Representing People With Denied Insurance Claims

Contesting a home insurance claim denial or settlement

| Jan 21, 2021 | Insurance

Disputes over homeowners’ insurance claims can occur for many reasons and may be frustrating. There are ways you can deal with these property insurance disputes but more complex cases may require legal assistance.

Know coverage

Review your homeowner’s insurance and its dollar limits. Determine if it covers the damage before you dispute coverage. This will strengthen your arguments in any dispute.

Review claims

Ask your insurer for an explanation if your claim settlement is lower than anticipated. Have the adjustor disclose the cited exclusion or term in the policy.

Prepare a log containing dates, who spoke to you, and statements made by the insurer or claims adjustor. Send a confirmation e-mail if you received information in-person or by phone.

After you learn your insurer’s position, get helpful documents. If there is a dispute over a home repair claim, for example, get a written estimate from a contractor.

Appeal

Disputing a denial or low settlement can start with a letter to your claims adjustor that briefly explains your position. Include any supporting evidence.

Request that that your adjustor review the claim and provide a response within a short time, such as 10 days. Provide a copy of the letter to the adjuster’s supervisor. If possible and safe, obtain proof of mailing.

Your correspondence should be polite. Do not threaten to hire an attorney, for now. Insurers may turn this matter to their legal department if there is an adversarial tone.

At-home visit

If there is a dispute over the extent of the damage, a second inspection by the adjustor may be helpful. Have any independent contractors or other professionals meet the adjustor at your home if they submitted second opinions. It can be helpful when professionals show damage to the adjustor.

Appraisal

Appraisal may help resolve disagreements. The policy holder and the insurer select separate appraisers to review the property damage and try to agree on the amount owed. A neutral party, an umpire, decides any deadlocks.

Appraisals, however, will not resolve disagreements over coverage, policy language or other claim issues.

Mediation

Mediation involves hiring an impartial mediator to help you and an insurance company representative reach a resolution. The cost is divided between the parties unless the policy requires the insurer’s payment.

The process is voluntary, nonbinding and typically fast. It does not prevent other measures for pursuing your claim.

However, insurance company representatives have mediation experience. They may use it to learn about your case.

Other serious options include filing a complaint with the Oklahoma Insurance Department. You may also need to seek legal representation or seek assistance with filing a lawsuit if the insurer is not acting in good faith or the claim is complicated.