A denied insurance claim can be distressing, leaving you wondering why your claim was denied and what to do next. At CCA Public Adjusters, we understand how difficult and confusing it can be when an insurance company denies your claim.
Our public adjusters are here to help you make sense of things, appeal properly, and get the settlement you deserve. Keep reading for guidance on why claims get denied, your options after a claim denial, and how CCA Public Adjusters can significantly increase your chances of a successful claim.
Why Would An Insurance Company Deny A Claim?
There are various reasons an insurance company may decide to deny part or all of your claim. Some top reasons for denied insurance claims include:
- Pre-Existing Damage: Damage that occurred prior to your policy coverage period will typically be excluded. Insurance will only cover damage that occurs within the active policy term.
- Insufficient Documentation: Failing to thoroughly document damage and losses can lead insurers to deny claims due to lack of evidence. Gaps in evidence make it easier for adjusters to dispute the extent and cause of damages.
- Policy Exclusions: Most insurance policies have exclusions for damage due to inadequate maintenance, corrosion, rot, mechanical breakdowns, vermin/insects, and more. Insurers often claim excluded causes as grounds for denial.
- Misrepresentation: Any misrepresented or omitted information on your application can allow insurers to deny claims. Facts impacting their risk decisions like prior claims, damage, renovations, etc. must be disclosed.
- Fraud Suspicions: If adjusters suspect claim exaggeration or overt fraud, they may deny the entire claim. Suspicions often arise when losses seem disproportionate.
- Time Limit Exceeded: Insurance policies include time limits to report claims and damages. Exceeding these limits allows insurers to legally deny claims regardless of merits.
What To Do If Your Insurance Claim Is Denied
If you receive a full or partial denial for your insurance claim, stay calm and take the right steps. Here is what you should do next:
1. Carefully Review The Denial Letter
Read through the entire denial letter word-for-word, paying close attention to understand why exactly your claim was denied. Make sure to identify and make note of any vague denial reasoning, misleading statements, questionable logic, or factually incorrect points made by the insurance company.
Having a strong grasp of how they came to their denial decision is essential to then appealing it properly with counter-evidence. You want to gather facts and documentation that specifically targets and disproves every reason they cited for claim denial.
2. Collect More Evidence
The burden of proof lies heavily on you as the policyholder to provide evidence throughout the claims process. After a denial, it becomes critical to gather additional supporting evidence regarding the loss damages, repair costs, and policy coverage definitively demonstrating that their denial reasons are invalid.
Key types of evidence to collect can include:
- Recent repair estimates from multiple reputable contractors
- Photographs and video clearly showing damage from all angles along with measurements
- Weather reports confirming storm, wind, hail dates correlating with damages
- Written professional opinions regarding the cause and timing of damages from engineers, contractors etc.
- Receipts for temporary repairs or preventative measures taken after damages occurred
- Additional documentation verifying the market value costs of damaged items
Compile a thorough claim evidence package with dated and signed documents from credible sources directly tied to refuting each point made in the denial letter. The key is comprehensively addressing all of their cited denial rationales.
3. Send In An Appeal
Once you have gathered persuasive evidence revealing the inaccuracies in the denial reasoning, carefully craft a professional letter of appeal to send to the insurance company. Clearly lay out a fact-based argument for why their listed grounds for denial are invalid and how your newly submitted claim documentation from reputable sources proves your losses are in fact covered.
Many denial letters provide instructions regarding the proper department and contacts for beginning appeals claim processes. Maintain an organized, methodical tone while firmly reiterating key timing and damage details demonstrating where coverage applies within your policy. Request a prompt review and reconsideration based on the evidence-backed merits of your claim’s eligibility.
4. Contact Public Adjusters at CCA
Getting experienced public insurance adjusters involved increases denied claim success rates from around 20% to over 90%. Public adjusters legally act as policyholder advocates, negotiating with insurers on your behalf to prove and recover losses.
Call CCA Public Adjusters at 704-266-0996 or email info@ccauaa.com to discuss your denied claim. Our public adjusters can handle correspondence, investigate damage causes, find policy openings, and relentlessly negotiate to overturn improper claim denials.
5. Consider Legal Action
For wrongfully denied claims causing serious losses, pursuing legal action against your insurer may become necessary. An insurance denial attorney can review case particulars, determine bad faith, and initiate settlement demand letters or litigation. Approximately 30% of policy lawsuits result from unreasonable claim delays and denials.
The Role of CCA Public Adjusters in Your Claim
Our team at CCA Public Adjusters plays a critical role in managing denied claims. We assess the validity of the denial, help gather additional evidence, and negotiate with the insurance company on your behalf. Our goal is to ensure you receive the compensation you’re entitled to.
Benefits Of Working With CCA Public Adjusters For Denied Claims
- Expert Guidance: Our team has extensive knowledge of insurance policies and claim procedures.
- 95% Claim Approval Rate: Our high success rate comes from precise adjustment of complex claims. We know how to prove and justify losses within policy provisions.
- Faster Settlements: Insurers recognize our credibility, often expediting the review process which means you get paid sooner.
- Maximize Claim Value: With one of the highest settlement averages in the industry, our hands-on involvement consistently yields maximum claim reimbursements.
- Hassle-Free Experience: We handle all documentation, communications, negotiations, inspections, reports, and meetings while keeping you updated.
- No Out-Of-Pocket Costs: Our public adjuster fees come as a percentage of the settled amount, requiring no upfront payments from policyholders.
- Personalized Support: We offer tailored solutions to meet your specific needs.
Ready To Get The Insurance Claim Settlement You Deserve?
Don’t let claim denials prevent you from repairs and financial recovery. The public insurance adjusters at CCA have the persistence, expertise, and resources needed for denied claim success. Call us at (407) 516-7277 or email info@ccauaa.com to discuss your situation with our denial claim specialists.
We proudly offer free claim evaluations and 100% transparency regarding our customized services and adjustable fees structured around results. Maximize claim value and obtain peace-of-mind by having CCA Public Adjusters oversee your entire insurance claim process. Schedule a meeting today to start the process of getting your claim resolved.