You paid your premiums, reported the loss, and cooperated with the insurance company’s investigation. Then you received a letter saying the claim was not covered.
Maybe the carrier blamed wear and tear. Maybe it called the damage pre-existing. Maybe it relied on an exclusion in the policy.
Whatever the reason, a denial is the insurance company’s position on your claim. It should be reviewed against the policy, the facts, and the evidence the carrier relied on.
We have reviewed hundreds of property insurance claim files. We know what to look for: inspections that missed important areas of damage, conclusions based on incomplete information, engineering opinions that do not match the condition of the property, and exclusions applied more broadly than the policy language allows.
Our job is to find out whether the denial holds up.
How Insurance Claims Get Denied
An incomplete inspection. A short inspection may become the basis for the carrier’s entire decision. If an area was never properly examined, important damage can be missed or dismissed.
A dispute over the cause of damage. The cause of loss often determines whether there is coverage. A carrier may characterize storm damage as wear and tear, or a sudden plumbing failure as long-term seepage. Those distinctions matter.
An exclusion in the policy. Insurance policies contain exclusions, but the wording matters. A denial should be evaluated against the actual language of the policy, not simply the carrier’s summary of it.
An alleged failure to comply with policy requirements. Carriers may raise issues such as late notice, insufficient documentation, failure to protect the property, or missed inspections. Whether those issues justify a denial depends on the policy, the facts, and applicable state law.
A decision made from the desk. In some claims, the final coverage decision or estimate comes from someone who never inspected the property. That can create a disconnect between what was actually observed and what ultimately appears in the claim file.
How We Review a Denied Claim
We usually begin with the policy, the denial letter, photographs and estimates, and the available claim documents.
First, we identify exactly why the carrier says the claim is not covered. Then we compare that explanation with the policy language and the evidence.
Depending on the claim, that may mean reviewing inspection reports, photographs, weather data, engineering opinions, repair estimates, communications with the adjuster, and the timeline of the loss.
If additional evidence is needed, we may work with contractors, engineers, or other professionals to document the damage and address disputed issues such as causation or repair cost.
Once we understand the claim and the basis for the denial, we can determine the appropriate next step. That may involve further negotiation with the carrier, appraisal where appropriate, mediation, or litigation.
A denial letter is important. It is not always the last word.