Reversing a Denied Insurance Claim

 

A denied insurance claim can be inconvenient in the least, and at the most, devastating.

In July of 2021, my client filed an insurance claim for hail damage to the roof of his commercial office building. Before deciding to file his claim, he consulted with professionals and was informed by several professional roofing contractors that the damage to his roof was significant; however, with the paid assistance of an engineer her company selected for her, the insurance adjuster denied the claim.

In January, the insured policyholder contacted me for assistance and yesterday (after a month) his insurance company agreed to cover his claim and issue a payment of $332,000.00.

All the facts I needed to convert this wrongful denial into a cash payment of $332,000.00 I found in the adjuster’s denial letter and the engineer’s report.  No magic or tricks were necessary or used.  No additional inspections or reports from other experts were sought or obtained.  The denial was successfully challenged simply because the adjuster focused on a small part of the engineer’s report that might have supported a denial (but didn’t) while ignoring those parts of the report that clearly supported my client’s claim.

In just the last two years, I have reversed multiple denials for similar claims under the same circumstances that resulted in payments to my clients in amounts ranging from $175,000.00 to $690,000.00 using the same engineer’s report to support the reversal that the insurance companies used to deny the claims.

It is important to know that denials are rarely, if ever, reversed and paid after presenting nothing more than different opinions by the policyholder or his contractor(s).  Circular arguments waste time, effort, and money.  What is necessary to prevail is to prove, definitively, that the facts that the denial were based upon were either wrong or non-existent.

A claim that results in a payment to the policyholder will come when the policyholder proves the loss to exist and covered under the policy.  A legitimate denial of a claim by the insurance company will require, under those circumstances, that they successfully prove that an exclusion to coverage under the policy applies.

Before accepting that your insurance company’s denial of your claim is the final word, seek the advice of an attorney or a licensed public adjuster.

 

 

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