Make an Appeal: Denied Property Insurance Claims

No-Nonsense Guide to Turning Rejection into Victory

Got a big, fat “denied” stamp on your insurance claim? Ouch—we know how much that hurts. A denial isn’t the end of the road—it’s just a detour. If you’re ready to file an appeal for your denial, it’s time to roll up your sleeves, gather your facts, and call the Premier Claims team to tackle the appeal process head-on.

Step 1: Get to the Bottom of Why Your Claim Was Denied

First, understand why you can appeal your denied insurance claim. Your insurance carrier will send you a formal denial letter explaining their reasons. The terms could be straightforward, like missing documentation or a policy exclusion, but sometimes, they’re more complicated.

Review the Denial Letter Thoroughly

Compare the reasons in the letter with the terms of your policy. Does the denial align with your understanding of your coverage? 

Discuss the Denial

Contact your claims adjuster or agent if the explanation doesn’t add up. Sometimes, a simple conversation can clear up misunderstandings. 

If the letter looks like it’s written in a foreign language, Premier Claims is here to help. Our team will break down the fine print and help you understand your policy and the so-called reasons for denial.

Step 2: Gather Your Evidence Like a Pro

Once you understand why your claim was denied, it’s time to build your case. This step is all about showing your insurance carrier why they got it wrong. You’ll need:

Proper Documentation

Collect all the paperwork tied to your claim—damage photos, repair estimates, and correspondence with the insurer. If you have photos of your property before the damage occurred, make sure to include them! 

The key here is thorough documentation. The more compelling your evidence, the harder it is for the insurer to stick to their denial. 

Step 3: File a Formal Appeal

If a friendly conversation with your insurance carrier doesn’t lead to a resolution, it’s time to file a formal appeal. Your insurance policy will outline the specific appeals process, including any deadlines. Don’t miss these—once the window closes, so does your chance to appeal.

Write an Effective Appeal Letter

Address the reasons for the denial directly and back up your argument with the evidence you’ve gathered. Make sure everything is organized and easy to follow. 

Stay Professional

This is all about facts, not feelings. Keep the tone professional, and let your evidence do the talking. 

Do you want your appeal letter to be as effective as possible? Premier Claims can take this task off your hands, writing a clear and compelling appeal intended to increase your chances of success. 

Step 4: Get a Public Adjuster on Your Team

Here’s where things can start to turn in your favor. A licensed public adjuster, like those at Premier Claims, can make a world of difference. They understand the ins and outs of property insurance claims and know how to best get results. 

Why You Need a Public Adjuster

Public adjusters work for you—not the insurance carrier. They’ll review your policy, document and value your losses, and negotiate your settlement on your behalf. 

Timing is Key

The sooner you get a public adjuster involved, the better. They can help strengthen your case and handle the tough conversations with your carrier. To learn more about when to get a Public Adjuster involved in your claim, read our blog: https://premier-claims.com/blog/when-to-hire-public-adjuster/

Don’t wait until your appeal is denied before calling for backup. Getting our team involved early can turn the tide in your favor before things get messy. 

Step 5: Consider Filing a Complaint or Taking Legal Action

If you’re still not getting anywhere, you may need to escalate the situation. Filing a complaint with your state’s insurance commissioner is one option. If things have really gone south, you might consider legal action. 

Filing a Complaint

Insurance regulations govern the industry. If you believe the insurer treated you unfairly, submit a formal complaint to your state’s regulatory body, which can sometimes push the insurer to reconsider.

Legal Action

In some cases, hiring a lawyer who specializes in insurance disputes may be necessary. This can be costly and time-consuming, but sometimes, it’s the only way to get what you’re owed. 

If you’ve reached this stage, Premier Claims can still help. We can connect you with trusted legal experts who know how to handle property insurance disputes and fight for your rights. 

Don’t Go It Alone

Appealing a denied insurance claim can feel like an uphill battle, but you don’t have to go through it alone. Working with experts like Premier Claims can significantly increase your chances of success. We’ve helped countless clients turn denials into approvals, and we’re ready to do the same for you. 

Need help with your appeal? Contact Premier Claims today!

