Why Do Insurance Companies Deny Claims?

When you file a home insurance claim, you expect a smooth compensation process. Insurance companies often deny claims, sometimes for valid reasons and other times for unexplained factors. Having a claim denied can be frustrating, especially when you believe it has been denied unfairly.

Insurance litigation lawyers in San Antonio point out the following as some common reasons why an insurer can deny a home insurance claim:

  • Natural wear and tear: Home insurance policies often don’t cover losses related to normal wear and tear. For example, you may not be compensated for equipment like your HVAC that has reached the end of its useful life.
  • Pre-existing damage: You may not be compensated for losses you incur due to damage that existed before a catastrophic event.
  • Lack of maintenance: Insurance companies require homeowners to maintain their property sufficiently. The insurer may deny the claim and blame you if a loss is due to a lack of maintenance.
  • Insufficient proof of loss: When you file an insurance claim, you must provide sufficient evidence of the damage or loss. The damage’s detailed description, photographs, and estimates of repair or replacement costs can help support your claim.
  • Fraud: Insurance fraud is a severe offense that, if detected, could further complicate your claim. Insurance companies take measures to identify and prevent fraudulent claims.
  • Exclusions in coverage: Most homeowners’ insurance policies have specific exclusions not covered by the policy. If a claim is not included in the policy, there is a high likelihood that the insurance company won’t grant the claim.
  • Improper filing of claims: You must file your claim correctly and promptly to avoid having it denied. Skilled storm damage lawyers in San Antonio can guide you through the process for the most favorable outcome.
  • Non-payment of premiums: Regular payment of your insurance premiums keeps your policy active. Make the required payments to avoid your policy lapsing and leading to denial of your claim.

Before submitting your insurance claim, let experienced lawyers help you evaluate it to ensure it doesn’t fall under the above categories of claims that insurers often deny. They can help you understand your claim and how to file a dispute if it is denied erroneously or for reasons you need help understanding.

What Should I Do If My Storm Damage Claim Is Denied?

Having your storm damage claim denied can be frustrating, but there are legal steps you can take to dispute the denial. If you believe your claim has wrongfully been denied, consult experienced storm damage attorneys in San Antonio for legal counsel. They advise that you take the following steps:

Review the Reasons for the Denial

Your insurer will send you a formal letter indicating the reasons for denying your claim. If you don’t receive a formal letter, your claim hasn’t been denied, and you would probably want to find out the reason for the delay in compensating you. The letter justifies the denial based on the specific language of your policy.

Ensure you read the letter carefully and compare it against the policy terms. Skilled San Antonio storm damage attorneys can help you identify any errors. If they determine a legitimate reason for denying the claim, there is nothing more you can do. If you believe the claim was wrongfully denied, note the issues you may want to raise with your insurer.

File an Appeal

If you’re unsatisfied with the denial explanation, you may need to file a formal appeal. The timeframe for doing this is limited, and the countdown starts when the claim is denied. The appeal process is outlined in your homeowner’s insurance policy. Depending on your insurance company’s requirements, it may entail gathering evidence and participating in mediation.

Get Professional Opinion

If you request a re-examination of your claim and the request is denied, it may be time to seek a professional opinion. You have a legal right to hire an independent appraiser or public insurance adjuster not affiliated with any insurance carrier. Conduct a background check to ensure the adjuster is licensed in San Antonio.

Remember that an independent party may support the insurer’s original denial or support your claim. If the latter happens, you may have grounds to request the insurance company to review your claim again.

Contact Your State Department of Insurance

Your home insurance company could still deny your claim or offer a very low settlement even after requesting a review. In that case, the next step would be registering a formal complaint with the state insurance department. Take this action if you feel the insurer denied your claim unfairly, and it would be in your best interest for the insurance department to investigate the situation.

When filing a complaint with the department, you could inquire if resources are available to contact your insurance company directly to discuss your claim. It’s also crucial that your insurer responds promptly within the time limit defined by the insurance for a favorable outcome. Skilled San Antonio insurance litigation lawyers can help you with the follow-up.

An Experienced Storm Damage Lawyer Helping You Dispute Denied Storm Damage Claims

Navigating insurance claims can be complex, given that insurers can sometimes deny claims for reasons you need help understanding.

Working with skilled insurance litigation attorneys in San Antonio can give you leverage. They can provide proper guidance and legal representation to protect your rights and increase the likelihood of a favorable outcome.

Stormlex Law Group hosts knowledgeable storm damage attorneys who can investigate your case and help you take the necessary steps if your claim is denied. Negotiating with insurance providers is daunting, and we will advocate to uphold your rights and interests. Call us at 855-786-7674 to schedule a FREE case assessment.