Sh*t! My Claim Got Denied!

I Have Been Denied!

I hear this every day!

So, you’re filing an insurance claim because you have water damage, wind damage, mold, something, and the insurance company comes back and they send you a letter and it says, “Really sorry to tell you, we’ve done our best but we’re not going to cover your loss, it’s denied. And really, thank you so much for your business.”

So, a denied insurance claim often leads to people wondering.

This might surprise you… but the insurance company isn’t going to teach you how to fight your denials. When you have a denial, they will not:

• Tell you what to do
• Tell you how to do it
• Tell you the options you have

Most people accept those denials, and I’m here to tell you, you probably don’t need to accept it.

DON’T ACCEPT YOUR DENIALS

Here’s a secret… it may have been properly denied. Here’s why… there are losses that are not covered under a homeowner’s policy which gets denied. So, if your claim was denied properly, it’s possible that there’s nothing you can do.

What’s not covered under the policy?

The following events have no coverage:

• ongoing losses that occurred over the years
• the rot that occurs sometimes is not covered even though some policies have coverage for hidden decay and rot and things that do occur over time.

There is going to be that chance that you filed a claim that isn’t covered, that’s for sure. Do you have the coverage needed for this type of loss? Recently, with the hurricanes and the storms and the major… we’ll call it flooding, we had a lot of basement sump pump losses. This type of coverage is almost always required to have an endorsement for sump pump coverage.

Now, premium policies do cover this without the endorsement.

But if you don’t have sump pump coverage and you had sump pump failure, it’s a pretty good opportunity for the insurance company to deny your loss and possibly correctly.

What if you had coverage and they still denied you?

So, if you have the correct coverage and you were denied, you kind of go back into the same step, we are all going to need to pursue this. But if you didn’t have sump pump coverage, and you were denied for not having sump pump coverage, there may be nothing you could do for that component.

Is it final? For the most part of the answer is no.

So, a claim that’s denied and closed by our insurance company does not mean it cannot be reopened, does not mean you can’t follow through with alternatives, does not mean that we can’t reopen your claim. So, there is no such thing as really “final” after a claim has been denied.

Can you sue them? Absolutely.

So, denied claims get sued all the time, and I would say that more than 50%, probably more than 75% of them ultimately, would end up in a successful claim.

BUT WAIT! Would a lawyer take the claim?

Basically, because of the size of the loss, the value of the loss/ And you still may need an expert to document the loss and show why it is covered. So, you need to have the proper policy provisions, you need to have the proper photographs and the explanation of the loss in order to turn that over.  So often, attorneys will work with public adjusters to help them as well. So, what are your options? Well, your options are: talk to a professional.

You could talk to a professional, describe what happened even without coming out to the property. Most professionals will be able to give you an honest answer if there’s a potential for coverage.

 If there is potential for coverage. And basically, you’ll also need a full copy of your policy, not just the declaration page. So, if there is some potential for coverage, having somebody out to the property to look at it, is important.

The general conditions at the property add to the coverage decision.

1. How did this occur?
2. Why did it occur?
3. Was there a concurrent cause?
4. Or add to that calculus of whether or not this would be a covered loss.

DO PEOPLE GET COVERED AFTER A DENIAL?

And I guess people ask all the time, “Well,  I understand, that sounds like a lot. But how often do people get coverage after denial?” I’ll give you a five to seven million reasons, because about five to $7 million worth got turned over last year, just from helping people that were improperly denied in the beginning.

Even as professionals, we get denied, not often, but we will get denied on claims and have to then overturn them later.

But if you get denied on your own, my advice is to seek a professional.

They’re going to ask you a few questions, they’re going to want to see your policy, and most likely, they’re going to want to come to the property to inspect to see if there is a potential for recovery.

Most of that is all done at no charge, you need to do the legwork, and get a copy of the policy, but the professional is most likely going to come out and take a look and give you a pretty good idea if they can represent you.

Hopefully, that answers your questions.

Hopefully, you learned something. If you have a question, you want it to be something specific for me to answer, you can call at 312-883-2064. Don’t worry we don’t sell insurance. We just advise.