Common Reasons for an Insurance Claim Denial

Homeowners, investors, and businesses rely on insurance to protect their property from unexpected disasters and damage. However, insurance companies are reluctant to pay – often searching for any technical error that they can use to justify refusing to pay. With more than forty years involvement with the insurance industry, including experience in insurance restoration and claims adjusting, we have seen the many tactics insurance companies employ to “deny, delay, and underpay.” Based on our experiences, the most common reasons for an insurance claim denial are: 

Late Filing

Your insurance policy includes strict timelines for filing and resolving claims. While these timelines may seem tedious, they should be taken very seriously – submitting a claim against your insurance policy even one day after the filing deadline can result in an insurance claim denial. 

Scope of Coverage

Insurance policies contain exclusion clauses that limit coverage. These exclusions can include types of damage and damage from certain events, such as flooding. Generally, the least expensive policies will have the most exclusions. If you file a claim for an event or damage that is excluded from your policy or otherwise not covered, you may receive an insurance claim denial for the scope of coverage. 

Non-payment of Premiums

Premium payments are the payments you make to your insurer in exchange for receiving coverage under the insurance policy. Without timely payments, your contractual agreement with your insurer may not be enforceable. If you fail to consistently pay your premiums on time, your insurer may deny your claim for premium non-payment. 

Insufficient Documentation

When making a claim against your insurance policy, you have the burden of proof to establish the damage being claimed. Unfortunately, the documentation that is necessary to establish your claim may be unclear. As a result, you may submit a claim that lacks the documentation that your insurer expects. If this is the case, your insurer may deny your claim for insufficient documentation.

Failure to Mitigate

Insurance policyholders have a duty to mitigate (reduce) damage. This means that a policyholder must take reasonable steps to reduce damage. If a pipe bursts, reasonable steps may include calling a plumber to help resolve the issue and mitigate further damage. Failure to mitigate may result in your insurer denying your claim or reducing the payment by the amount of damage you’re deemed to have failed to mitigate. 

False Statements

When filing official statements with the insurance company or an insurance adjuster, you must supply only truthful information. If you make false statements or supply false evidence, your insurer may deny your claim. Additionally, falsification of evidence or statements may result in further action by your insurer.

Insurance Lawyer in Rhode Island, Massachusetts, and Connecticut

At PALUMBO LAW, we have helped thousands of homeowners, investors, and businesses challenge insurance claim denials. Prior to entering law, managing attorney Richard Palumbo devoted 16 years to restorative contracting and insurance adjusting. As a result, he knows the insurance companies’ tactics such as “deny, delay, and underpay”, and he knows how to overcome these tactics to get you the money that you deserve. If you have had an insurance claim denied or are concerned about a claim, please contact our office to set up a consultation or complete the contact form