insurance denied

How to Prevent Claims from Being Denied

How to Prevent Claims from Being Denied

Residential homeowners’ insurance policies are complicated and, if not interpreted correctly, can cause thousands of dollars to be thrown out the window. One of the best things to do initially, before buying a house or refinancing, is to have a professional home inspection done, especially taking note of the condition of the roof and if there are any cracks or leaks in the basement, as these are vulnerable areas that could cause huge problems later.

When checking these spots, the roof should be inspected for cracks, damaged shingles, or missing tiles that could cause water to enter the home. The basement should also be checked for cracks in the foundation or walls that can lead to water seepage. These steps are vital to ensure that your home is adequately protected both from an insurance perspective as well as from water or storm damage.

It is best to look for companies specializing in all roofing phases, from roof repairs to re-roofing, from maintenance programs to complete roof overhauls. Make certain they provide customers with a Lifetime Warranty on workmanship and products. Then when it comes time to claim damages after a hailstorm, for example, everything should be covered as the professional you hired is recognized as a trustworthy contractor in insurance “eyes” as well as with the Better Business Bureau.

And even if you crossed all your “T’s” and dotted all your “I’s,” your roof damage is still denied, and if you disagree with the decision, contact the insurance company and schedule a re-inspection. Be sure to have a reputable roof repair contractor on-site to document the list of damages alongside the adjuster.

Why would homeowners insurance deny a claim?

Most likely for false statements or questionable claims. Post-disaster, expect the insurance company to send their own adjuster to investigate the claim. Your claim may be denied if they find anything suspicious or questionable involving the original application for coverage or the claim itself.

Insurance company denial of roof replacement claims is often an unfortunate result of misunderstandings or miscommunication. When the insurer denies a claim, it is usually because the customer did not have proper documentation. Hence why hiring a pro is so vital to receiving your maximum benefits.

Whatever the case, the insurance company must act fairly and reasonably per the contract and the law while providing valid and proper reasons for denying the claim.

Remember to keep in mind that even if the claim is denied, the insurer is not rejecting the customer but rather the claim itself. Try not to take it personally (although, quite frankly, it feels like it), but stay calm, professional and rely on the pros to walk you through this arduous process.

Another reason the insurance company may deny a claim is due to policy exclusions, limitations, or damages not meeting their minimum threshold or deductible amount. These exclusions and limits are laid out in the policy, and the customer is responsible for understanding them when purchasing the policy. Again, professional public adjusters are trained to know these limits and how to recognize when the insurance companies are not complying with the customers’ best interests.

When the insurance company denies a roof replacement claim due to inadequacy of the policy, they do so to protect the insurer and ensure that the claim meets the terms and definitions of the policy. The insurance company may also deny a claim if the policy does not cover the roof damage or the policy is explicitly excluded from certain types of damage. Be sure to carefully review all policies and get second opinions and “eyes” on these contracts. Unfortunately, these policies are in place because some people consistently commit insurance fraud, ruining it for the rest of us folks trying to do the next right thing.

Another reason an insurance company might reject a roof replacement claim is if the customer fails to meet their coverage requirements, including providing sufficient evidence of the roof damage or not following reporting procedures after the incident.

How to know when an insurance company is using settlement tactics on you during a claim?

Experts have suggested that the following list includes typical scare tactics some insurance companies use if they are trying to deny a claim:

  • Denys liability without an investigation
  • Denying liability citing that there is a lack of evidence: Denying liability despite evidence to the contrary: for example, citing that there is “insufficient evidence” despite the submission of photographs or witness testimonies.
  • Pressures to accept a low settlement: for instance, they may suggest that it is in your best interest to accept the inadequate settlement offer because they attest that it is based on your actions or negligence contributing to the incident.
  • Quickly contacting you after an accident with a settlement offer: some insurers may attempt to contact claimants shortly after an accident with a lowball offer to close the case before they’ve had time to research their rights or speak to an attorney or a professional adjuster.
  • Intentionally slow down the claims process: this is a common tactic used to “run out the clock” or to wear the claimant down so they are more likely to accept a low settlement offer.
  • Offering “lowball” settlements: offering a settlement payout noticeably different from the claimant’s desired outcome and which does not adequately cover the damages incurred.

When these tactics are presented, hiring a professional adjuster and an attorney is best to protect your biggest asset; your home. Additionally, if you had a professional roofing expert work on your property that warranties their work, contact them immediately.

Next, ask for evidence of any wrongdoing or negligence they cite as the basis for the denial. Additionally, if the insurance company attempts to fast-track a settlement offer, again, contact an attorney or professional adjuster to help ensure that your rights are protected.

Ensure that the amount offered is sufficient to cover all the damages incurred in the incident. An experienced attorney or adjuster can review the policy, any applicable statutes of limitations, and the settlement offer to ensure that your rights and interests are appropriately represented. It is also advisable to have any correspondence with the insurer in writing and to keep any notes on the discussions and conversations.

When possible, have a professional roofing expert examine the affected area and report on the roof’s condition before submitting a claim — or, ideally, before purchasing the policy. A roof inspection can help identify any damage and may be used as evidence in a dispute or claim.

If the insurance company denies a roof replacement claim, it is best to contact your state’s Department of Insurance to file a complaint. Provide the department with sufficient background information, a detailed description of the circumstances that led to the claim, and all evidence of wrongdoing. If your state accepts such complaints, the department can investigate and help ensure that the insurance company handles the claim fairly and in accordance with the law.

How to prevent claims from being denied

In conclusion, when attempting to prevent an insurance claim from being denied, always have a thorough home inspection taking special note of the vulnerable areas such as the roof, basement, or any other potentially vulnerable areas.

Lastly, consider purchasing a home warranty plan that covers the cost of repairs for certain parts of the home, as this will help provide additional protection and peace of mind if a claim needs to be filed.

By understanding the policy terms and taking proactive steps prior to filing a claim, homeowners can help ensure their claim is not denied. Taking the time to document evidence and research all of the policy terms properly can help avoid headaches and stress in the event of a claim.

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