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What to do if your insurance claim is denied

Florida homeowners, like other homeowners throughout the U.S., forego filing insurance claims for minor items, such as a broken window or damaged storm door, because they know their premiums might be raised. When they do file a claim, it is for something significant, and they expect it to be approved. When they receive a letter from the insurer denying the claim or fail to hear anything at all, they are understandably puzzled, to say the least.

For those who find themselves in this position, Fox Business suggests that first, homeowners do their homework, review their policy and make sure they understand their coverage. Common reasons for denial are lack of evidence or documentation, not taking adequate preventive measures or simply that the damage is not covered under the policy.

The insurer must provide a reason for denying the claim, which homeowners should double-check against the policy. Insurance companies are run by people, and to err is very human, so claimants should look for evidence that the claim is fully understood. If it is not, claimants should consider whether further documentation, such as more detailed photos, would help the insurer better understand the damage?

If homeowners do not receive a letter after several days, they should take the initiative and follow up with the insurance company. If they feel there is some misunderstanding, error or no reason for the denial, the next step is to file an appeal.

FindLaw explains that state insurance laws generally require insurers to approve or deny a claim in a specific timeframe, and, if denied, provide an explanation for the decision. They also are bound by law to make an appropriate investigation and to do it in a timely manner, before the deadline to contest the denial has passed.  

At any point in this process, homeowners can seek legal advice. In fact, their claim might be better represented by having a legal expert provide guidance. If they are unable to reach a settlement with the insurer, a legal representative can help them decide what legal action to take, such as pursuing lawsuits for unfair trade practices or breach of contract. Compensatory damages, which can include lost income or medical bills, may also be part of the suit. 

From the very start of a claim, homeowners should document all phone conversations and correspondence with their insurer and its representatives, including emails. They also need to document the damage with photos and save receipts for repairs that are made, as well as any medical or related expenses. This information will help form the basis for a lawsuit.

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