Denied Claims
Your claim was denied. That is not the end of it.
254 denial reasons explained. Find yours below. Most are negotiable, many are improper.
254 pages in this collection
Pre-Existing & Causation Disputes
19The most common denial pattern: "this damage was already here" or "wear-and-tear, not a covered peril."
Carrier blames the loss on someone else's bad workmanship
Carrier claims prior workmanship caused loss.Carrier called your storm roof damage wear, neglect, or poor maintenance
Carrier claims damage is from lack of maintenance, not covered peril.Carrier labeled your wind or hurricane roof damage as wear and tear
The most commonly overapplied denial. Carrier claims your damage was pre-existing wear.Carrier says the asbestos or lead was already in the home
Carrier claims asbestos, lead paint, or mold existed before loss.Carrier says you did not list a prior loss on your policy
Carrier alleges undisclosed prior loss affected this claim.Claim denied because of an earlier settlement, the carrier says
Carrier alleges prior settlement extinguishes current claim.Claim denied because the carrier relabeled the cause of loss
Carrier classifies covered peril as excluded.Claim denied because the carrier says the damage was gradual
Carrier claims the damage occurred over time, not suddenly.Claim denied because two causes of damage happened at once
Policy language excludes any loss involving excluded perils, even partially.Damage denied as gradual instead of a sudden event
Carrier classifies event as gradual (excluded) rather than sudden.Insurer calls your water damage a flood event
Carrier treats water damage as continuous flood rather than sudden storm event.Insurer grouped separate wind events into one
Carrier groups multiple wind events into one for deductible application.Mold claim denied because the carrier says it was already there
Carrier claims mold pre-dated water event.Mold claim denied because the carrier says the water was gradual
Carrier denies mold remediation because underlying water was gradual.Roof claim denied as pre-existing wear, the carrier says
Carrier claims storm damage was actually prior wear.Two causes of damage and insurer blamed the excluded one
Multiple causes contributed; carrier selects the excluded one as proximate.Water claim denied because the carrier calls it seepage, not a burst
Carrier classifies water damage as slow seepage (excluded) rather than sudden discharge.Your claim was denied as damage that already existed
Carrier claims damage existed before the policy period or loss event.Your sinkhole claim was denied as pre-existing foundation damage
Carrier claims foundation damage predated sinkhole activity.
Coverage Exclusions
27When the carrier points to specific policy language to deny coverage entirely.
A/C condensation damage was called maintenance, not a covered loss
Carrier classifies HVAC condensate damage as maintenance.Asbestos, lead paint, or PCBs were found and now it's excluded
Asbestos, lead paint, or PCB discovery triggers exclusion.Below-grade water intrusion was excluded from coverage
Below-grade water damage excluded.Carrier calls the damage flood and says your policy excludes it
Carrier classifies damage as flood, which is excluded under homeowners.Carrier denied the claim saying the damage was done on purpose
Carrier claims damage was caused intentionally.Carrier denied the claim saying the failure was a product defect
Carrier claims the failure was a manufacturing defect, not a covered peril.Carrier paid for new carpet only and won't match the pile height
Partial carpet replacement with pile height difference.Carrier says the damage is from earth movement, not a covered cause
Carrier claims damage is from earth movement (not sinkhole activity), which is typically excluded.Carrier says you gave the property away willingly
Carrier alleges insured voluntarily gave up property.Carrier says your home was vacant when the loss happened
Carrier claims property was vacant beyond policy-allowed window at time of loss.Claim denied because the carrier blames heat or humidity
Damage from extreme heat or humidity excluded.Claim denied because the carrier blames insects for the damage
Termite or carpenter ant damage excluded.Claim denied because the carrier says rodents caused the damage
Carrier claims damage is from rodents/vermin, which is typically excluded.Claim denied because the carrier says rodents damaged your stuff
Rodent damage to contents typically excluded.Claim denied under a recycling or destruction equipment exclusion
Loss from recycling or destruction equipment excluded.Damage to your utility trailer excluded from coverage
Utility trailers excluded from coverage.Insurer blames damage on old construction flaws
Carrier attributes damage to original construction defects, which are excluded.Metal roof hail dents called cosmetic and excluded
Metal roof hail denting classified as cosmetic.Mold claim denied because your basic policy excludes mold outright
Basic policy excludes mold entirely.Property claim denied because a tenant occupied the home
Policy excludes losses when property is tenant-occupied.Roof claim denied because the carrier says the roof is too old
Carrier denies because roof is older than policy's age cutoff.Spoiled food during a power outage and the carrier says not covered
Food spoilage during power outage not covered.Theft claim denied as a mystery disappearance, not real theft
Carrier classifies theft as mysterious disappearance to invoke exclusion.Your claim was denied because damage was caused by your pet
Damage caused by domestic animal excluded.Your cleanup costs were denied under the pollution exclusion
Carrier applies pollution exclusion to remediation costs.Your electronics damage was denied as a power surge
Carrier claims electronics damage from power surge is excluded.Your policy has specific, limited wildfire coverage
Florida policies may have specific wildfire provisions.
