What to Do if Your Homeowners Insurance Claim Is Denied- Experian - Experian (2024)

In this article:

  • Why Are Homeowners Insurance Claims Denied?
  • What Are Your Options When a Homeowners Insurance Claim Is Denied?
  • How to Pay for Home Repairs if Your Insurance Claim Is Denied

When you're faced with damage to your home and property from a fire, tornado or other disaster, learning that your homeowners insurance claim has been denied can be devastating. Homeowners insurance claims can be denied for many reasons, including unpaid premiums and incomplete documentation. Here are some common reasons your claim may be denied and what you can do if this happens to you.

Why Are Homeowners Insurance Claims Denied?

Common reasons homeowners insurance claims are denied include:

No Policy in Force

If you don't pay your premiums, your home insurance policy could lapse. Consider setting up autopayments to avoid this risk. If you've just bought the policy and haven't yet made a payment, it won't be in force.

Not a Covered Peril

Homeowners insurance typically includes liability coverage for injuries on your property as well as damage or loss of your home's structure and your possessions from fire, smoke, wind, hail, lightning, theft, vandalism and some water damage. It also covers additional living expenses (ALE) if you must move out while repairs are being made.

Homeowners insurance usually doesn't cover damage from floods; earthquakes; sinkholes; landslides; sewer, septic tank or drain backups; or failed sump pumps. It also may not cover mold, plumbing or water damage. To protect your home, consider buying additional flood insurance or earthquake insurance policies or adding riders to your existing policy.

Damage Is From Negligence or Normal Wear and Tear

Damage from normal wear and tear or lack of maintenance isn't covered by homeowners insurance. Neither is damage from pests, war, pollution and nuclear accidents.

Missed Filing Deadline

There's usually a time limit for filing a homeowners insurance claim, so don't delay. Check your policy or contact your insurer for details.

Suspected Fraud

When you file a home insurance claim, an insurance adjuster typically visits your home to inspect the damage and calculate any insurance payout. If the adjuster finds something questionable, your claim may be denied.

Insufficient Documentation

The more evidence you provide to support your claim, the better. A home inventory list including photos, receipts and the estimated value of your belongings can help quantify your loss. You might also be asked for photos of damage or receipts for emergency repairs.

You Made Unapproved Repairs

You need to make urgent repairs, such as boarding up broken windows, to prevent additional damage to your home. However, you should delay making major repairs or moving out of your home until the insurance company approves these actions, or your claim could be denied.

What Are Your Options When a Homeowners Insurance Claim Is Denied?

When your home insurance claim is denied, the insurance company should provide a written explanation. If you review the explanation and still believe your claim was unfairly denied, try these steps.

Contact the Insurance Company

Claims are often denied due to insufficient information. Ask your claims adjuster what's missing from your claim and how you can help. Additional photos, receipts or a home inventory may be all that's required to get your claim reevaluated.

Keep Detailed Records

Document all communications with the insurer, including letters, emails, texts and phone calls. Keep copies of every document and photo you submit. Note whether the insurance agent fails to keep appointments or return calls or emails; this could be helpful in court.

File an Appeal

You may have to file a formal appeal with the insurance company to review your claim. There's typically a time limit for this; check your policy or ask your insurance agent for the deadline and directions for filing an appeal.

Contact Your State Department of Insurance

State insurance departments regulate insurance companies according to state laws and can explain your rights when your claim is denied. If filing an appeal with the insurance company gets no results, file an official complaint with your state's department of insurance. Some states also provide for mediation between insurers and homeowners.

Hire a Public Adjuster

Public adjusters examine damage to your home just like insurance adjusters do, but they work for you. Public adjusters may charge a flat fee, hourly rate or percentage of your insurance payout. Find public adjusters through your state department of insurance, the National Association of Public Insurance Adjusters or the National Association of Independent Insurance Adjusters.

Hire an Attorney

Some states don't allow public adjusters to assist homeowners with insurance claims; in this case, you'll need an attorney. You might also want to sue if you believe the language in your insurance policy is deceptive. Check your policy and state laws to see if there's a deadline for filing a lawsuit.

How to Pay for Home Repairs if Your Insurance Claim Is Denied

The average homeowners insurance claim is $14,935, according to the Insurance Information Institute. If your insurance company won't pay, you have other options for financing home repairs.

  • Seek help from FEMA. The Federal Emergency Management Agency (FEMA) may offer temporary housing, money for living expenses or home repairs if your home is damaged by a major natural disaster.
  • Tap your emergency fund. Be sure to adjust your budget to replenish your savings as soon as possible.
  • Get a personal loan. Available from banks, credit unions and online marketplaces, personal loans typically require no collateral and may have fixed or variable interest rates. You'll receive a lump sum and pay it back in monthly installments over a relatively short time.
  • Use a home equity loan. For larger repairs of $10,000 and up, you could use a home equity loan to borrow a lump sum against the equity in your home. Interest rates are usually lower than for personal loans or credit cards; terms of up to 30 years help make monthly payments manageable. Because home equity loans use your home as collateral, however, failing to repay the loan could cause you to lose your home.
  • Use a home equity line of credit (HELOC). A HELOC uses your home equity as collateral for a revolving line of credit you can borrow from, up to your credit limit, during the draw period. Make interest-only payments on the amount borrowed until the draw period ends; then you'll repay the principal, typically over 20 years. HELOCs often have variable interest rates, so payments may rise. Like home equity loans, they can put your home at risk if you can't make the payments.
  • Consider a credit card. Credit cards can be sufficient for smaller home repairs. Just avoid maxing out your card, which could hurt your credit score. Pay off the balance as soon as possible, or interest can quickly snowball. An intro 0% annual percentage rate (APR) credit card could be an option: Pay off the balance before the promotional period ends, and accrue no interest.

