The Reason why Insurance Claim Denied

46 views 6:00 am 0 Comments April 11, 2022

The Reason why Insurance Claim Denied

 

Why was my insurance cancelled?
The claim was refused.
I’ve been paying insurance for years and years, and then I make one claim and it’s denied. I can’t tell you how many times a week I hear this from potential clients who call into our office and say brit, I need your help, my insurance company is wrongfully denying my claim, and while I agree that insurance companies frequently deny claims improperly, there are times when a claim is denied and it should be denied.
Typical homeowner’s insurance policies in Florida ho3 policies state that the insurance company will cover direct physical loss to property except in certain circumstances. This is important to understand because your insurance is literally saying we cover for everything except these things, so you want to know what these things are and what the exclusions are so you can one plan ahead of time because you need to come up with the money to make repairs or two know when to contact someone.
If the insurance company is erroneously refusing the claim, let’s go through some of the exclusions that are included in your policy and, more than likely, in the rejection letter you received from your insurance company.
Wear and tear or deterioration is always listed as an exclusion in the policy, which means that if something breaks down or is damaged due to its age because it has been deteriorating over time, the insurance company will not cover or pay for it. Another exclusion that is always listed in the policy is existing damage.
This means damage that occurred prior to the start of the policy period, and it’s important to note that it doesn’t matter if you weren’t aware of the damage or if no one was aware of the damage; anything that existed prior to the start of the policy period is not covered by your insurance, whether you were aware of it or not. The next exclusion is constant or repeated seepage or leakage.
I realize this seems wide, but it includes anything that has been going on for weeks, months, or years, even if you were unaware of it.
Another typical exclusion is the seepage or leakage of water, moisture, or steam on a regular or recurring basis.
This is something that has been going on for weeks, months, or years; it doesn’t matter if you didn’t realize the damage was happening; it doesn’t matter if you didn’t know there was an issue at all; insurance won’t cover it if something has been going on for a long time.

Read Also: Top Reason Why Car Insurance Claim Denied

Another frequently cited exclusion in your insurance policy is faulty repairs or materials. This works in conjunction with another provision in your policy that states that you must take reasonable steps to mitigate your damages, such as performing temporary repairs and ensuring that no further damage occurs to the property after a loss.
It’s critical that if you’re taking these actions to make interim repairs or otherwise, you choose qualified professionals to complete the work because any action by the repair firm that causes additional harm or fails later on is not covered by insurance.
Neglect is another type of exclusion under the insurance policy, and it simply means the insured’s failure to take reasonable and necessary steps to protect and save the property after a loss occurs. This is sometimes incorrectly cited by insurance companies because the neglect, or failure to do anything, has to actually cause the damage that is being claimed, which is distinct from damage already caused by the first loss.
Earth movement and flood water are two other key exclusions to be aware of. Earth movement can refer to a variety of things.
It’s a fairly broad term that might refer to a sinkhole or an earthquake or anything else where the land moves and causes damage to property in practically all regions. If you need coverage for something like this, you’ll need to seek additional insurance.
Flood water is something else that insurance does not cover and that you must obtain separate insurance for if you live in a flood zone. It is critical to distinguish between flood water and rain water.
Flood water is something that comes up from the ground and slowly rises to create a flood in an area this includes flash floods or slow floods and floods caused by weather however this is the difference between flooding or pooling of water that happens from weather water or rain water this type of water happens when water comes from the top down so rain wind pushing that rain that is completely separate from flood water and it’s something that happens when water comes from the top down so rain wind pushing that rain that is completely separate from flood water and it’s
There are many other exclusions in the insurance policy, but these are the major ones that cause the majority of litigation between the insurance company and the insured. When you report a claim to your insurance company, they will send out an adjuster to inspect your property. The adjuster will look at the damages, look at the property, and try to figure out what happened and what caused the loss.
what the damages are and what it’s going to cost to fix after that initial inspection either that adjuster or somebody in house of the insurance company will take a look at that information and then apply your policy language to the loss to figure out if there’s coverage or not now sometimes the insurance company will apply provisions like the exclusions I just listed improperly to a certain set of facts either they won’t have the full facts or they’ll misread the policy and think that a provision applies when it doesn’t so it’s important to have a professional such as an attorney review your claim to make sure that the provisions the insurance company are applying saying we’re denying the claim because of the x y and z exclusion it’s important to have somebody review that to make sure that the exclusions they’re applying actually apply to this specific claim because the insurance trusters are overworked overtired they handle hundreds of claims sometimes they don’t have time to review the entire policy to make sure that the provision or citing actually applies to this loss for example you could have an exclusion in your policy that says vandalism isn’t covered so if you make a claim for flooring damage from vandalism and the insurance adjuster is running through the policy and they see a provision that says vandalism not covered well they may cite to that but it could be in the wrong section so if you were claiming a couch damage from vandalism maybe that would apply if it’s under personal property but for your purposes when you’re claiming flooring that wouldn’t apply so it’s important to do a thorough review of the policy to make sure that the provisions that are being cited and used actually apply to your specific claim and set of facts
If you’re perplexed, if you’re overwhelmed, if you’re going through an insurance company letter quoting all this legal jargon and all these provisions and saying, “I have no idea what this means,”
enlist the assistance of a professional and contact us so that we can review the letter and your policy.
evaluate the facts and tell you, hey, this is a proper denial, this is not covered by your insurance company, or this is not a proper denial, the insurance company should cover this, and we should take legal action against the insurance company to get you what you’re owed under the policy you have.


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