Disputing a Home Insurance Claim Denial or Settlement Offer

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Disputing a Home Insurance Claim

Home insurance offers you the desired peace-of-mind, the protection you need. And it is also quite common that some disputes arise between insurers and the policyholders. Then arises the situation of an insurance claim dispute that is settled between the two.

Therefore, we suggest some steps you can take to settlement the insurance claim dispute.

dispute insurance claim letter

1. Reviewing your insurance policy and claim

You need to review your insurance policy and claim to get thorough information about the insurance policy. For this one should know about the type of dispute, find the state law applicable, the documents kept, etc.

2. Contact the insurance company.

The dispute process can be started by calling the insurance company and talking about the claim’s adjuster. Be calm, and express your discomfort with the policy amount being offered.

3. Speak to a supervisor.

In Case the claims adjuster is not able to assist you can contact the supervisor for the settlement of the insurance dispute.

4. Endorse the appraisal clause

When insurers and policyholders disagree on some point or the other, then there may arise a situation of conflict. To solve this, endorse the appraisal clause in your home insurance policy. This can be appealed by you or your insurance company. It states that when two of the three appraisers agree on a decision or clause then it is resolved. The only thing is, you need to pay for your appraiser and half of the cost involved in the third appraiser.

Resolving Home Insurance Claim Disputes

Home Insurance Claim disputes are communal. It is for certain that you and your insurer may disagree over certain things or issues relating to the home insurance policy be it damage, home repairs, bills, etc. For these many resources are available that help you trouble-shoot disputes arising over precise issues dealing in fair market value, depreciation, causation, and policy interpretation. As most of the home insurance claim’s disputes are related to technical and legal issues.

how to dispute an insurance claim against you
Therefore, one should know how to settle insurance disputes and negotiate a settlement. The best route to resolve a claim dispute depends on your situation. The main aspects that help to determine which route is best for you to include:

  • How much will be the cost of process?
  • Who will pay for the process cost?
  • How long the process will take?
  • What is the amount of your settlement goal?

Which Damages are covered By Homeowners’ Insurance Cover?

Buying homeowner’s insurance is a wise decision to make to protect yourself financially and in case of disaster or damage to your home. Though we know, there are certain terms & conditions attached to each policy we purchase. So, is the case with home insurance cover. The sources of damage covered by a homeowner’s insurance policy are usually referred to as “perils” or “hazards.” These “perils” or “hazards” include damage caused by:

  • theft or vandalism
  • explosions
  • lightning strikes
  • fires and smoke
  • windstorms, including hurricanes and tornadoes
  • hail
  • weight of ice or snow on your roof, and
  • freezing pipes bursting.

Note: damage due to water discharging from air conditioners, plumbing or pipes, water heaters, and fire-protection sprinkler systems are the types of damages covered by one of some insurance companies.

Damage That Is Excluded from Standard Homeowner’s Insurance Policy

While you purchase home insurance policy most of them do not cover damage caused by:

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  • flooding
  • earthquakes
  • landslides
  • mudslides
  • sinkholes, or
  • sump pump failure.

Tips to Maximize Your Property Insurance Claim

You need to handle your homeowner’s or renter’s insurance by getting yourself a coverage. But before that, you need to organize and keep certain things in mind for your eventual recovery. Consequently, some tips to make the best use of your property insurance claims are:

1. Take photos of the damage

There’s a time gap between the happening of the incident and when the insurance agent arrives to investigates your claim. So, taking the photographs exactly after the event would help the agent and company to prove the actual happening and damage caused.

2. Stop ongoing problems

Do act yourself before it’s too late or you cannot avoid the damage. You will surely get a claim reimbursement for the temporary repairs you have made; you just need to save the receipts.

3. Set aside damaged items

All the damaged items should be kept aside, don’t throw them unless you have claimed the amount the policy covers in the cost of replacing personal possessions up to a limit. As these damaged items will act as proof for your claim.

4. Don’t argue with neighbours

In case of damage to the neighbour’s property, be sure of what all are covered in your policy and figure out who pays for what. As there may be some claims that your neighbour insurance policy might cover.

5. Examine the damage yourself

Examine and take a look at your home after the damage is caused as You might be able to properly and much carefully see the cracks, breakage, tilting floors, or stains or damage caused.

6. Know your repair estimates from contractors

Try to find out the estimated cost involved in getting your home repaired from a contractor. This will help you in knowing how much they claim the company is providing. And in case of low claims offered you can bargain for more depending upon the estimates offered by the contractor.

7. Prepare a complete home inventory.

You might need to give the list to the insurance adjuster in the case to cover the damaged items in the home insurance policy.

8. More items included in home inventory

Be aware of the extra expenses covered by your home insurance policy as it may include landscaping items, food items and sundries, etc that you might not be aware of.

