The Homeowner’s Guide to Fighting a Denied Insurance Claim
Do You Know The Proper Steps to Fighting A Denied Insurance Claim?
Most property owners who make insurance claims for obvious property damage get paid something. What insurance companies are good at is nibbling around the edges, meaning they pay most of the claim but deny or underpay part of the claim. In this way you are left mostly satisfied, and you figure the big insurance company knows best so you don't figure it's worth fighting.
By using this tactic, insurance companies add MILLIONS to their bottom line each year. They know that only 20% of underpaid claims will ever be disputed! And even if they eventually pay a majority of the disputed claims (along with mandatory attorneys fees for those that hire an attorney) they’ll still come out way ahead. Remember, insurance is BIG business and they’re out to make as much profit as possible at your expense.
What's worse, if you make a claim that is denied, or if the repairs aren't made in full due to lack of claim funds, you could actually be at risk of your premiums being increased and/or a decrease in coverage, including the possibility of your policy being cancelled altogether.
Don’t be a victim twice, fight back!
So what do you do if your claim is delayed, underpaid, or denied altogether? Below we outline the 5 steps you can take to recover what you deserve.
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Discrepancies over the extent of damage and repair costs are common between insurance companies and policy holders. Understandably, policy holders pay premiums and expect their claim to be paid in full. Conversely, insurance companies want to pay as little in claims as the policy holder will accept.
But not all denials or underpayments are intentional. Upon receiving a payout that's less than satisfactory, review the claim documents to make sure you understand the reason for the denial and see if there are mistakes. If something doesn't make sense or doesn't seem right, call the claims adjuster and ask questions. Seek out informational resources on Property Insurance Claims such as this blog or the Texas Department of Insurance.
You should also consider if there are ways to improve your claim submission. Is there additional information that could be provided? Would submitting more photos, videos, or estimates affect the outcome?
Insurance policies are written by attorneys for the insurance company's benefit. They're intentionally difficult for the average policy holder to understand in an attempt to keep you in the dark.
Don't give in to the temptation and assume they're right just because they wrote the document! Do your best to understand your insurance policy. Read the details of what is covered and what is excluded. Double check that you didn't over-estimate or under-estimate the amount of coverage you had when you filed the claim. Understand your deductible and what role it plays. Ask questions!
If you have hail damage, and hail damage is covered in your policy, and the claim is denied - the insurer has acted in bad faith and must be held accountable. You should then compare the denial reason(s) with the language cited in your policy. If the reasons are ambiguous or vague, you should request further clarification in writing from your insurance company.
When you do, make sure you document all interactions to include the date and time, person(s) you spoke to, and any dates or commitments made during the interaction. Start a file and keep these contact notes as well as any written correspondence together in that file. You might need this evidence down the road should legal action be unavoidable, and the more documentation you have, the more likely you are to win.
If you can’t get anywhere with your insurance adjuster, you can file a formal appeal with the company. Most insurers have a standard form to do so.
Organize the facts and present them in a straightforward manner. Don’t get emotional or make any threats, just stick to the facts. Have your spouse or a friend review the appeal from the insurers perspective to make sure it makes sense to them. Include any feedback they have to improve your appeal and increase your chances of victory. Keep a copy of the appeal and document when and how it was sent.
Finally, confirm the appeal process timeline with the insurance company. The process will take time, so be patient. Be sure to regularly follow up at regular intervals, documenting each interaction as noted previously. Don’t be afraid to request to speak to a supervisor or manager to facilitate the process, especially if your claims representative becomes unresponsive or if they don't respond in the time frame they said they would.
If your appeal is denied and you still dispute the insurance company’s action, you can file a complaint with the state of Texas.
You can go to the Texas Department of Insurance website or call 800-252-3439 for assistance. The Texas Department of Insurance helps consumers resolve complaints against insurance companies, insurance agents, and adjusters. Each year, they help thousands of Texans get millions of dollars in additional claim payments and refunds and they may be able to help you too.
Report unfair treatment to the Texas Attorney General’s Office at 800-252-8011 or make a claim on the Attorney General's website. The Attorney General for the state of Texas protects consumers and the legitimate business community. Lawsuits are filed on behalf of the state and the public good. This agency cannot represent individual consumers. Nevertheless, some legal actions do produce restitution for individual consumers.
If you’ve exhausted all other avenues, don’t have the time or desire to fight yourself, and you’re convinced the insurance company is trying to pull one over on you, it may be time to get professional help. A great place to start is with a law firm experienced in Property Insurance Claims. Look for those with a clean record with the State Bar of Texas and good ratings on AVVO, a lawyer rating service.
The good news is that getting the help you need requires zero out-of-pocket cost!
If your claim has been denied in writing, Texas law says you have the right to hire an attorney to help you enforce your claim, and if the claim is eventually paid (which it usually is) the insurance company is responsible for paying for your legal fees.
For that reason, most competent lawyers who help homeowners with “bad faith” insurance claims do so on a contingent basis, and so can The Lane Law Firm.
For help with your claim, call our experienced legal team at 877-408-3328 or schedule a consultation at a time most convenient for you.
NO WIN, NO FEE GUARANTEE
We are pleased to assist clients with property insurance claims on a contingent fee basis, meaning that if the firm does not obtain a recovery, or if the amount recovered does not exceed the amount of costs and expenses, then the firm is not entitled to any fees.
ZERO OUT-OF-POCKET COST TO YOU MEANS ZERO RISK. CONTACT US FOR MORE DETAILS.
What people are saying
We made our claim and got denied. Our company said our roof wasn't damaged enough. Boy are we glad we had [The Lane Law Firm] fight for us. Eventually we got every penny we had coming to us. Thanks to the great team there!
- Judy S.
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