Understanding Denied Insurance Claims: What to Do Next
A denial of your insurance claim can come as an unpleasant surprise, to put it mildly. You can challenge a denial, but you need to take action immediately. Get the help you need to rebuild your business or home by engaging the help of an experienced insurance recovery attorney.
Understand Why Your Claim Was Denied
When your insurance company denies your claim, they will issue a formal letter explaining the basis for their decision. The claim decision letter should state a specific reason why the claim was denied, and possibly cite the specific provision of your policy that supports the decision. Common reasons why claims are denied include the following:
- Delayed notice of the loss
- Insufficient documentation
- Failure to pay premiums
- A policy exclusion or limitation
Understanding the basis for the denial is important because it shapes how you should proceed going forward. While this sounds simple enough, an insurance claim decision letter may be indecipherable for people who do not work in the insurance industry. Don’t be surprised if the reasons given for denial do not seem to apply and don’t feel embarrassed if you do not fully understand the decision letter. If you do not understand why your claim was denied, an experienced insurance recovery attorney can provide valuable insight.
Gather Your Records
If your claim has been denied, make sure your case is well-documented in order to successfully challenge the denial. Gather and organize any and all records related to your claim including the following:
- Copies of correspondence with your insurance company and their adjuster including emails
- Photographs documenting the extent of the damage
- Proof of the cause of the loss
- Documentation of your financial losses including copies of receipts, invoices, estimates, and any other financial impact suffered as a result of the loss
If you need to challenge the denial, the process moves quickly. Having your records in order can save valuable time and help you put forth the strongest possible case. If your case was denied because of missing documentation and you don’t know what to do, contact an insurance recovery attorney for help.
File an Appeal
Under the terms of your insurance policy, you very likely have a right to file an appeal of your denial. Be aware that your insurance company may not reference your right to an appeal in their denial letter or otherwise advise you of this right. However, there are strict deadlines for filing an appeal so it is critical that you take action immediately following your denial.
If you believe that your claim has been wrongfully denied, filing an appeal may be your only option to get the coverage you deserve. You could lose all of your rights if you do not file your appeal in a timely fashion. If you do not know what to do or when the deadline expires, contact an insurance recovery attorney for help.
Contact an Insurance Professional
The insurance claim process is more complex than people realize, particularly when it comes to denied claims. There is no embarrassment in seeking professional assistance – insurance companies do not make it easy for their policyholders to get the coverage they paid for.
One option is to contact a public insurance adjuster. The adjuster that the insurance company sent to evaluate your claim is an employee or agent of the insurance company and is arguably biased in their favor. In contrast, a public adjuster is an insurance adjuster who works for the property owner. Public adjusters are often very skilled in reading and interpreting insurance policies. They also will make a thorough assessment of the damage you have suffered and the value of your claim. An opinion from a public adjuster can be helpful when deciding whether your claim was appropriately denied.
If you engage a public insurance adjuster and they are unable to resolve your claim, you should consult an experienced insurance recovery lawyer. Most public insurance adjusters routinely work with insurance recovery attorneys, know when it is appropriate to engage legal services, and understand what documentation the attorney needs. Once you consult an insurance recovery attorney, they can answer any questions you may have, but they can also handle every aspect of your denial on your behalf, from assessing the validity of the denial to filing a lawsuit on your behalf and representing you in litigation.
Why It Is Important to Fight Your Denial
It is easy for property owners to lose sight of the big picture when they are navigating the claim process, especially when they are facing a denial of coverage. Often, property owners find the claims process frustrating and give up without determining whether the denial was proper. Ultimately, a wrongful denial of your claim means you will have to pay for any damage that should have been covered under your insurance policy. Whether it is your commercial property or your home, this can present a tremendous financial burden, especially if you have experienced significant losses.
Contact Pearson Legal, P.C. if Your Insurance Claim Has Been Denied
A denial of coverage can be a devastating blow after experiencing damage to your business or home. Fortunately, you have options but you need to take immediate action. If your property insurance claim has been denied, contact Pearson Legal for help. We aggressively protect our client’s right to compensation under their insurance policies so that they can rebuild their businesses and homes.