What to Do if Your Homeowners Insurance Claim is Denied

Having your home or belongings damaged in a fire, storm or other disaster can be traumatic. It’s even worse if your insurance company refuses to pay for your losses. Although insurance companies are tough to fight, you have the right to contest their decisions. Here’s how to fight your home insurance company over a denied claim.

How do I fight my home insurance company over a denied claim?

The process for fighting an insurance company over a denied home insurance claim typically requires the following steps.

Step 1: Review the insurance company’s reasons for denying your claim

The first step in fighting the insurance company over a denied claim is to review the letter it sends explaining its decision.

An insurance company is required to state its reasons for denying your claim in writing. The letter should include specific language from your policy and findings from the adjuster who inspected your home.

If the insurance company’s denial is based on inaccurate information, your next step is to contact them to point out these errors.

Before you do, gather evidence that supports your claim. This can include before and after photos of your home, repair estimates, receipts for your belongings and/or other relevant documents.

Step 2: Consider hiring a public adjuster

If you need help, consider hiring a public adjuster. Public adjusters are licensed insurance professionals who can negotiate with your insurance company for you. They typically receive 5% to 15% of your claims payment after your case is resolved, but nothing if your claim is denied. You can hire one to help you file your initial claim or after your insurance company denies your claim or offers a low settlement.

If you go this route, make sure to check the license status of the public adjuster you choose on your state insurance commissioner’s website. Reputable public adjusters provide their fee structure in writing before you hire them. Be wary of those who ask you to pay in advance.

Step 3: Contact your insurance company

After you have reviewed the insurance company’s reasons for denying your claim, it’s time for you or your public adjuster to contact the insurance company to point out the inaccuracies in its denial letter.

If you have digital photos or documents that support your claim, you may be able to send them to the claims representative while you are on the phone with them.

Step 4: File a complaint with your state’s insurance commissioner

If your insurance company continues to deny your claim after you have contacted them, consider filing a complaint with your state insurance commissioner.

Complaints are free and your insurance company is required to cooperate with your insurance commissioner’s investigator. In most states, the process takes about 30 days, though complex claims may require more time.

Your insurance commissioner can determine if the insurance company has violated the terms of your policy or violated state law. However, insurance commissioners generally do not rule on factual matters related to claim, such as whether the damage was caused by a covered peril or normal wear and tear.

You can also ask the insurance commissioner’s staff for tips and advice on how to proceed.

When should I sue over a denied home insurance claim?

Suing an insurance company over a denied homeowners insurance claim is typically seen as a last resort. This is because the lawsuit could cost you a lot of money. If your other options fail and the potential value of your claim justifies the expense, suing may be your best option.

When choosing an attorney to represent you in a lawsuit, hire one who specializes in homeowners insurance law and has a record of favorable outcomes. Don’t be shy about asking for references. Check the attorney’s license status with your state’s bar association, too.

Mediation as an alternative to lawsuits over a denied insurance claim

Some states, including California and Florida, offer mediation as an alternative to litigation for disputes over certain types of home insurance claims.

In mediation, you and the insurance company present your evidence to a mediator, who provides a non-binding resolution. The process can save you time and money, compared to a lawsuit.

The types of home insurance disputes eligible for mediation vary by state. In California and North Carolina, mediation is only available for claims resulting from a state or federally declared disaster. In Florida, the process is available for any homeowners insurance claim in which the amount in dispute is $500 or more, after deductibles.

Under what circumstances are home insurance claims denied?

There are only a few circumstances that allow an insurance company to deny your claim. One is if your policy doesn’t cover the cause of damage. Another is if you don’t fulfill your responsibilities under the terms of your policy. Here are examples of why or when an insurance company may deny your claim.

Excluded perils

Floods, earthquakes and water backups are among the most common homeowners insurance exclusions. However, depending on your location and insurance company, your policy may also exclude other perils.

It’s generally best to find out about your policy’s exclusions when you buy your policy, or anytime you’re not sure.

Nevertheless, your insurance company must pay for damage from a covered peril that accompanies an excluded one. For example, if a fire breaks out in your home after an earthquake, your homeowners insurance should cover the fire damage.

Missed filing deadline

Most companies give you up to a year after your home or property is damaged to file a claim, but this time limit can vary by state and insurance company.

It’s generally best to open a homeowners insurance claim for major damage as soon as possible. For minor damage, it’s ok to take a few days or weeks to decide whether you want to file a claim or pay for repairs yourself. In the meantime, you can assess the damage and get estimates. Just don’t wait too long.

Insufficient documentation

If you claim your state-of-the-art entertainment components or luxury cooking utensils were destroyed or stolen, the insurance company is probably going to want to see receipts or other proof of ownership and value.

It is best to maintain a home inventory listing your possessions with as many details as possible about each item or set. Include brands, model names and numbers, purchase dates, photos, receipts and serial numbers.

If you don’t already have an inventory when a disaster strikes, you may have to retrieve purchase data from old emails, past credit card statements and other sources. You can also scour your smartphone for recent photos showing the condition of your home and possessions. Ask friends if they have recent photos in your home, too.

Neglect or a lack of maintenance

An insurance policy typically requires you to maintain your property with reasonable care. If it believes that damage from a ruptured water heater, burst pipe or failure of another appliance or system is the result of neglect, it may deny your claim.

Providing inspection reports or maintenance records can help demonstrate the steps you took to keep your appliances and systems in good working order.

Damage to undisclosed improvements

If you don’t let your insurance company know about remodels and additions to your home, your insurance policy may not fully cover damage they sustain.

It’s best to let your insurance know about home improvements, including cabinet and flooring upgrades, as soon as you complete them. Although doing so may lead to a minor rate increase, it also provides the additional coverage you need for your improvements.

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