Mold Exclusions: What Your Insurance Carrier Isn’t Telling You

Mold Mayhem

Mold— it’s like that uninvited guest who shows up at your party, eats all the snacks, and leaves you with a mess to clean up. Unlike a party crasher, mold can cause serious damage to your property and health. The real kicker? Your insurance policy may not cover the damage. Surprised? You’re not alone. As storm damage and water woes hit record levels, mold exclusions in insurance policies are catching property owners off guard. Let’s dive into the murky world of mold exclusions and see how to avoid getting stuck with the cleanup bill. 

Mold Exclusions: The Fine Print You Can’t Afford to Ignore

In the grand game of “What Does My Insurance Actually Cover?” Mold exclusions are like the joker card—unexpected and not very funny. These sneaky clauses wormed their way into property owners’ policies after some high-profile lawsuits in the early 2000s. Remember the Ballard v. Farmers Insurance Group case? Neither did we—until it led to a $32 million lawsuit that made insurance carriers nationwide sweat bullets. The insurance industry responded with a collective “Nope!” by slapping mold exclusions on policies and placing caps on the amount of coverage available for mold damage. 

Why Mold and Insurance Don’t Mix

Insurance carriers are the friends who refuse to eat at certain restaurants because of a bad experience years ago. Mold is their bad experience. The problem? Mold is expensive to fix, and health issues linked to mold exposure can linger like a bad odor (pun intended). To avoid footing the bill for moldy messes, insurers decided to cut their losses— literally— by excluding or limiting mold coverage. They figured it’s better to lose a few customers than face another muti-million dollar lawsuit. 

The Creeping Threat: Why Molid Is More of a Problem Than Ever

Mother nature has been throwing a lot at us lately— floods, hurricanes, and windstorms that have turned buildings into waterlogged, mold-friendly environments. While mold might start as a small patch, it can spread faster than gossip at a neighborhood BBQ. The bad news? As severe weather events become more common, the risk of mold damage increases. It gets worse— your insurance policy might not have your back when you need it most. 

Don’t Let Mold Make You the Punchline

How to Protect Your Property

  1. Read the Small Print (Yes, All of It)

Read your insurance policy like a thriller novel—every word matters. Look out for red-flag phrases within your policy exclusions like fungus, rot, and moisture damage. 

  1. Mold Insurance: Not Just for the Paranoid

You wouldn’t buy a house without a roof, so why settle for insurance that doesn’t cover all your potential risks? Some insurance carriers offer separate coverage or endorsements that cover mold damage more comprehensively. 

  1. Maintenance is Your Best Defense

The best offense is a good defense, and that’s true for mold, too. Regular property maintenance is like taking your vitamins— boring but essential. Fix leaks, keep your gutters clean, and don’t ignore that weird, musty smell coming from the basement. The quicker you act, the less chance mold has to settle in and make itself at home. 

  1. Insurance Policies are Confusing— Ask a Professional

Don’t worry about having to review insurance policy alone; our team at Premier Claims is here to help. If you’re scratching your head over what’s covered and what’s not, consult with one of our professionals. They can help decode your policy and suggest coverage options to protect your property adequately. Submit your insurance policy for review today: https://premier-claims.com/policy-review/

Mold might be one of life’s little unpleasantries, but discovering your insurance doesn’t cover it? That’s a nightmare. By staying informed, reviewing your policy, and taking preventative steps, you can avoid the mold trap altogether. After all, the only thing worse than mold is mold and a denial letter from your insurance carrier.

Hurricane Ian Claim Denials: Has Your Claim Been Reviewed?

The State of Hurricane Ian Insurance Claims

Hurricane Ian brought widespread devastation to Florida, prompting a surge in insurance claims. However, data from the Florida Office of Insurance Regulation (FLOIR) reveals a concerning reality: a significant portion of these claims were denied. Specifically, 28.3% of residential and 30.6% of commercial claims were fully denied, leaving many policyholders without the compensation they needed to recover. 

The Scale of Denials and Underpayments

These Hurricane Ian claim denial rates indicate that over one in four policyholders received no payment for their claims, not even partial settlements. This situation highlights critical issues within the insurance claim process, especially in high-impact areas such as Lee and Charlotte counties, where the denial rates were particularly high. The statistics underscore a broader challenge in ensuring that policyholders receive fair and timely settlements.  