Roof & Matching Denials
22Roof age, partial roof denials, cosmetic-only carve-outs, and "matching" disputes for siding, tile, brick, and finishes.
Carrier approved a different window brand and won't match the system
Partial window replacement with different brand.Carrier approved a partial roof repair that will leave a visible mismatch
Carrier authorizes partial repair that cannot match existing roof.Carrier approved new bricks only and won't pay to match the rest of the wall
Partial brick replacement with visible difference.Carrier approved new cabinet doors only and won't pay to match the rest
Kitchen cabinet partial replacement with visible aesthetic difference.Carrier approved new cabinets only and won't pay to match the existing run
Carrier authorizes partial cabinet replacement without matching.Carrier approved new countertop only and won't pay to fix the seam
Partial countertop replacement creates visible seams.Carrier approved new flooring only and won't pay to match the rest
Carrier refuses full flooring replacement despite matching issues.Carrier approved new siding only and won't pay to match the elevation
Carrier approves partial siding replacement not matching existing.Carrier approved new tile only and won't pay to match the rest of the floor
Partial tile replacement with different lot.Carrier approved one door only and won't pay to match the series
Partial door replacement with visible difference.Carrier denied the claim saying there is not enough proof of cause
Carrier requires more evidence of covered cause.Carrier paid for drywall patch only and won't match the wall texture
Partial drywall repair with texture mismatch.Carrier will only pay for a cheaper fence than what you had
Carrier approves lower-grade fence than original.Claim denied because the carrier says the proof of loss was late
Carrier alleges POL filed beyond policy window.Claim denied because the carrier says your proof of loss was flawed
Carrier claims the sworn proof of loss was deficient.Claim denied because your mitigation steps were not documented
Carrier denies portions of claim citing insufficient mitigation documentation.Claim rejected because no sworn proof of loss was submitted
Carrier rejects claim absent a sworn proof of loss.Flat roof claim denied because the carrier says it was foot traffic
Carrier attributes flat roof puncture to foot traffic.Insurer says the damage is just cosmetic
Carrier claims damage is cosmetic and excluded under cosmetic damage endorsement.Insurer says your roof damage is just cosmetic
Carrier classifies hail or wind roof damage as purely cosmetic.Roof claim denied because the carrier says it was already worn
Carrier attributes damage to pre-storm condition.Roof claim denied because the carrier says it was wind, not hail
Carrier accepts cause but disputes specific peril.
Procedural, Timing & Documentation
21Late notice, missed deadlines, examinations under oath, sworn proof of loss, and documentation defects.
