Insurance is meant to protect you financially and legally in the event of an accident. Auto and homeowners insurance can keep you from having to shoulder the burden of costly repairs or replacement if your car or house is damaged. Unfortunately, claims are occasionally denied for a variety of reasons. Fighting this judgment is not easy in some cases, and in a select few requires an attorney – but there are things you can do to challenge a denial yourself.
Contesting an auto claim denial
Step 1: If your insurance company comes back with a claim figure that is lower than expected, contact the insurance rep (adjustor). Present your case and reasoning for believing you should be awarded more money. There is often room for the adjustor to pay more. If that doesn’t work, ask to speak to a supervisor or anyone whom has the authority to make or change claims decisions.
Step 2: If you can’t reach an agreement with the adjustor, consider hiring an independent appraiser. “Having an independent analysis of your situation that agrees with your assessment will strengthen your case,” according to the DMV.
You might also need to think about hiring an attorney who specializes in auto insurance claims. You can often get a free consultation, and at that time the attorney will let you know if you should proceed.
Step 3: If you’ve exhausted the first two options, consider trying mediation, arbitration, or small claims court. Mediation is a non-binding legal proceeding which is moderated by an unbiased third party. Arbitration is a similar process, except that both sides must follow the ruling. If the matter is serious enough, you can take your case in small claims court. All of these options can result in substantial legal fees, so make sure the expense is worth it before going this route.
Refuting a homeowners claim denial
Step 1: Review your policy and determine exactly what is (and isn’t) covered. You want to understand what type of damage is covered as well as the dollar amounts included in your policy.
Step 2: Next, review your claim. Ask questions and pay attention to specific language or exclusions. Document everything the insurance company and/or claims adjustor says, including a detailed log of everyone you speak to, when you spoke to them, and what was said. Send follow-up emails to confirm what you talked about.
If you decide to fight the denial, start preparing documents to prove your case. It’s a good idea to hire an independent contractor to obtain a written estimate. If you need help, the consumer advocacy group, United Policyholders, has examples of forms and documents you can use.
Step 3: Once you’re ready, send a letter to your claims adjustor. You’ll want to include your documentation, independent estimates, and any other “proof” needed to make your case.
Step 4: You can also request that your insurance company send an adjustor to your home so he or she can see the damage in person. You’ll want to have your independent contractor or legal counsel present as well when either is involved. You can also choose to have an appraisal done. In this case, you and your insurance company will both choose an appraiser. They will review the damage together and try to decide how much money you are owed.
Step 5: If all else fails, you can choose to go to mediation, or as a last resort, file a lawsuit. Both proceedings can result in substantial legal fees so make sure you understand the financial consequences.
Good insurance offered by reputable companies typically pays out when you have a legitimate claim. If you are ever forced to challenge a denial, however, you do have avenues to get what you are owed.
If you have more questions about homeowners or auto claims and policies, contact us.