Lines of Business Claims Reported Open Claims with Payment Open Claims without Payment Claims Closed with Payment Claims Closed without Payment Percent of Claims Closed
Residential Property 558,299 24,180 13,369 362,626 158,124 93.3%
Homeowners 454,072 20,259 11,463 286,786 135,564 93.0%
Dwelling 57,451 2,950 1,672 37,912 14,917 92.0%
Mobile Homeowners 42,861 491 87 35,839 6,444 98.7%
Commercial Residential 3,915 480 147 2,089 1,199 84.0%
Commercial Property 33,010 4,508 4,383 11,363 12,756 73.1%
Private Flood 5,645 378 85 3,705 1,477 91.8%
Business Interruption 582 25 21 411 125 92.1%
Other 179,405 1,097 998 151,764 25,546 98.8%
TOTALS 776,941 30,188 18,856 529,869 198,028 93.7%
Data collected by the Florida Office of Insurance Regulation as of April 22, 2024

Why Are So Many Claims Denied? 

Several factors contribute to the high rate of claim denials. According to industry reports and expert analyses, common reasons include:

Insufficient Documentation

Often, claims are denied due to inadequate documentation. Policyholders must provide comprehensive evidence of their losses, including photographs, receipts, and detailed descriptions. Without this, insurers may find grounds to deny a claim. 

Policy Exclusions

Many insurance policies contain specific exclusions that are not always clearly understood by policyholders. These exclusions can cover a range of situations, from particular types of damage to specific causes of loss, and can lead to unexpected denials. 

Misinterpretation of Policy Terms

Misinterpretation or misunderstandings about policy coverage can also result in claim denials. Both insurers and policyholders may have different interpretations of what the policy covers, which can lead to disputes. 

The Importance of Claim Reviews

Given these high denial rates, it is crucial for policyholders to seek a professional claim review. This process can identify potential underpayments or improper denials, allowing policyholders to receive the compensation they’re owed according to their policy. The FLOIR encourages policyholders facing issues with their claims to report them and seek assistance. Professional reviews by trained adjusters, like those at Premier Claims, can help navigate the complexities of insurance policies and advocate for a fair settlement. 

Taking Action

The data above clearly shows a significant number of claims from Hurricane Ian were denied or remain unresolved to this day. Affected policyholders need to act proactively. By seeking a professional claim review, you can set yourself up for success to help rectify your losses. 

If you experienced a Hurricane Ian claim denial or you suspect it was underpaid, consider getting a thorough claim review. Contact Premier Claims today to learn more.

Being Blind to Your Insurance Coverage Can Lose You Money

When was the last time you read your policy? Do you remember ever seeing it? The claims process can be incredibly overwhelming and confusing, especially if you aren’t familiar with policy language. Premier Claims is here to help. 

Know Your Coverage Inside Out

Whether or not you understand your insurance policy can make or break your claim. The policy serves as a blueprint for your protection and outlines the scope of insurance coverage in place. If you’ve never seen your policy and are filing a claim, it’s like exploring the jungle without a map.

The first step is to reach out to your insurance broker or agent. They are your direct contact regarding your insurance coverage and can provide you with a copy of your policy upon request. 

Knowledge is Power

Armed with the policy in hand, you gain insight into what you’re protected against and, equally as important, what you’re not. This knowledge is invaluable when navigating the claims process. 

After obtaining your policy, simply forward it to a Premier Claims representative. Premier Claims will assign the policy to one of our licensed professionals to do a thorough ]review. By familiarizing ourselves with the specifics of your policy, we can assist in making informed decisions. The more information we have, the better advocate we can be. To have your policy reviewed by our team, please complete the following form: https://premier-claims.com/policy-review/. This should take less than a minute to complete. 

Recognizing Red Flags

If your broker or insurance carrier is hesitant to provide you with a copy of your insurance coverage, it’s a red flag. Transparency is key in the insurance industry, and any reluctance to share information should prompt further questions. Your policy is a binding contract, and you have EVERY right to review its contents. 

