Filing a claim with your homeowners insurance company can be a stressful situation. Not only have you suffered a loss but, depending on the situation, you could end up receiving a low-ball offer or having your claim denied altogether
But a denied claim isn’t necessarily the end of the discussion — you have the right to appeal a claim, hire a public claims adjuster, or even file a complaint with your state’s department of insurance to get your claim paid out.
We break down the process of disputing an insurance claim to help you get the money you deserve.
How to dispute an insurance claim denial
If you believe your home insurance claim was wrongly denied, here are the steps you can take to get it resolved and, ideally, paid out.:
1. Appeal the claim with your home insurance company
If you've reviewed your policy information and believe your home insurance claim was incorrectly denied, you can call your insurance company and ask them to review your claim again, or even request a different claims adjuster be sent to perform a new inspection.
Gather any documentation that may help your case, including photos, videos, police reports, and witness statements, and submit them along with your request for an appeal.
2. Hire a public adjuster to review your claim
If your appeal was denied, you have the legal right to hire an independent or public insurance adjuster to review your claim. A public adjuster isn’t affiliated with any particular insurance company and can help you prove that your claim should have been paid. If the public adjuster finds that your claim was wrongly denied, you can take that information back to your insurance company and request another appeal.
But keep in mind that hiring an adjuster on your own comes at a cost and doesn’t guarantee your claim will be paid, so you’ll want to be certain you’re correct about your claim before investing the extra time and money into hiring a public adjuster.
3. File a complaint with the state.
If you’ve filed an appeal and hired a public insurance adjuster but your claim is still denied (or the settlement the insurance company is offering is too low), you can register a complaint with your state’s department of insurance.
The department of insurance can take your complaint and direct you to other resources that might be helpful. Filing a complaint is an especially good idea if you believe your claim was denied in bad faith, though your state’s insurance department is there to help you no matter why your claim was denied.
4. Hire an attorney to dispute the claim in court.
If all of these steps have failed and you want to take your insurance company to court over the denial, you’ll need to reach out to an attorney for assistance. A lawyer who specializes in insurance claims can guide you through the process, but you’ll pay an hourly rate and other fees. You’ll want to weigh those extra costs against any potential settlement, or worse, having your claim denied again.
Why do home insurance claims get denied?
Home insurance claims can be denied for a variety of reasons, including some things that are beyond your control, including:
The damage isn’t covered by your policy. If the damage to your home was caused by something that’s excluded from your policy, like termite damage or black mold, any claim you submit will be denied.
The damage is considered normal wear and tear. Your home and belongings deteriorate over time, and your insurance company doesn’t consider that covered damage. If you have problems like rotted shingles, a slow leak that causes water damage problems, or routine maintenance issues, your homeowner’s coverage will likely deny a claim for those damages.
But the good news is that some denied claims are caused by things you can control, which means that a little effort on your part can be the difference between a claim that’s denied and a claim that’s paid in full.
Some problems you can prevent are:
Your home insurance lapsed. If you miss a payment and your insurance policy gets canceled, any damage that happens won’t be covered. Making your policy payments on time is a good way to avoid having a claim denied for nonpayment.
Your claim is missing information. Filling out a claim requires a lot of information, including proof of damage, receipts, and other documents showing proof of ownership. If you don’t provide the right information, your claim will be denied. You can make sure you’re prepared for future claims by keeping receipts and other proof of purchase information, and taking pictures of your property while it’s in good condition.
You weren’t honest with your insurance company. Lying on an insurance claim is a very bad decision. Filing a fake claim, hiding pre-existing damage, or over-inflating the value of your property are all types of insurance fraud and can cause your claim to be denied or even put you in prison. Be completely honest with your claims adjuster to make sure your claim isn’t denied for fraud.
How to negotiate a homeowners insurance claim
Sometimes an insurance company will approve a claim, but pay less than you think they should. If this happens, you have the right to negotiate the claim. Remember: You don’t have to take the first offer if you feel it’s too low.
Before you reject their offer, you’ll need to do some research and figure out how much you should be paid for your claim. It’s important to know the cost of repairs, as well as the details of your home insurance policy to have an idea of how much you should get paid when you file a home insurance claim.
Collect quotes from multiple contractors, review your policy details, and collect evidence for your claim (like pictures from before and after the damage) to strengthen your case for how much you should be paid when you file your claim. Also, try to be polite and honest whenever you speak with your claims adjuster — it will go a long way toward making your negotiation a successful one.
Frequently asked questions
Which insurance company denies the most claims?
While some insurance companies have better reputations than others, the number of claims denied by a company depends on a variety of factors. The best way to determine if a company does the right thing for its customers is to check its complaint score with the National Association of Insurance Commissioners. You can do this by reading the customer experience section of our home insurance reviews.
What is the 80% rule in homeowners insurance?
Also known as the coinsurance clause, the 80% rule says you need to have a policy that covers at least 80% of the total value of your home to be able to receive full replacement cost for any losses.
Do insurance companies intentionally deny claims?
Claims that aren’t covered by your policy, like termite damage to your home, will be intentionally denied by your insurer. Also, claims where fault or damage is not clear will be denied, and it’s your responsibility to provide additional evidence if the denial was incorrect. If you believe your claim was denied in bad faith, you can file a complaint with the insurance commissioner or speak with an attorney about how to address the situation.