9. Get or hire an independent professional help

The insurance claims offered by the companies differ from company to company. So, you might need an independent insurance adjuster that will help you in getting the rightful claim form your house insurance policy.

10. Retain a log of all communications regarding your claim.

All the bills and receipts, as well as the other relevant details relating to phone calls, voice mails, and email messages, etc with the insurance company should be with you in case of need.

When to Sue Your Home Insurance Company?

In case the insurance companies don’t comply with the conditions mentioned in the policy or deny your claim, delaying payment, paying you less than you are owed, etc then you can sue your insurance company to get the money you deserve. But before this you need to know the situations when you can sue your insurance company:

1. When it unreasonably delays payment of your claim.

As we know the fact that Insurance companies are tangled into the business of making money. Therefore, the longer time the insurance money is with the company the maximum profit it can earn. But, as per the law Insurance companies are obligated to pay valid insurance claims on time. And in case, the insurance company is making a delayed payment or is delaying your insurance claims then you can sue the company.

Note: Take the written reason for delaying the insurance claim payment from the company, as it may be proved worthy to sue the company. As it will act as a shred of written evidence.

2. When it tries to settle your claim for an unreasonably low amount of money.

When you think of that your insurance company is knowingly trying to lower down your claims, or trying to talk you down from the amount you request to cover or the insurance company is refusing to offer you anything but a small amount of money that are not enough to cover the amount of loss you suffered, then you can sue your insurance company as the company is not judiciously covering the claim amount.

3. When it unreasonably denies your claim.

There may be many circumstances when your insurance company denies you to pay the claim as the company may say that it was your fault, or the policy doesn’t cover the exact circumstances, your claim is too high, etc. Then you can sue the insurance company for denying your claim without a virtuous validation.

4. For post-claim underwriting

Underwriting is a process in which the insurance companies identify or investigates you and your history to determine whether they should offer you an insurance policy or not. And on this note sometimes insurance companies refuse to pay your claim to avoid it. Then you can sue your insurance company for extravagant behaviour.

5. For failing to defend you in court.

Your insurance company protects you from certain damages that are mentioned in lawsuits against you. Therefore, it is an insurance company’s duty to defend you by providing legal counsel to represent you in covered claims and also the fees and expenses will be borne by the company. In case, the company does not defend you, then you have a right to sue your insurance company.

How to Sue Your Insurance Company?

Suing homeowner’s insurance company involves a detailed process one need to discover before filing a complaint or suing the company. Thus, take a look at some points that will help you to know how can you sue your insurance company?

  1. Contact your insurance company

Before taking any step, you should contact your insurance company and try how to resolve dispute insurance claim or talk with your insurance agent and resolve your issues.

2. Acquire a copy of your signed insurance policy.

Try to get a signed copy of your home insurance policy from the company as well as other necessary documents to support your policy. In case you have lost the policy or kept it somewhere, then you can request a copy of your home insurance policy.

3. Read your insurance policy meticulously.

To sue your insurance company, on the terms mentioned in the policy you need to read each and every detail of the policy. As each small detail might prove a turning point to your policy. Give proper emphasis on how payment is handled, the process for submitting a claim, and how disputes are resolved.

4. The loss must be covered under the terms of the contract.

As we all are aware of the fact that insurance companies are quite specific towards what to cover and what not to in their policy. And likewise, we already have discussed this above in Which Damages are covered By Homeowners’ Insurance Cover? And Which are the damages That Are Excluded from Standard Homeowner’s Insurance Policy? So, try to find out whether the loss covered by your insurance policy is matching the terms of a contract that it agreed to cover in your policy.

5. Compile an estimate of your losses.

Attain the necessary records, bills, receipts, etc that can prove as a valid claim to the insurance company. And this will help you in estimating the loss that should be covered by the insurance company.

6. Investigate the insurance law of your state.

Every state has its laws, get some information about your state law and do Read your state’s laws thoroughly. That way it will help you in filing a case or suing the company.

7. File a claim with your state’s insurance department

Each state has its law and department to help the consumers. Therefore, you can file a complaint against the insurance company. After, the complaint is filed you need to provide the documents the department asks for. For further details, you can also see the consumer protection laws mentioned.

Note: You can use the state insurance department website to file a complaint.

What happens when you sue an insurance company and you?

  • Win
  • Lose

When you win?

In case, you sue an insurance company and wins the dispute, well, in that case, you may be able to recover:

  1. The full amount of your economic losses

You recover all the economic losses you have suffered which further include:

  • Property damage
  • Medical bills
  • Loss of use of your home or car
  • Lost wages
  • Lost interest/loss of opportunity

2. The amount spent on attorney fees and costs of suit

  • For having to sue to mend insurance benefits owed
  • For all your losses consequential from unpaid insurance profits

3. Non-economic losses

  • pain and suffering resulting from the insurance company’s conduct

4. Penalties

A penalty under statutory or case law for the insurance company’s failure to pay benefits owed

When you Lose?

