Homeowners Insurance Claims: How to Increase your Chances to Win When Your Claim is Denied

So, you have filed a home insurance claim and the homeowners insurance company has denied it. You are not alone. After hurricanes Harvey and Irma, around 300,000 claims were filed for wind damage, and another 150,000 claims for flood damage. This means that half a million homeowners are going to negotiate with their homeowners insurance companies to get the flood damage cleaned up and get their properties either rebuilt or repaired in the coming months or even years.

hj667Unfortunately, not all of these people will have the chance to fulfil this dream. In fact, one in every 5 home insurance claims is turned down every year.  So, what do you do if you know you have a case; yet, your claim has been denied? Below are 8 tips to turn things around for you and not only keep the claim active but also try to reverse the decision.

1. Don’t Take their NO for Granted – It is Not Always Final
Most claimants give up when their claim is denied. However, of the less than 1% that query and decide to fight back, more than half get positive results and eventually have their claim accepted. So, don’t give up just yet. Chances are you can still get what is rightfully yours.
First, make sure your claim is 100% legitimate so you can proceed to taking further steps with confidence. About 10% of claims are unjustly denied so you can certainly query your claim. Most likely, you will get, at least, a better settlement.

2. Don’t Take Their Word For It – Get Everything in Writing
If your claim was denied, it is your right to know the exact reasons for the rejection. Therefore, ask for a review of your case and make sure you get a comprehensive explanation of the reasons for denying the claim in writing. Don’t be surprised if your insurer is not willing to provide you with their rejection in writing. A vast majority of them don’t fancy the idea, even though, in some states, it is a legal requirement. So, check your state’s laws and have the insurer write everything down. That way, you can move forward with Step #3 described right below.

3. Check Your Policy
So, you have the homeowners insurance company’s decision in writing. Time to check the reason for denial against your policy. If there is something (anything) that doesn’t make sense or add up, you can query your findings in writing. Don’t forget to refer to quotes from the policy if and where necessary to support the validity of your claim. In most cases, the insurer will reconsider your case.

4. Don’t Accept Claims Filing or Process Mistakes
When you file a claim, there is a process to follow. Some insurers look for the smallest mistakes on your behalf (usually in the filling process) to deny a claim. For example, your claim may be rejected because you have missed the window of time the insurer gives you to file a claim or because you didn’t fill in a form correctly.
In most jurisdictions, if your claim is otherwise valid, the insurance company cannot refuse to pay you. The only way they can build a case around your error is in the case your mistake has prevented the company from investigating adequately or has harmed the company. Before you do anything else, first check your state’s regulations about claims and responding to them.

5. Call the State Insurance Department
Calling the authorities about what your rights are is your best shot to have your claim re-evaluated, and potentially reverse the negative decision.  The State Insurance Department, as well as the Department of Insurance, are the legal authorities that govern insurance in the USA.

6. Hire an Agent
Although it may sound a bit strange, hiring an agent to represent you in the claim could give you the results you wish for. Insurance companies use agents all the time so that they don’t need to deal with every client personally. Likewise, you can do the same.

Know that such agents charge a fee of around 10% of your claim (they may increase your claim for you so that it covers their fee) and are usually called Professional Loss Consultants. They are experienced professionals that know how to deal with both claims and insurers. However, do check who will pay the fee if you win and what the fee will be because many agents make a no win no fee arrangement with their clients that doesn’t specify these two points and you may end up giving all the money from the winning claim to pay the agent’s charges.

7. Bring a Lawyer or Attorney In
Have this as a last resort option because, although insurance companies do take notice when a client hires a lawyer for their case, it could take too much time before both parties reach an agreement. Plus, it may weigh down on your wallet. This is because when you bring in a lawyer, all communications between the insurance company and the agent (if you have hired one) can only be done through the lawyer, which can be both costly and time-demanding.

Your attorney may in turn hire an insurance expert witness, a person knowledgeable regarding both insurance and the law who can help you fight for your legal rights.

8. Don’t Give Up
Don’t let time fly, after you have stated that you wish to have your claim reconsidered. Instead, call the company every couple of weeks and seek a suitable response. If you don’t get the reply you wanted, politely ask for the person’s manager or supervisor. Remember to log all calls with every detail (i.e. time and date of call, names of people you spoke with, etc.), follow up with a letter (keep copies of these letters) explaining the issue you have with the conversation that took place between you and the employee, and ask for a written response within a fortnight. If you still don’t get a response, call again.

Every letter you send should be by certified mail with return receipt so you are fully covered.
It may be worth it to ask your agent for advice. They may either assist you or direct you to the most appropriate person you should contact for the tips mentioned above.

Although nothing (and nobody) can guarantee that you will get your claim paid, you can certainly give it a try. Follow these tips, or any of them, and you could successfully win your insurance claim and get your home renovations paid for. After all, 50% of that 1% that insists on asking to have a denied claim revised wins!

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