Just because your insurer denied your claim does not mean it’s the end of the road for you. Insurance companies are not always correct in their investigation conclusions about whether a claim is covered or not. If they are wrong in their claim denial, it then becomes your responsibility to prove it. Altieri Insurance Consultants Tampa is the partner property owners rely on, and we’re here to help you by going over the basics of appealing a denied insurance claim. Learn how to turn the tide and get what you are owed!

Why Did My Insurance Deny My Claim?

You might be wondering why your insurer denied you in the first place? The answer usually boils down to there is no coverage for your event. However, in many cases, we have seen where the insurance company misinterpreted the facts or did not fully investigate the claim with your interests in mind. Should this be the case, you may have a viable option to achieve a reversed decision through appeal. Even with the facts on your side, you still need a trained professional working for you to make that happen.

Here are some of the reasons why insurers may deny your claim:

• Not all required documentation was submitted
• The cause of the loss is in dispute
• The claim was reported late, and the insurer investigation is prejudiced
• The insurer indicates damages are not covered in the policy
• Reported damages were due to homeowner negligence
• There is a lack of evidence on the cause or scope of the damage
• A deadline has been missed by the insured

While these may seem like valid reasons to deny a claim, there are times miscommunication between any of the parties or misunderstanding of circumstances will skew the facts causing the insurer to reach an incorrect conclusion. If you’re confident that this is the case, you have the right to make an appeal.

Appealing a Claim, Step-By-Step:

1. Review Your Policy Before Making An Appeal

For a valid appeal, you need to ensure that your denial was truly unwarranted. Look over every detail in your policy to see if your insurer’s reason for denial is justified based on the coverage terms. Policy language is complex and can be extremely confusing, even to the most experienced readers. Be aware that policies often provide coverage on one page, then deny the same coverage several pages later. 

2. Gather Any Evidence That Supports Your Reason For the Appeal

Evidence can include anything that can show proof of the damage incurred by your property. If you think it’s important, then it’s worth including it in your report. It can be receipts documenting repairs and costs, and it can be photos of the damage before the repairs were made. There’s no such thing as too much evidence, so collect everything that you can to prove your position is correct.

3. Write and Send Out a Detailed Report Stating Your Appeal

Establish your position in writing to the insurer. Your appeal will have a better chance of being accepted if you make an official and detailed report. This is a good time to hire a public adjuster who has the familiarity with insurance policy language to match your set of facts to finding policy coverage. The public adjuster will also prepare, in writing, your set of facts explaining why coverage exists, to help your insurer understand your position more clearly. 

4. Reporting Insurer Misconduct to the State’s Insurance Department

Reviewing your case with a professional public adjuster or an attorney, prior to acting, may be prudent, however if it is clear that your insurance company refuses your good faith attempts at correcting their misapplied denial, you can report them to the state’s insurance department. Doing so may culminate with the insurance company being held accountable for their actions to prevent them from causing more harm in the future.

Avoiding Denied Claims In the Future

You now know how to appeal a denied insurance claim. However, the best way to deal with a denial is by preventing it from happening. You can reduce your chances of being denied coverage by carefully reviewing your policy and having a plan in place for future incidents. An insurance consultant can review your policy and point out potential pitfalls that can affect you before you have the need to file a claim. From there, you can revise your policy coverage to promote opportunities for better future claim success. 

Need a Representative? Hire Altieri Insurance Consultants For Unfair Insurance Claim Denials

Whether you need to appeal a denied insurance claim or want to review your policy to avoid denials in the future, Altieri Insurance Consultants Tampa is here to help you get your life back! See how we’ve helped clients in the past receive what they were owed by hearing their success stories before reaching out to our dedicated team of public adjusters for more information.