In case you lose an insurance claim dispute, then your state law and the Attorney-Client fee agreement decides the amount of penalty. Further, the general rule says that each party to a lawsuit pays his/her legal fees.

How to write an Insurance Claim Dispute Letters

It is quite common to have a dispute with the insurance company over your claim. So, I will cover some general guidelines to compose a request insurance claim dispute letter as well as what points should be covered in disputed insurance claim letter.

Language of the letter

Try to be precise, humble and possess valid legal options in your dispute letter. So here I’m mentioning some tips for putting your dispute in writing:

  • Request extra than you think you will get, but not so much that you seem greedy.
  • Be humble, but firm.
  • Be precise.
  • Show a willingness to negotiate.
  • Do not bluff.
  • Study your legal options and assess your cost before you make a threat.

Further, adding on to the formatting structure of the insurance claim dispute letter, you can consider the following:

  • Firstly, cover date, address, Reference #, Insurance claim number, Loss Date, Accident Date Claimant, $ Amount of Damages, Claims Dept / Adjuster Name, etc in the letter.
  • Start with an introductory line.
  • Explain about your damages and make the person feel that the insurance company owes you a certain amount.
  • Attach the actual evidence to support your statements in the letter to claim the insurance amount.
  • End the message in the insurance claim dispute letter with the tone of reason and provide the amount of insurance claim that you are ready to accept as a full settlement of your damages.

What is a home insurance adjuster?

Home insurance adjuster evaluates your claim and decides the amount of money the insurance company is required to pay out. the home insurance adjuster acts as a paid employee or independent contractor of the insurance company.

Tips to deal with a home insurance adjuster

Here we are mentioning some tips to keep in mind while dealing with or negotiating with the home insurance adjuster regarding your insurance policy.

  • Do not give the adjuster a recorded statement in writing
  • Try not to speak to the adjuster unless necessary
  • Avoid signing any documents from the insurance adjuster
  • Don’t be quick to settle your insurance claim
  • hire a public adjuster or an attorney if the insurance company is acting in bad faith
  • Try to cooperate with that adjuster
  • ask for further justification on the low amount of claim offered by the company
  • get your settlement in writing, when a claim is settled.

When your insurance claim is denied what you can do?

Insurance companies possess a habit of denying claims to their trustworthy customers as they don’t want to pay your bills and avoid the losses. Thus, we have some tips that would help you to get the insurance claim you deserve.

  1. Review Your Claim

Just go through your home insurance claim policy that will help you to know the points covered as well as excluded from the insurance policy. And in case you find something, you have a right to ask your insurer about the reason for denial of the insurance claim.

2. Know Your Policy

Go back and review your home insurance policy. Understand your home insurance policy in detail. Don’t miss out the little things mentioned in the home insurance policy, know your rights, the sum covered in the policy, damages, etc.

3. Gather Details

Gather evidence to support your insurance claim and the amount you are claiming for. Focus on the following details:

  • Know the facts regarding the incident
  • Look out for an independent appraisal
  • Take pictures of damages.
  • Depict records of purchases to protect your home
  • Look out for a witness who may speak on your behalf.
  • All relevant & necessary Documents that the insurance company might demand.
  • A copy of the insurance policy

4. File an Appeal

You can file an appeal if your claim was denied without reason and your existing insurance policy covers the claim. Though An appeal isn’t a guarantee of the claim, you can sue or file the home insurance company.

Conclusion

We all know that Insurance companies deny claims. More than 90{367c01af22dc6c3a8611ff25983b0f0a247ed9fc1c45fd9103ad49b47a0c5f39} of the claims are denied by them but that doesn’t specifically mean you can’t go against them or have no right to be fully aware of your rights and policy terms. You deserve insurance reimbursement if your home has been damaged or destroyed. So, know your insurance policy and act wisely. As far as now you might have got a better knowledge of all the insurance claim disputes.

So, have you been denied a homeowner’s insurance claim and sued a company as well? Do let us know your experiences in the comments section mentioned below.

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Frequently Asked Questions-

You can contact the insurance company, hire an independent adjuster or attorney, make a Complain to your state's insurance department, etc.

To file or lodge a complaint against the insurance company you need to write a formal insurance complaint letter that should contain the date, policy number, any evidence to support your complaint, etc.

Yes, you can sue an insurance company for denying a claim if you feel that there’s no particular reason to deny your claim or the insurance company is denying your claim without good justification for doing so.

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