Insurance companies are a for-profit business entity, and they will do what is in their best interest. If your claim was denied, delayed, or underpaid, then odds are there may be money on the table you are entitled to. This does not mean claims are never denied without reasonable cause; it just means many claims are mishandled, and the actions taken by insurance companies can at times be fraudulent or wrongful.
To avoid being taken advantage of, one of the best things you can do is speak with an experienced property insurance claim attorney and ask them if you have a case.
Why was my claim denied?
This is a common question many property owners ask themselves upon receiving a claim denial letter from their insurance company. The truth is any number of reasons could have led to the denial of your claim – from not filing on time to insurance fraud and anything in between.
Understanding why your claim was denied is important because it will guide you in deciding what to do next.
Common reasons why claims get denied
Here’s a list of common reasons why insurance companies deny, underpay, or delay property damage claims.
• Not filing on time
You are required to notify your insurance company as soon as possible after your property has been damaged or has sustained any loss. Additionally, there may also be time-sensitive documentation that needs to be filed. Missing a deadline or filing a damage claim after an excessive amount of time has passed from the initial date the damage occurred may result in the denial of your claim.
• Exclusion clauses
An insurance company’s dream come true – exclusion clauses. Every property insurance policy has its own set of exclusions that come into play under certain circumstances. If the cause of your property damage is part of an exclusion clause, then your claim will most likely be denied.
• Questionable claims
Claims that raise suspicion will be handled cautiously and, without adequate evidence, can be denied. During the claim process, your insurer will most likely conduct an investigation to determine the cause of your damage or loss. If anything suspicious or questionable is discovered, they may delay or deny your claim.
• Insufficient documentation
Insurance companies basically require you to prove your claim to them. Meaning it’s the property owner’s responsibility to collect enough evidence to prove the damage occurred and point to a cause. Insurance companies will usually send in their own adjusters, who will then develop their own explanation as to whether or not they see any damage and attempt to determine what caused it. Your claim may be denied if the evidence handed to the insurance company is not enough to determine what caused the damage or whether there is any damage present.
• Preventative measures were not taken
After a property has sustained any damage or a loss, the property owner is required to protect the property from further damage by taking reasonable actions to ensure the property is protected. If the property owner fails to take any preventative measures to keep the damage from sustaining further damage, then an insurance company may deny your claim.
• False statements
After a property has been damaged and you file a claim, the insurance company will collect statements from you to attempt to discover the severity of the damage and whether or not your statement is true. If at any point they feel your statements are false or they cannot be verified, then your claim may be denied.
How likely is it that my claim was denied due to insurance fraud?
It’s definitely possible. Here are two cases Attorney John Tolley, one of our founding partners, was involved in where he uncovered fraudulent actions being taken to get the claims denied.
Link 1: Do insurance companies commit fraud?
Link 2: Insurance companies are directing field adjusters to alter their reports to deny claims.
Insurance fraud is not always the reason why claims get denied, but at JT Law Firm, we’ve seen enough insurance fraud occur to know it happens very often.
Your claim was denied. What can you do?
Speaking with an attorney can drastically improve your odds of getting your claim approved. Attorney’s, especially ones with experience winning, understand how insurance companies work and the actions they take to deny claims.
JT Law can give you a free case evaluation, and if we believe you have a case, we’ll work to get your claim approved. There’s no cost or fee to you unless we win.
Call us at 855-585-2997 to speak with us today.
