Why did my insurance claim get denied?

If you’re like many homeowners, you know that filing a claim with your insurance company can be frustrating. For many homeowners, the time and stress involved with dealing with the insurance company makes filing a claim not worth it – especially when you are likely to get denied or severely under-compensated.

Here’s what happens when most homeowners file a claim with their insurance company:

You talk with the machine for the first several minutes until you are put on hold with cheesy hold music, often interrupted by advertisements for new insurance policies
When you finally get a hold of a customer service representative, they thoroughly interrogate you about your claim to find a reason for denial – “Why didn’t you report your loss sooner?” or “Was your roof properly maintained?”
After providing a summary of your claim, many insurance companies train their first contact representatives to discourage you from pursuing a claim. They tell you it may not be worth it with your rate increase, or that the damage may not exceed your deductible.
When the insurance adjuster comes out to inspect your damages, many times his or her primary objective is to keep their job at the insurance company rather than pay you fairly. Many times the insurance adjuster will deny the claim for being worth less than your deductible.
If you do finally receive a settlement, you find that it is not anywhere near what you had hoped for, and you will not be able to pay your contractor to fix your damages. So why do so many homeowner claims get denied? Here are several reasons:
1. Insurance companies like to pay out for patch-work, which often does not exceed the deductible.
2. Insurance companies pay on wholesale value rather than retail value – and don’t factor in the profit, overhead, and sales tax that a contractor will charge you for.
3. The insurance company got you to say the wrong thing. For example, many homeowners have called to report a “flood” in their bathroom and were denied by homeowners insurance. Why? “flood” is not covered under the homeowners policy. What really happened was an overflow or leak, but because the homeowner used the word “flood” on the phone, they were denied.
4. They talked you out of it. Many times the insurance company’s representatives will make you feel guilty or unjustified in putting in a claim. Realize that insurance is big business, and unfortunately many times the client’s priorities take a back seat to the bottom line of the company.

What’s the solution? Hire a Public Adjuster like ACI Adjustment Group, ranked #1 by the United Public Adjusters Association for Customer Service and Satisfaction in PA & NJ. ACI Adjustment Group is a team of professional Public Adjusters who are licensed and bonded to negotiate your claim with the insurance company. They know how to present your damages, how to negotiate your policy, and how to estimate the true cost of restoring your property to its pre-loss condition.

When you hire ACI Adjustment Group for your claim, you are hiring a team of individuals with decades of experience in the fields of insurance and home construction and inspection.

Many times homeowners hire a contractor to “patch it up,” and don’t find out how much it devalues their home until their home is up for sale. ACI Adjustment Group’s scope of damages includes all materials and labor needed to get your replacement job done right! ACI Adjustment Group thoroughly negotiates your claim from start to finish. Most homeowners are not well-versed on their policy, home construction, and how to negotiate their settlement. Through a series of appointments, letters, e-mails, and phone calls, ACI Adjustment Group fights for homeowners like you to receive fair settlements.

ACI Adjustment Group performs FREE Property Inspections to qualify if your damage is worth pursuing or not. ACI Adjustment Group has an exclusive NO FEE GUARANTEE – meaning that you pay no money out of pocket at any time and if no money is recovered, no fee is owed!

To schedule a FREE Property Inspection, call 1-800-809-4302. ACI Adjustment Group is available for Emergency Services 24 hours/day, 7 days/week.

Frequently asked Questions

My insurance claim was denied. Is there anything I can do?

Yes. We successfully overturn denials every day. Often, the insurance company will deny a claim over the phone, will determine the wrong cause of loss, or deny the claim because the damage doesn't meet the deductible. Whatever the case, ACI Adjustment Group may be able to get you covered.

How is ACI Adjustment Group able to help prevent you from having your claim denied?

ACI Adjustment Group estimates the full scope of work for what you are entitled to in your policy - full indemnity. Full indemnity means restoring your home to the same condition, function, appearance, and value that it was before the loss occurred.

Can the insurance company deny my claim over the phone?

Yes. We have handled numerous claims that were denied for "maintenance" over the phone, and then had those denials overturned after our inspection. Also, the insurance company's representative may determine the cause of loss as not covered if the homeowner reports the damages as "flood," "mold" or another peril that is not a covered cause of loss.

My insurance company denied my claim by saying that the damage was a maintenance issue. Are they allowed to do this?

Maintenance is not covered under homeowners insurance. However, most insurance company adjusters are trained to spot maintenance issues and deny claims. We have had many of these denials overturned. On several occasions, a property owner had the insurance company assess and deny their claim 2-3 times before we were contacted, and we were able to overturn the denial.

My insurance company denied my claim because the damage did not meet the deductible. Is there anything I can do?

Yes. Denying a claim because it doesn't meet the deductible is one of the most common tactics the insurance companies use to prevent a "Bad Faith Lawsuit." These claims are easy for us to overturn, because they are not a coverage issue, but an issue of scope. We'll often turn a "patch job" into a whole room.

How do I reopen a denied claim?

You can start a claim online by clicking HERE or call 1-800-809-4302 to have an expert inspect your damage first, free of charge.