denies your claim or you don’t agree with your claim settlement, you have the right to question it. Take these steps to dispute a claim:
- Read the denial carefully. The claim denial should outline the reason for the decision. Take note of any comments within the denial that you disagree with.
- Gather evidence. Put together records that support your claim and refute the reason that the insurer denied your claim.
- Contact the claims representative. Contact your insurance provider to voice your concerns, and escalate your claim to management if you’re not satisfied with the outcome.
- Contact your state’s insurance department. Each state has an insurance department where you can file complaints about an insurance agent or carrier. The process varies depending on where you live, and you can file your complaint online in some cases. Explain the details of your claim and state why you disagree with the claim denial or settlement. Your state’s insurance department may be able to help you and your insurance provider come to a resolution.
- Get legal help. If all else fails, hiring an attorney could help you fight your case.
Does a denied home insurance claim count against me?
Filing a home insurance claim can count against you because claims history is one of many factors insurance providers consider when determining whether to insure you. With past claims on your record, an insurance carrier could consider you to have a higher risk of filing future claims, which could result in higher rates when you apply for a new policy.
During the underwriting process, insurance companies typically pull your Comprehensive Loss Underwriting Exchange (C.L.U.E.) report. This report outlines past claims and loss payouts for your car and home insurance.
Since insurance providers have different methods of determining insurance risk and rates, shopping around with multiple insurance carriers could help you find the most competitive rate for the coverage you need, even if you do have claims on your record.
Disclaimer: All insurance-related services are offered through Young Alfred.