Contesting an insurance claim denial can be a complex process, but here are the steps you can follow to challenge the decision effectively:
Review the Policy: Start by carefully reading through the terms and conditions of her homeowner’s insurance policy. Pay particular attention to sections dealing with coverage for water leaks, maintenance requirements, and definitions of pre-existing conditions.
Understand the Explanation for Denial: The insurance company should have provided a detailed explanation for why the claim was denied. Examine this explanation closely. A ‘pre-existing condition’ typically pertains to an issue that was known or should have been known at the time the insurance policy was incepted, not necessarily related to how long someone has lived in a house.
Gather Documentation: Collect all relevant documents, including inspection reports, proof of regular maintenance, any correspondence with the insurance company, and photos of the damage. Documentation showing that the leak was not apparent before it was discovered can be crucial.
Request a Detailed Written Explanation: If the reason for denial is unclear, request a more detailed written explanation from the insurance company. You have the right to know precisely why the claim was denied and how the pre-existing condition clause was applied.
Consult a Professional: Consider hiring a public adjuster or an attorney specializing in insurance claims. They can provide an expert opinion and may identify aspects of the claim that can be contested.
File a Formal Appeal: Utilize the insurance company’s appeal process to formally contest the denial. Draft a well-organized letter detailing why you believe the denial is incorrect, supported by policy terms and evidence collected.
Contact the State Insurance Department: If the appeal is unsuccessful, you can file a complaint with your state’s department of insurance. They oversee insurance companies and can intervene if the denial is unwarranted.
Consider Legal Action: As a last resort, if her efforts do not lead to a fair resolution, consider pursuing legal action. An attorney can help assess the viability of filing a lawsuit against the insurance provider.
Challenging an insurance company can be daunting, especially for an elderly homeowner, but following these structured steps can help in seeking a fair resolution. It’s important to document everything and stay organized throughout the process.