The Bottom Line

Whether you're applying for credit to cover home repairs or shopping for new homeowners insurance, checking your credit score and credit report could save you money. Insurance companies in many states check your credit-based insurance score before issuing a policy, just as lenders check your regular credit score. Paying down debt and making payments on time can help improve your credit score for lower interest rates and better terms.

What to Do if Your Homeowners Insurance Claim Is Denied- Experian - Experian (2024)

FAQs

What to Do if Your Homeowners Insurance Claim Is Denied- Experian - Experian? ›

If your claim is denied without valid reason or you suspect bad faith practices, it's worth consulting with an attorney. They can interpret policy coverage to determine whether your coverage is being fully applied and advocate on your behalf.

What are the possible solutions to a denied claim? ›

If you believe that the insurance company's decision was incorrect, you can file an appeal. This may involve submitting a written request to the insurance company explaining why you believe the claim should be approved. You may also be able to present your case to an independent review board.

How do I argue with my home insurance adjuster? ›

  1. Step 1: Contact your insurance agent or company again. Before you contact your insurance agent or home insurance company to dispute a claim, you should review the claim you initially filed. ...
  2. Step 2: Consider an independent appraisal. ...
  3. Step 3: File a complaint and hire an attorney.
Feb 16, 2024

What is the protocol to have a denied claim resolved? ›

Ask the insurer to explain the reason for the denial in writing. Review your policy to see if you should be covered. Ask the medical provider to help you get answers from the insurer. Take notes about all discussions with the insurer and the health care provider (include dates, names and what was said).

Why do I keep getting denied homeowners insurance? ›

Carriers typically look at the history of claims on a given property — if there have been a lot of payouts for foundation repair, for example, it might suggest a more serious structural problem. In addition, If you've filed a lot of claims on a previous homeowners policy, it could also count against you.

What are the 3 most common mistakes on a claim that will cause denials? ›

Here, we discuss the first five most common medical coding and billing mistakes that cause claim denials so you can avoid them in your business:
  • Claim is not specific enough. ...
  • Claim is missing information. ...
  • Claim not filed on time (aka: Timely Filing)

How do I challenge an insurance claim denial? ›

You can start the appeal process by calling your insurance provider. Ask for more details about the denial and review your appeal options. Your insurance agent can walk you through the appeals process to help get you started.

What not to say to a home insurance adjuster? ›

However, if you do have to speak with the company's adjuster, here is what not to say to an insurance adjuster.
  • Don't Admit Fault. What should you not say in a claim? ...
  • Don't Downplay Damages. ...
  • Don't Give a Recorded Statement. ...
  • Don't Accept the Initial Settlement Offer.
Mar 22, 2023

What not to say when talking to insurance adjuster? ›

5 Things You Should Not Say to Car Insurance Adjusters
  • Do Not Admit Fault. ...
  • Do Not Minimize Personal Injuries to Adjuster. ...
  • Do Not Describe Your Injuries. ...
  • Do Not Hypothesize What Happened During the Accident. ...
  • Do Not Provide a Recorded Statement. ...
  • Having Trouble with an Insurance Company After an Accident?

What happens if you disagree with insurance adjuster? ›

Your insurance policy likely has an arbitration provision, meaning that when you and your adjustor cannot agree, a third party will be assigned to hear you out and recommend a settlement.

Can you resubmit a denied claim? ›

If you've received a denial, you have the option to submit it again. Depending on the denial reason, you may only need to resubmit the claim with any corrected fields.

What happens after a claim is denied? ›

You may be able to appeal to your insurance company multiple times based on the evidence you provide. If the outcome is not satisfactory, you can consider contacting a public adjuster to advocate on your behalf or file a complaint with your state's insurance department to act as an intermediary for the dispute.

What steps would you take if you received a denied claim due to an incorrect diagnosis code? ›

Contact your healthcare professional

If the denial was due to a medical coding or data entry error, your professional's office may be able to correct it and resubmit the claim to your health plan. Sometimes, your insurance company may contact your professional directly to resolve the issue.

Is it hard to get homeowners insurance after being dropped? ›

If your insurer nonrenewed or cancelled your policy because your house needs repairs or you filed too many claims, you may have difficulty finding an insurance company willing to insure your home.

Can you be turned down for insurance because of your credit score? ›

In some states, yes, you could be denied coverage due to your credit. A very low insurance score might mean that a company considers you too great of a risk to insure, which could lead to the carrier denying coverage. However, some states do not allow this practice.

In what circ*mstance would a property insurance claim be rejected? ›

Insurance companies expect policyholders to take reasonable care of their property. If damages occur due to negligence or lack of maintenance, the claim may be rejected. It is essential to keep your property in good condition, address maintenance issues promptly, and take necessary precautions to prevent damages.

How would you resolve a denial for no authorization? ›

Submit an appeal.

Contact the plan for details about its appeal process and filing deadlines. If treatment is the issue, focus on why the treatment is the most clinically (and cost) effective. Include copies of relevant documents.

What actions would you take for a claim that is denied due to timely filing? ›

Your biller fixes the claim, resubmits with the correct information, and the claim returns once again, this time denied for timely filing. Next you must appeal the denial. Some carriers require special forms and others do not. Regardless, you should attach a copy of the claim and your proof of timely filing.

What are the reasons for claim denial and how can you correct them? ›

Six common reasons for denied claims
  • Timely filing. Each payer defines its own time frame during which a claim must be submitted to be considered for payment. ...
  • Invalid subscriber identification. ...
  • Noncovered services. ...
  • Bundled services. ...
  • Incorrect use of modifiers. ...
  • Data discrepancies.

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