Carrier denied the claim saying you reported the loss too late
Carrier claims you reported the loss outside the policy notice window.Carrier refused to send the adjuster back after a scope dispute
Carrier refuses re-inspection after scope dispute.Carrier said you waited too long to invoke the appraisal process
Carrier argues insured waited too long to invoke appraisal.Carrier says the mold was already there longer than you noticed
Carrier denies mold coverage citing late discovery.Carrier says you destroyed evidence before they could inspect
Carrier claims you destroyed evidence critical to assessing cause.Carrier says you refused to sit for an examination under oath
Carrier claims insured refused to sit for EUO.Claim denied after a rushed inspection that missed major damage
Carrier's inspection was cursory; missed substantial scope.Claim denied after you signed a scope you did not agree with
Agreed scope was signed but insured now disputes.Claim denied because emergency work started without carrier approval
Work done without specific contractor authorization.Claim denied because the carrier says you filed too late
Carrier alleges legal deadline passed before claim.Claim denied because the carrier says you waited too long to file
Carrier claims you filed too late.Claim denied because the carrier says your notice was only verbal
Carrier alleges verbal notice insufficient.Claim denied because the first scope sheet missed obvious damage
Initial scope sheet excluded obvious damage.Claim denied because you did not document the damage before demolition
Carrier denies based on insufficient pre-demolition documentation.Claim denied over incomplete discovery responses
Carrier alleges discovery responses were incomplete.Insurer says you failed a policy condition
Carrier claims a specific policy condition was not satisfied.Insurer says your claim paperwork isn't complete
Carrier claims submitted package missing required items.Theft claim denied because no police report was filed in time
Carrier denies theft claim because no police report was filed.Tornado damage claim denied for insufficient evidence
Carrier denies tornado classification affecting scope.Your demand for appraisal was called too late
Carrier claims appraisal invocation was too late.Your partial loss was denied because of a reporting rule
Carrier claims partial loss triggered specific reporting obligations.
Misrepresentation & Fraud Allegations
9When the carrier alleges the application, the claim, or the loss itself is misrepresented or fraudulent.
Carrier says you failed to disclose past renovations
Carrier claims material renovations were not disclosed.Carrier says you lied on the application or during the claim
Carrier claims you misrepresented facts on application or during the claim.Carrier says your home was vacant longer than your policy allows
Carrier claims the home was vacant beyond policy limit.Carrier sent your claim to its special investigation unit
Carrier refers claim to special investigation unit.Carrier suspects you set the fire on purpose
Carrier investigates or denies claiming intentional fire.Claim denied because the carrier says your damage story changed
Carrier alleges inconsistent descriptions of damage.Claim denied over alleged false statements in your filing
Carrier alleges material false statements in claim.Claim denied over alleged misrepresentation on your policy
Carrier claims you misrepresented facts on application or renewal.Insurer sent your claim to its fraud investigation unit
Carrier invokes SIU investigation.
Settlement Math, Sublimits & Caps
151Depreciation, ACV/RCV math, hurricane deductibles, sublimits, and lowballed scope of repair.
Appliance damage is being limited to a small sublimit
Carrier limits appliance damage to specific sublimit.Carrier accuses you of acting in bad faith during the claim
Carrier alleges insured acted in bad faith.Carrier applied a landscaping cap to your mature trees and plantings
Carrier applies landscaping cap to mature or specimen plantings.Carrier approved builder-grade fixtures in place of the originals
Builder-grade fixtures approved for high-end originals.Carrier approved cheaper materials than your home had
Carrier authorizes paint-grade where stain-grade existed.Carrier calls repairs an upgrade and refuses to pay
Carrier refuses to pay for upgrades, classifying as betterment.Carrier cancelled or non-renewed your policy before paying the claim
Carrier non-renewed or cancelled before paying claim.Carrier capped your tree and shrub damage at a small sublimit
Tree and shrub damage capped per policy.Carrier classes your water damage differently than you do
Carrier disputes Category 2 or Category 3 water classification.Carrier delayed the inspection past the required window
Carrier inspection delayed beyond statutory windows.Carrier denied the claim because no one could identify the driver