Your insurance policy is more than just a document—it’s your lifeline in times of crisis. Taking the time to understand the legal lingo is an investment in your peace of mind and financial security. Don’t hesitate to reach out to Premier Claims for guidance, and remember, knowledge is power. By arming yourself with information, you can navigate the claims process with confidence and clarity.

Take control of your insurance journey today. Reach out to your broker or agent to request a copy of your policy and then submit your policy for a complementary review by our licensed professionals to ensure your property is properly protected. Embark on the path to empowerment– peace of mind is worth it.

Why Policyholders Hesitate to Sign Contracts with Public Adjusters

When disaster strikes and your property is damaged, hiring a public adjuster can ensure you receive a fair settlement from your insurance company. However, many policyholders hesitate to sign a contract with a public adjuster. Understanding the reasons behind the hesitation is crucial for policyholders and public adjusters.

Concerns About Fees and Costs

One of the primary reasons policyholders are reluctant to sign contracts with public adjusters is the fear of high fees. Many worry that the percentage charged by public adjusters will significantly reduce their settlement amount.

UNDERSTANDING THE FEE STRUCTURE

Public adjusters typically work on a contingency fee basis, meaning they only get paid if you do. In most states, the fee represents a percentage of the settlement amount, incentivizing the adjuster to maximize your claim. However, some states require the fee to be calculated on an hourly basis. Discussing and understanding both fee structures upfront is vital to avoid any surprises.

Fear of Increased Premiums

Another common concern is the fear that hiring a public adjuster will increase insurance premiums. Policyholders worry that making a claim, especially with professional assistance, might flag them as high-risk to their insurers.

CLARIFYING PREMIUM IMPACTS

Filing a claim, with or without a public adjuster, can affect your premiums.

Suppose multiple claims are filed after a storm. In that case, your insurance carrier may raise the premiums for all policyholders in an affected area to help mitigate the financial impact of the widespread damage. However, a public adjuster’s expertise can improve your claim’s outcome. Public adjusters are motivated to help you make the most of your claim so that your property can be adequately restored, aiming for you to be fairly compensated for your losses. Insurance carriers primarily base premium adjustments on factors such as fault and Catastrophe Area designations. To learn more about what can affect your premiums, read our blog: Will My Insurance Premiums Go Up?

Worry About Policy Cancellation

Policyholders sometimes fear that hiring a public adjuster will cause their insurer to cancel their policy. This concern stems from the belief that insurance companies might view the involvement of a public adjuster as adversarial.

UNDERSTANDING INSURANCE POLICIES

It’s illegal for an insurance company to cancel your policy simply because you hire a public adjuster. Public adjusters work to ensure you receive a fair settlement, and their involvement shouldn’t negatively impact your policy status. Public adjusters exclusively represent the policyholder’s interests, aiming for your claims to be maximized without jeopardizing your policy. Their role as your advocate can provide a buffer between you and the insurer, helping to facilitate a smoother claims process.

Belief That There Is No Damage

Some policyholders hesitate to sign contracts with public adjusters because they believe their property has not suffered significant damage. They might think the damage is too minor to warrant professional assistance.

ASSESSING THE DAMAGE

Public adjusters identify and document damage that policyholders might overlook. Even seemingly minor issues can lead to substantial claims. An initial consultation with a public adjuster can help determine the true extent of the damage. Their professional damage assessment can uncover hidden damages and ensure that all aspects of your loss are documented, potentially increasing your settlement.

Lack of Trust and Transparency

Finally, the hesitation often comes from a need for more trust or understanding of what signing a contract entails. Policyholders might fear hidden clauses or unfavorable terms.

ENSURING TRANSPARENCY

Before signing a contract, you should thoroughly read and understand the terms. A reputable public adjuster will be transparent about their fees, processes, and what you can expect. Don’t hesitate to ask questions and seek clarification. Policyholders should feel comfortable with their public adjuster and verify their credentials and references to build trust. Public adjusters who are open and communicative can help ease these concerns, fostering a collaborative and trust-based relationship.

Addressing these common concerns can help policyholders like yourself feel more confident about signing a contract with a public adjuster. Our team at Premier Claims wants you to make an informed decision and know that we’re here to help every step of the way. Remember, working with a public adjuster aims to make the most of your claim. A licensed public adjuster’s expertise and advocacy significantly benefit policyholders, ensuring professional and effective handling of the claims process.

