Ask Apex: Insurance Claim Denied?


Ask Apex: Insurance Claim Denied?By Jeremy Neel

Have you ever had an insurance claim denied? There are several reasons a claim can be denied.

1. The incident was not covered in your insurance policy. It is extremely important to read an insurance policy, and understand which perils may be covered and which ones are not before filing a claim. For example, your neighborhood floods, and you have not been covered by flood insurance, then your claim would be denied.
2. The premiums have not been paid in a timely manner. If your insurance company has not already canceled your policy, they have the right to deny your claim for late payments of your premiums.
3. Acts of negligence of the homeowner. For instance, you have a hot water leak, and you attempt to fix the problem on your own instead of hiring a plumber, this would be considered negligence. Your claim could be denied because of improper maintenance involving the hot water heater.
4. You may not have enough coverage on your home. Homes can be insured for either Replacement Cost or Actual Cash Value. Replacement cost would be the price to restore the home to comparable conditions as when the home was first purchased. Actual Cash Value is the cost of replacing the home back to current conditions minus depreciation, or the market value of your home. Once again, it is extremely important to make sure you have enough coverage on your home should you ever need to file a claim due to water, fire, mold, or other perils that may effect your home.
5. Not filing a claim in a timely manner. Waiting too long to file a claim could result in the denial of your claim. It would be advantageous to discuss with your insurance company the time frame in which to file a claim, just in case the occasion should arise.
6. Filing a claim under false pretenses. Once a claim is filed, an insurance adjuster will come to your home to prove it is worthwhile for the insurance company’s payment for necessary repairs. If the adjuster finds you have not been truthful with your claim, or the damage is not as extensive as he/she can prove, your claim may be denied. Taking pictures of your property, once your policy is written, and after damage has occurred, would be helpful to your adjuster.

Here are a few ways to minimize denial of a claim:
1. Get to know your homeowner’s insurance policy, front to back. Understanding what perils are covered and which ones are not will play an important role when unexpected incidents occur.
2. Increase your coverage when necessary. For instance, should you build an addition to your home, or remodel your kitchen, you will need to increase your coverage as your value will increase.
3. Pictures, pictures, pictures. Taking inventory and pictures of your belongings and the structure of your home can benefit the adjuster, or, if necessary, prove your case should your adjuster deny your claim.
4. Let your insurance agent know of any life changes, such as marriage, or addition of residents into your home. In this case, the added possessions should be covered in your insurance policy.
5. Review your policy at least once per year. Should you have any questions regarding your homeowner’s insurance policy, your insurance agent would be glad to explain your coverage. It is best to have the questions answered before an event occurs caused by an emergency. In this manner, you are properly prepared to handle the stress that comes with the unexpected.

Apex is the people’s choice when it comes to water, fire, wind or mold damage. Should you have an emergency water loss or mitigation needs, please contact Apex at (850) 660-6900.