Carrier claims inability to identify at-fault driver defeats claim.Carrier denied the claim saying the loss was not really accidental
Carrier alleges the loss was not accidental (foreseeable or intentional).Carrier denied the claim saying you caused the damage yourself
Carrier claims the insured intentionally or through gross negligence caused the loss.Carrier denied the theft claim because there is no forced entry
Carrier claims no forced entry means no covered theft.Carrier denied the water claim because the leak source is unknown
Carrier denies water claim citing failure to identify source.Carrier denies water damage because a sprinkler caused it
Carrier excludes sprinkler-caused water damage.Carrier depreciated items the policy shouldn't depreciate
Carrier depreciates items that policy doesn't allow.Carrier did not respond to your Civil Remedy Notice in time
Carrier failed to cure during 60-day CRN window.Carrier is demanding financial records before it pays the claim
Carrier requests extensive financial documentation.Carrier is denying the claim over an alleged lack of mitigation
Carrier claims inadequate mitigation allowed damage to worsen.Carrier is using a previous claim against you on this new claim
Prior claim history impacts current claim.Carrier refuses to pay for repairs your unlicensed contractor did
Carrier refuses to reimburse repairs performed by unlicensed contractor.Carrier refuses to pay parts of your claim at all
Carrier refuses to process parts of claim.Carrier says failed recovery from another party hurts claim
Carrier argues failed subrogation affects insured recovery.Carrier says foreclosure voided your right to claim
Carrier alleges foreclosure voided claim rights.Carrier says home business activity voids your coverage
Carrier claims business use on residential property voids coverage.Carrier says the damage happened before your policy started
Carrier says loss occurred outside the policy period.Carrier says the damage is ground movement not structural damage
Carrier distinguishes land subsidence (covered) from structural failure (not).Carrier says the emergency mitigation bill was too high
Carrier claims mitigation charges were excessive.Carrier says the person on the claim is not on the policy
Carrier alleges loss claimant is not the named insured.Carrier says the rain came through an old opening, not wind
Carrier claims rain entered through pre-existing opening, not wind-created.Carrier says the repairs your contractor scoped are excessive
Carrier classifies necessary repair as excessive.Carrier says the wind was not strong enough to damage your home
Carrier classifies wind as insufficient for damage claimed.Carrier says the window warranty expired and bars replacement
Carrier disputes window replacement due to warranty/age issues.Carrier says you deliberately ignored the damage
Carrier alleges deliberate neglect by insured.Carrier says you did not stop the damage from getting worse
Carrier claims you allowed damage to worsen.Carrier says you let the damage get worse before reporting it
Carrier blames insured for allowing damage to worsen.Carrier says you lost insurable interest before the damage happened
Carrier claims insurable interest terminated before loss.Carrier says your contractor's terms shifted the risk
Carrier alleges contractor terms shifted risk to contractor.Carrier says your damage does not require sinkhole testing
Carrier denies testing under FS 627.706 citing insufficient triggering conditions.Carrier says your divorce affected coverage and you didn't tell them
Carrier alleges divorce affected coverage but wasn't disclosed.Carrier sold you a more restrictive policy form than expected
Carrier issued a restrictive form (HO-2) when homeowner thought HO-3.Carrier stopped paying temporary housing before you returned
Carrier caps ALE duration.Carrier testing says no sinkhole caused your damage
Carrier-selected geotechnical testing reports no sinkhole activity.Carrier took too long to approve the repairs
Carrier delays authorizing repair work.Carrier used a reservation of rights to deny your claim
Carrier attempts to deny claim after improper reservation of rights.Carrier wants a death certificate to pay an inherited claim
Carrier requesting death certificates for inherited property claim.Carrier wants arbitration after you invoked appraisal
Carrier pushes arbitration when appraisal was invoked.Carrier wants to repair a home you say needs rebuilding
Carrier proposes repair when total loss rebuild should apply.Carrier won't cover a structure not listed on your policy
Carrier refuses coverage for unlisted accessory structure.Carrier won't credit the deposits you paid the contractor
Carrier refuses to credit deposits paid to contractors.Carrier won't pay until a loss control inspection happens