Tornado Recovery, Where Do You Start?

Emotions run high as communities assess the full extent of devastation caused over the weekend. About 40 tornadoes tore across the Midwest, including Nebraska, Iowa, Oklahoma, and Kansas, as well as a few down in Texas. Some reports show around a hundred tornadoes touched down over the tumultuous weekend. It’s clear there is much work ahead to recover from this disaster. But where do you start?

If this whirlwind of devastation affected you, then you most likely asked yourself that very question: Where do I start?

When you experience such a level of devastation that rips your entire life from its foundation and scatters it about, it becomes almost impossible to think straight. The flattened view of homes and memories before you is captioned by children’s confused cries as they search for their Wubbie or bicycle – the equivalent of an emotional tornado. Where do you find time to pick up the pieces of littered remnants of your home and everything within it?

Recovery & Claim Tips

Next Steps

The next steps become increasingly complicated and time consuming. The claims process can take 6 months to a year or longer. Do you have an additional 20 hours available to spend on a claim for the next 6 months to a year on top of your normal life? I know I don’t and most other people don’t either.

Are you prepared to tackle all that is required in the claims process?

Unlike the carrier adjuster, a public adjuster solely has your interests in mind. They can manage the additional 20 hours a week to handle your claim, reducing your burden. Public adjusters are experts in their field. They will advise and assist you throughout the entire claims process, eliminating those nagging questions and uncertainties you have right now.

What should I do?

Where do I start?

How do we get through this?

Premier Claims is familiar with disaster response and aiding property owners with claims, and this time, it’s in our own backyard. Our experts are here to help our community rebuild and heal from this tragedy. For more support, reach out to our team today: https://premier-claims.com/storm-damage/ 

By: Ashley Workman | Sr. Paralegal & Licensed Public Adjuster

Mastering the Game of the Claims Process

Who are the players in the intake process?

Think of the claims intake process as one big video game, where the decision maker or policy owner plays the most integral part of the claims game. Throughout your quest for a fair claim payout, you’ll meet some additional key figures or characters to help you along the way. 

Player Character or Protagonist: The Policy Owner

The policyholder is the main character. They’re the ones whose name is listed under “Named Insured” in the policy. This person is typically the business or building owner who either knows all of the information needed in connection to the property or knows the best person to ask for help obtaining the necessary information.

Ensure you know the differences between signee, named insured, and claimant. Not sure what they are? We’ve got you covered.

Signee vs. Named Insured

Named Insured vs. Claimant

Signee vs. Claimant

The Guide: The Property Manager

The property manager serves as a point of contact for the building’s condition. They may provide essential information about the property and assist with gathering documentation throughout the claims process. Their job is to oversee the property and ensure that its condition is up to par. They should have records of any issues with the building and repairs made, the insurance policy, and inspection records. When it comes to providing information on any changes to the property or past issues, they are an excellent resource.

Information Hub: Your Broker or Insurance Agent

Your broker or broker agent is the keeper of policy knowledge. They’re key when trying to track down your policy. That isn’t a problem if you’ve never seen your policy. Your broker is required to give you a copy if the signee asks. If you are getting a runaround when requesting a copy of your policy, Premier Claims is happy to assist.

The Ally: Premier Claims

Premier Claims is your claims team’s muscle and brains. Throughout the intense battle with the insurance carrier, we will always be on your side, advocating on your behalf. We are experts in the claims process and have the tenacity and drive to fight for your rightful compensation. 

Your Arsenal

One of the first steps in the claims process is to gather all necessary information about the property. The policy owner should have access to their insurance policy documents, including the declaration pages outlining key coverage details. This readily available information can expedite the intake process and facilitate smoother communication with the insurance adjuster.

You should also have a detailed timeline of the building. Whether it’s recent renovations, prior damage, or maintenance issues, you should be prepared to provide insights into the building’s history. This information can help the adjuster properly assess the extent of the damage.

Once Premier Claims has the primary information concerning your property, we can start investigating and ultimately battling it out with the villain of the claims process: the insurance carrier.

Where is My Insurance Policy?

