Your insurance Claim Has Been Denied, Now What? - Five Star Claims Adjusting - Five Star Claims Adjusting
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Your insurance Claim Has Been Denied, Now What?

Having your insurance claim denied can feel like a personal insult. After years of paying premiums, finding out your insurer won’t be coming to your rescue when you need it the most is extremely disappointing. But a denial of your claim doesn’t have to be the end of the road. Many of the claims that are initially denied can be reversed, but only if you follow the process.

Review The Details Of Your Policy

Most insurance claims are denied due to the details of the policy that were missed before the claim was filed. There may be an exclusion in the policy that exempts the insurer from covering your loss, or the insurer may have found you to be lacking in the preventative maintenance of the home. Review your policy to familiarize yourself with the reasons that your claim may have been denied, and start gathering any documentation that helps to show you have complied with the terms laid out in the policy.

Understand The Reasons for Denial

The reason your claim is being denied should be provided to you in a letter from the insurance company. If you have not received an official document listing the reason for your denial, you should continue to follow up with the insurance company until you receive one. The insurer has to give you this documentation for your personal records and review. Once you receive this information, review the reason given against the conditions listed in your policy.

Get Ready For an Appeal

As a policyholder, you have the right to file an appeal if you feel your claim has wrongly been denied. But, filing an appeal does not automatically mean that the decision will be reversed. In addition to submitting the insurer’s appeal form, you’ll need to submit a written rebuttal to the company, as well as any documentation or proof you may have to back it up. The appeal process can be a lengthy one, so be sure to request a resolution date or estimate from the insurer before the process begins.

Consider Further Action

If your appeal is denied, you do have other methods of recourse available, but they may be more involved or costly. At this point, you will want to make an assessment of whether or not it is worthwhile to continue pursuing the claim. You can hire an attorney with experience in insurance claims to review your claim and advise you on whether to pursue the claim in court, or make a complaint to the regulatory board in your state that governs the insurance industry. Either one of these processes will take time, so prepare yourself for a wait before any resolution happens.

Having a claim denied can be a learning experience for the policyholder. If the claim was rightly denied, there is little you can do besides learning from the denial and being sure to protect yourself against future denials. However, if you believe the claim was wrongly denied, you can and should exercise your right to an appeal. Having a public adjuster review your denied claim is a great way to find out if you have a case for an appeal or not. To have your claim reviewed by one of our public adjusters, contact Five Star Claims Adjusting today.