Carrier conditions payment on loss control inspection.Carrier won't reimburse you for the engineer you hired
Carrier refuses to reimburse engineer fees.Carrier's engineer and your contractor can't agree on what's broken
Carrier engineer and contractor disagree on scope.Carrier's scope of damage is much lower than the actual damage
Carrier scope is materially less than actual damage.Catastrophe team wrote a low estimate of your damage
Catastrophe team adjuster produced a minimal scope of loss.Claim affected because carrier calls your home substandard
Carrier claims property was substandard at renewal.Claim capped because rebuilding cost exceeds your policy limit
Rebuild cost exceeds Coverage A limit; carrier pays only to limit.Claim challenged over your subcontractor's qualifications
Carrier challenges subcontractor qualifications.Claim denied because neighboring homes showed no visible damage
Carrier claims absence of neighbor damage undermines your claim.Claim denied because rain came in through a vent, the carrier says
Carrier claims rain entered through vent (excluded as maintenance).Claim denied because the carrier blames a previous contractor
Carrier attributes current damage to prior contractor errors.Claim denied because the carrier calls the wind non-hurricane
Carrier classifies loss as non-hurricane wind to avoid deductible structure.Claim denied because the carrier questions your public adjuster
Carrier questions PA qualifications or licensing.Claim denied because the carrier says its reinsurance ran out
Rare but carrier claims reinsurance exhaustion.Claim denied because the carrier says the peril is not covered
Carrier claims specific peril is outside policy scope.Claim denied because the carrier says the premium was unpaid
Carrier alleges premium was unpaid when loss occurred.Claim denied because the carrier says you did not disclose the use
Carrier alleges undisclosed use (Airbnb, long-term rental, etc.).Claim denied because the carrier says you got rid of the damage
Carrier claims disposition of damaged property affected claim.Claim denied because the carrier says you rented the home
Carrier claims property was rented but policy was written as owner-occupied.Claim denied because the carrier says you sold or transferred the home
Carrier alleges ownership transfer voided coverage.Claim denied because the carrier says your roof is too old
Carrier applies age-based exclusion to materials.Claim denied because the defect was on the underwriting inspection
Carrier argues inspection at underwriting noted the defect.Claim denied because the repair cost is under your deductible
Damage doesn't exceed deductible threshold.Claim denied for the cost of moving and storage during repairs
Carrier won't reimburse moving or storage costs.Claim denied over a different inspection conclusion than your expert
Carrier inspection reached different conclusions than homeowner's own experts.Claim denied over a pre-policy inspection report
Carrier claims pre-insurance inspection found issues.Claim denied over an address mismatch on the policy
Carrier alleges policy covers a different property than the loss location.Claim denied over weather data that does not match the loss location
Carrier cites weather data that doesn't match conditions at loss location.Claim filed past the deadline your policy requires
Claim filed beyond policy notice requirement.Claim restricted because the property is a second home
Policy restrictions apply to second/vacation homes.Code enforcement citation is blocking your claim
Code enforcement citation on property creates coverage complications.Contractor pushed an AOB on you right after the storm
A contractor solicited an AOB in the days after a declared disaster.Contractor's insurance lapsed and insurer is using it
Carrier denies payment for work when contractor liability insurance lapsed.Couldn't report your claim because you were evacuated
Carrier argues delayed FNOL exceeds reasonable window even during evacuation.Damage costs more than your policy will pay
Carrier pays only up to policy limit; damage exceeds that limit.Damage spread to parts of your home the policy doesn't cover
Carrier refuses coverage when damage spread beyond initially covered zone.Damage that happened while contractors were working on your home
Carrier excludes damage during active construction.Damage went past your policy limit and the carrier paid up to the cap
Carrier pays only up to limit; damage exceeds.Electronic surge damage to your appliances was excluded
Carrier excludes electronic surge damage.FEMA redrew your flood map and now the carrier denies
FEMA reclassification affects coverage.Fire claim denied because the fire report was incomplete
Carrier rejects fire claim citing missing or incomplete fire marshal documentation.Flood claim denied because the space sits below elevation
