You Have Religiously Paid Your Premiums & Now Your Claim Has Been Denied. What Can You Do About It?
Wind and hail damage claims are commonly denied by insurance carriers. Often times, carriers will deny claims for the following reasons:
- Improperly installed products used in construction,
- Defective products used in construction,
- Pre-existing damage,
- Roofing materials are beyond their useful life, and
- Failure to timely report a claim.
Valid Claims Are Denied Everyday
Often times, insurance adjusters improperly deny claims that should be covered. By doing this, the insurance company is breaching its contract of insurance and sometimes operating in bad faith as defined by Texas law. Furthermore, insurance companies are required to promptly pay claims or they will be in violation of the Texas prompt pay laws. If you find yourself in a situation where your insurance company is refusing to pay, you must contact a lawyer immediately so they can evaluate your rights as outlined in your insurance contract and as provided by Texas law.
What Should You Do If Your Claim Has Been Denied?
First, you should make sure all of your communication with the insurance company, it’s adjusters, and your insurance agent is in writing.
Second, you should ask the insurance company to take a second look at your property. If you have a professional such as a roofer or contractor that is helping you assess the damages and provide an estimate for the repairs, have them present when the insurance company reinspects.
If the insurance company still refuses to pay, you should consult with a lawyer to assess your legal rights.
Is It True That My Only Remedy Is Appraisal?
No. Often times insurance companies will inform policyholders that their only remedy in the event of an underpaid or denied claim is appraisal. That is simply not the case.
Appraisal is intended for situations where the insurance company and a policyholder cannot agree as to the value of a covered loss. For example, if the only issue in a claim situation was the actual cost or value of a roof, then that could be one circumstance where appraisal would be appropriate.
If the insurance company has completely denied your claim, they are taking the position that you have not suffered a loss that is compensable under the policy. As such, there is a disagreement as to coverage and not value of the loss. Failing to pay a covered loss is a breach of contract. You will require a lawyer to protect your rights when the insurance company has breached their insurance contract.