Denied Claims

If you’re in the unfortunate position of having to file a claim on your homeowner’s insurance policy and then find the claim has been denied, it’s important to know what to do next. Your first instinct may be to lash out against your insurer, the company adjuster or the system in general, but try to remain calm and don’t let your emotions take over. Consider the situation rationally and logically. The following steps should help you negotiate the process to your best advantage.
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Why Deny?

First of all, remember this – insurance companies deny policyholder claims frequently. Sometimes their denials have good cause, sometimes they make mistakes, and other times they try to deny in hopes you don’t argue the fact and or accept a claim that is under the deductible. They may have made some kind of filing error, misread your policy terms or someone new and inexperienced in the insurance office didn’t fully understand the particulars of your policy. If you’ve suffered a loss and made an honest claim that’s been denied by your insurer, here are the steps you can pursue.
If you’ve not already been doing so, it’s important to keep accurate, detailed records of all communications with anyone having to do with your loss or claim. This includes your insurance company, any experts whose guidance you seek, witnesses to your loss, etc. Document emails, telephone calls and face-to-face meetings.
Review your claim and the claim denial. You should have received a denial letter from your adjuster which should include the section of your policy referenced as a reason for the denial. If you didn’t receive a formal letter of denial or don’t understand its contents then contact your adjuster. The company is obligated to explain the reasoning behind their denial.

Contact Admirable Public Adjusters to over turn your denial to an APPROVAL TODAY!

Our team can verify your coverage, document and value your losses, and negotiate the maximum settlement allowed under the terms of your homeowners insurance policy. The sooner you contact US, the more we can do to help you recover!
When your home has been damaged—whether by bad weather, fire, theft, or other causes—you expect that the homeowner’s insurance policy that you’ve dutifully been paying will kick in and cover your losses. That’s what you’ve been paying for all this time, right? Your claims adjuster should be working for you to help you get the money that you’re owed. Unfortunately, that’s not always the case. Here’s what you need to know about working with an adjuster to get a settlement that works for you.

You shouldn’t be intimidated by the job title or in thinking that you’re facing down with a professional negotiator who is out to “get” you. There are two key facts that you should bear in mind:

  • Your insurance company must act in good faith. The contract you entered into was mutual, after all. If the insurer fails to act in good faith, it may be liable for a lawsuit,      which can quickly get much more expensive than simply paying the claim.
  • You have the upper hand when it comes to negotiations. The adjuster likely has dozens of claims come across his or her desk every week, but you only have one claim to handle—your      own. You are the expert when it comes to your claim.

Forearmed with that knowledge and with a little bit of legwork to prepare, you’re already in a great position for your claim. You may not want to accept the very first offer that the adjuster makes, but there’s nothing wrong with accepting a reasonable settlement and closing the claim out. Sometimes, though, it doesn’t work out that easily.

If you can’t get your rightful claim covered to a satisfactory amount (or at all) and you know the damage should be fully covered according to your policy, that’s when things can get tough. At this point, it may be a good idea to contact an attorney who has experience with the claims process.

Your attorney will know about the many ways that insurers often try to use to minimize or deny claims that they should rightfully be paying out, and he will work to protect your legal rights. Never let the insurance company talk you out of hiring an attorney, and if things have gotten to a point where you’re not comfortable negotiating on your own, don’t delay getting legal assistance. The claims process is often on a short timeline that varies according to policy, and the longer you wait, the harder your claim is to prove.

Insurance companies were founded with the purpose of protecting peoples’ assets and providing them with benefits in the event of unforeseen losses. This industry is notorious for failing to live up to its responsibilities, however, as insurance companies employ questionable and illegal tactics to avoid meeting their end of the agreement when it is time for them to pay claims. Obtaining legal representation will let your insurance company know that you are serious and cannot be taken advantage of.

Deny and Delay: An Effective Tactic Employed by Insurance Companies When Evaluating Property Claims

The two primary tactics that insurance companies use to avoid paying claims are known as deny and delay. For example, if you require a medical procedure to address an illness or injury, your health insurance company may claim that the procedure is not needed and refuse to pay for it. If the insurance company knows that it cannot get away with denying that the claim is justified, insurance adjusters may string policyholders along and continue to aggravate them by putting up roadblocks to delay payment. If your insurance company is implementing either of these tactics, you may need to seek legal representation to move the process along to a conclusion which is in your favor.

One of the mistakes that many people make when an insurance adjuster is denying that the claim is covered or delaying the process is to accept a settlement that is not in their best interests. The insurance company may require people to give up certain legal rights as part of the settlement offer and may also be fishing for information that can be used for its legal defense should the matter make it to court.

If you choose to communicate with an insurance company yourself, it is important for you to know that every conversation will be recorded so that the insurance company can look for errors in your recollection of events or other information that can be used against you. It is well within your rights to refer your insurance adjuster to your legal counsel. Some insurance companies will threaten you at the mere mention of an attorney and make the erroneous claim that the deal being offered will not be available if you seek the advice of an attorney.

The truth of the matter is that insurance companies know that an attorney is aware of both the laws that apply to your claim and the legal responsibilities that the insurance company bears. Having an attorney puts you in a stronger position when negotiating with insurance adjuster, which is exactly why they want to deter you from retaining one.

Another thing to consider is that insurance companies spend massive amounts of money maintaining their own legal teams, which are on call and available to represent their interests. They will jump at any opportunity when their legal teams feel they have the grounds to challenge a claim or deny payment. Even if you believe that the insurance company is being cooperative and working with you, the insurance company’s legal team is already assessing the strengths and weaknesses of your claim.

Your Rights Under the Illinois Insurance Act.

If your insurance company has decided to play games, their tactics may be questioned under the Illinois Insurance Act, and if a court determines that the company’s methods were illegal or your insurance adjuster wrongfully denied your claim, you may be able to collect punitive damages in addition to the full value of your claim. This is yet one more reason you should retain the services of an experienced and qualified lawyer