NFIP coverage denied for basement or below-elevation spaces.Garage floor coating damage claim was underpaid by the carrier
Specialty floor coating replacement undervalued.Hurricane damage disputed as storm surge instead of wind
Wind and storm surge caused damage, but carriers dispute allocation.Hurricane deductible applied when the storm was not a hurricane
Carrier applied the hurricane deductible when a non-hurricane storm caused damage.HVAC claim denied because the unit is past the age limit
Carrier denies HVAC replacement citing age-based policy exclusion.HVAC or electrical breakdown not covered by homeowners
HVAC or electrical breakdown not covered under homeowners.Impact claim denied because the carrier says the damage is older
Carrier claims current impact damage existed before the loss event.Insurer is using a narrow definition of collapse
Florida policies define collapse narrowly.Insurer is using outdated values for your belongings
Carrier disputes contents values using outdated scheduled amounts.Insurer keeps pushing you to give a recorded statement
Carrier demands a recorded statement before documentation is complete.Insurer says the coverage wasn't active that day
Carrier claims specific coverage (flood, sinkhole, AOB) was not in force.Insurer won't cover crawlspace sealing after water loss
Carrier won't pay for crawlspace encapsulation after water loss.Insurer won't honor your assignment of claim rights
Carrier disputes assignment of claim rights.Jewelry claim paid only up to the unscheduled $1,500 cap
Carrier pays only the $1,500 sublimit for unscheduled jewelry.Lender required flood coverage and the carrier still denied
Lender required flood coverage in dispute at loss time.Mortgage servicer is withholding your insurance repair money
Mortgage servicer won't release insurance proceeds from escrow.NFIP or private flood carrier denied your flood claim
NFIP or private flood denied claim.Paid only ACV because the carrier says RCV repair rules were missed
Carrier pays only ACV because RCV repair conditions weren't met.Personal property claim denied as a mysterious, unexplained loss
Carrier invokes mystery-disappearance exclusion for lost items.Pipes froze while the home was vacant and heat was off
Pipe freeze damage while property was unoccupied and heat not maintained.Repairs were done by an unlicensed contractor
Repairs performed by an unlicensed contractor; carrier refuses reimbursement per policy licensing clause.Roof claim denied because the hail was below the policy threshold
Policy requires specific hail size for damage claim.Roof paid only actual cash value when replacement cost was owed
Carrier applies ACV when RCV should apply.Scheduled property claim denied over missing records
Carrier denies scheduled item replacement due to documentation gaps.Sewer backup claim denied because coverage was not added
Sewage or sump backup damage claimed without sewer backup endorsement.Sink or toilet overflow damage excluded from your claim
Carrier excludes sink or toilet overflow damage.Sinkhole claim limited because the carrier calls it non-CGCC
Sinkhole activity classified as non-CGCC to limit coverage.Smoke damage denied because the fire was not covered
Carrier attributes smoke to non-covered source.Stucco crack claim blamed on foundation settlement
Stucco cracks attributed to foundation settlement vs covered peril.Supplemental claim filed past the carrier's deadline window
Carrier rejects supplemental claim as filed outside statutory window.The adjuster's estimate is far below what the repair actually costs
Carrier adjuster's scope materially undervalues the loss.The carrier says the damage you reported isn't in your policy
Carrier denies specific damage elements as outside policy.Tornado claim denied because the carrier says it came from a hurricane
Tornado spawned by hurricane creates classification ambiguity.Tree removal payout capped by your policy sublimit
Carrier caps tree removal at policy sublimit.Two insurers both say the other one has to pay first
Multiple policies dispute primary coverage.Vandalism damage denied because the home sat empty for 30 days
Policy excludes vandalism on property vacant over a stated period.Vehicle damage is not part of your homeowners policy
Homeowners policy excludes damage to personal vehicles.Wind-driven rain claim denied because no opening was documented
Carrier denies wind-driven rain citing missing documentation of wind-created opening.You fixed things after the loss without the carrier's okay
Carrier alleges unauthorized repairs defeated claim investigation.Your car is worth less now but the carrier won't pay for it
Carrier refuses compensation for value loss after repair.Your carrier and the other carrier are disputing who is liable
Your carrier and the at-fault party's carrier dispute liability.Your carrier paid once but will not pay for damage found later