Hiring an insurance broker can save you a ton of money. They can quickly compare plans of dozens of insurance carriers, taking the stress off of your plate. While that is great in the long run, when it comes time to file an insurance claim, you’re left wondering which carrier your insurance policy is even with.

Not having a copy of your insurance policy can land you in hot water. Even worse— you don’t know who your insurance carrier is! Take action and ensure you have your policy ready to go when you need it most.

Where do I start?

This is where Premier Claims steps in. When you hire us, it’s like getting a hammer when you’ve been driving nails in with the end of a screwdriver. The screwdriver was able to get the nail into the wood. However, the hammer is more accurate and cuts time in half. 

Are you having a tough time getting your insurance information from your broker? One of our representatives is happy to help get the info you need. As an additional service, we offer free policy reviews. To have your insurance policy reviewed, use the following link: https://premier-claims.com/policy-review/

Our tenacity does not waver throughout the claims process. We are your hammer. We are going to call who we need to call, meet who we need to meet, and debate who we need to debate in order to get what you are owed. 

What’s next?

As we gather your insurance information, we’ll make sure you have a digital file with all necessary documents in case of another catastrophe.

These include:

Once we start the claims process, we will need to track down all of these documents to get a clear picture of your property. The more information our adjusters have, the smoother the claims process. 

Insurance Coverage for Collapse

You just bought your dream property— investing time, effort, and resources into making it a reality. Yet, amidst the joys of ownership lies the uncertainty of potential structural disasters. Enter collapse coverage, a policy feature often overlooked, but essential in shielding your investment. Learn about the depths of this coverage type, demystifying its significance, and empowering you to navigate your policy with confidence.

Do I Need Collapse Coverage?

Collapse coverage protects policyholders from financial losses resulting from the sudden and unexpected collapse of a building or a part of the property. This collapse could be due to various reasons, including structural defects, hidden decay, or other covered perils. Collapse coverage typically comes in two forms: broad and narrow.

Broad Collapse Coverage

Broad collapse coverage offers protection against a wide array of causes, including hidden decay, insect or vermin damage, and weight of contents. This comprehensive coverage ensures that policyholders protect their property from a broad range of potential risks.

Narrow Collapse Coverage

Narrow collapse coverage requires proof of a specific cause, such as fire, explosion, or perils explicitly listed in the policy. This type of coverage is more specific in its requirements, but still offers essential financial protection in the event of a collapse.  

What Does This Look Like in Your Policy?

One fundamental aspect to consider is how your insurance policy defines collapse. Definitions can vary significantly depending on the policy and carrier. While some policies define collapse as an abrupt falling down or caving in of a structure, others may include substantial impairment of structural integrity. Understanding how collapse is defined in your insurance policy is key when it comes to protecting your property.

Covered Causes

We recommend policyholders review the events or perils covered in their insurance policy to assess their level of protection comprehensively. Covered causes may encompass structural defects, insect or vermin damage, the weight of ice, snow, or sleet, and specific natural disasters, among others. By understanding these covered causes, policyholders can better anticipate and mitigate potential risk to their property.

Exclusions

Similar to other insurance coverages, collapse coverage has a set of exclusions that can limit what it will cover. Common exclusions include gradual deterioration, wear and tear, settling, and maintenance related issues. These exclusions highlight the importance of routinely maintaining your property. Being aware of these exclusions allows you to understand the extent of the coverage provided by the policy and any potential gaps that may exist.

Why Your Property Needs Structural Protection

Collapse coverage provides policyholders with financial protection against unforeseen structural failures that could result in significant repair costs. Property owners may face substantial expenses to repair or rebuild damaged structures without this coverage type.

Review Your Policy

To ensure adequate protection, we recommend policyholders carefully review their insurance policies and understand the terms and conditions of their coverage. They should also consider consulting with a qualified insurance professional to assess their coverage needs and make informed decisions. To have your policy thoroughly reviewed by our team of licensed professionals, submit your policy here: https://premier-claims.com/policy-review/

Collapse coverage is a vital component of property insurance, offering protection against unexpected structural failures. By understanding what their insurance policy entails and ensuring they are adequate coverage, policyholders can protect their properties accordingly. Knowing that you’re financially protected in the event of a collapse, is the peace of mind every property owner deserves.