Carrier paid initial amount but refuses supplemental for newly discovered damage.Your claim covers damage but the policy lapsed in between
Gap between policies during damage progression.Your claim investigation went past 15 business days
Policyholder asserts carrier exceeded investigation window without communication.Your claim paid for cheaper plumbing fixtures than you had
Builder-grade plumbing fixtures approved for high-end originals.Your claim was capped at the other-structures coverage limit
Carrier limits claim to Coverage B sublimit.Your claim was denied as sewer backup instead of overflow
Carrier classifies event as backup (excluded) rather than overflow (covered).Your claim was denied because the policy did not transfer
Property sale terminated policy but seller filed claim.Your claim was denied because the policy form does not fit
Carrier says the policy form doesn't cover this type of loss.Your claim was denied because the policy had lapsed
Carrier claims policy lapsed before the loss date.Your claim was denied because you were not living there
Carrier claims you were not living there at time of loss.Your claim was denied for work done without a building permit
Carrier denies reimbursement for work requiring a permit but none obtained.Your claim was reduced because some fault was assigned to you
Carrier attributes partial cause to insured's actions.Your deductible refund is stuck waiting on subrogation
Your deductible reimbursement is delayed while your carrier pursues the at-fault party.Your driveway cracked and the carrier says it's not covered
Driveway damage from settling not covered.Your living expense offer does not cover the time you need
Carrier offers insufficient additional living expense coverage.Your policy was cancelled for cause before your loss
Carrier cancelled policy before loss based on cause (typically misrepresentation).Your pool heater damage was denied as not covered
Pool heater damage coverage disputed.Your pool resurfacing claim was denied or scoped too small
Pool surface damage not scoped for full resurfacing.
Guías en Español
5Las razones más comunes de denegación, explicadas en español.
Daño Preexistente. Guía de Reclamo Denegado.
Aseguradora dice que el daño existía antes del período de la póliza o del evento de pérdida.Deducible de Huracán Aplicado Incorrectamente. Guía de Reclamo Denegado.
Aseguradora aplicó el deducible de huracán cuando una tormenta no-huracán causó el daño.Desgaste Normal. Guía de Reclamo Denegado.
La denegación más frecuentemente mal aplicada. La aseguradora dice que su daño fue desgaste preexistente.Lluvia Impulsada por Viento No Cubierta. Guía de Reclamo Denegado.
Aseguradora dice que la lluvia entró por una abertura preexistente, no creada por viento.Reparación Parcial de Techo Denegada (Sin Coincidencia). Guía de Reclamo Denegado.
Aseguradora autoriza reparación parcial que no puede igualar el techo existente.
The practitioner view
From Eli: a denial is not the end of your claim.
A denial is not the end of your claim. In Florida it is very often a form letter. We have read 875 of them. Wear and tear was the most common reason given, and in most of those the letter never said what actually caused the damage. If yours does not name a cause, that is not you failing to understand it. There is nothing there to understand. Find one thing in that letter and write it down: the specific policy section they cite. That single line is the entire fight, and now you have it. Write down the date on the letter. Deadlines run from dates, and your policy has a time limit for bringing suit. You do not have to act on it tonight, but you need that date somewhere other than a piece of paper on the kitchen counter. Nothing else has to happen tonight. Nothing on that page expires at midnight.
Do not call the carrier at eleven at night and argue. Recorded line, you are exhausted, and anything you guess at becomes a statement in the file. Do not sign anything. Not a release, not a final settlement, not a repair authorization, not a proof of loss you have not read. Do not deposit a check labeled full and final without knowing what it settles. Partial payments are usually fine. Releases are not. If you cannot tell which one it is, it waits. Do not clean, repair, tear out, or throw away anything that is still damaged. Tarp for safety and stop there. Once it is in the dumpster you cannot prove it existed. Do not post about the claim on Facebook. And do not hire the first person who knocks tomorrow morning either.
In the morning: photograph everything, put the letter and the policy and every email in one folder, and then get somebody who reads these for a living to read it.
— Eli Goins, Florida licensed public adjuster #P159790. Ocean Point Claims Company (FL DFS #W829547).
A denial is the carrier's opening bid. People treat it like a verdict.
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