Stay calm
I understand you’re upset. But you don’t want to lose your cool and let the issue become about you instead of the disagreement that you are trying to fix. Decide exactly what it is you want from the company and ask for it calmly and politely. As you go through the process of resolving the claim, keep a log of the names of the people you talk to, when you talk to them, and what is said in each conversation. Keep records of any written correspondence you receive.
Ask questions
Sometimes people are angry over a simple understanding, so make sure that you and the insurance adjuster are understanding each other correctly. One way to do this is to restate what you think they mean and ask if that is correct. If it’s a simple misunderstanding, it should be easily fixed once you understand each other. It’s also important that you understand why the company is making this decision so you can determine if you are likely to be successful in disputing their decision.
If you are making a claim against your own policy for damage to your property and can’t reach an agreement on the value of the property, ask what the adjuster would need to reconsider. Make sure that they have the correct information regarding the property including the brand name, age and any special features. If all else fails, find the “appraisal” clause in your insurance policy, or have your insurance company send it to you. This part of the policy explains how disagreements about property values will be settled. Usually it says that you and the company will each hire an appraiser, the appraisers will agree on an umpire, and if the appraisers can’t agree on the value of your loss the umpire will determine the correct value. You would be responsible for paying the cost of your appraiser and half the cost of the umpire, but if there is a significant amount in dispute and you feel you have a good chance of winning, it may be worth the money.
If you are making a liability claim against another person’s insurance company, make sure that they have all the relevant documentation. If you were injured, make sure that you have provide contact information for all the doctors you see so that the adjuster can document your injury. Keep records of medical expenses, lost income, and travel costs. If you have scarring, have photographs taken to document the appearance of your scars. If there is a dispute regarding liability, check the police report if there is one and try to find out if the insurance company has all the relevant facts, especially the ones that favor your position.
Get it in writing
Having proper documentation will be important to resolving your claim. If it becomes clear that the claim is not going to be easily settled, put your requests to the insurance company in writing and file a copy of your letter with their response. This will be helpful later if you have to prove what was said.
If you are the customer and the company denies coverage for a loss, you should receive a written denial of coverage that quotes the policy language that they are relying on and explains how it applies to your claim and why they have determined the claim is not a covered loss. Most companies will provide this to you automatically. If they don’t, insist that they send you a coverage denial letter.
Review their decision
If you receive a coverage denial letter, review it carefully. Insurance policies are very complex contracts. They typically include a declarations page, an insuring agreement, conditions and exclusions. Let’s go over these in a little more detail to make it easier to understand your insurance policy.
The declarations page contains information about who is insured, what coverages apply, and what the coverage limits are. You will receive a declarations page each time your policy renews. This part of the policy is pretty self-explanatory. If you have an insurance policy that covers you for damage to your home and your neighbor’s home is damaged in a storm, the policy doesn’t pay for damage to your neighbor’s home. Unfortunately, things aren’t as easily understood we look at the rest of the policy.
The insuring agreement states briefly what the policy is intended to cover. If a loss occurs that falls outside of the scope of coverage granted by the insuring agreement, it is not covered. For example, most liability insuring agreements specify that they cover loss arising from an which is an accident. If a loss does not arise from an occurrence, it is not covered.
The conditions portion of the policy states that you have certain duties that you must comply with before you are entitled to coverage. Common duties are to report the loss promptly, cooperate with the investigation of the claim, and provide the documentation reasonably necessary to investigate the claim. This is one reason that you should be sure to report claims promptly. If you try to handle things yourself and it doesn’t work out, you may have impaired the company’s ability to investigate the claim, which could give them grounds for a coverage denial.
Ask your agent for help
If you have trouble understanding your policy or aren’t making any headway with the adjuster, your agent may be able to help. Explain how the claim has developed so far, why you are unhappy and what you would like to see happen next. If the policy isn’t clear to you, ask your agent to explain it. Your agent may have an insight you have missed or connections within the company to help you get the claim settled to your satisfaction.
Contact a claims supervisor
You have the option of asking to talk with the adjuster’s supervisor. Give them a recap on how the claim has been handled to date and ask any questions you have about policy language or company procedures. Tell them what you want and ask if there is additional documentation that you can provide to help them see things your way. Ask if they are open to compromise and let them know if you have room to negotiate. Ask them to let you know what the next steps in the process will be and when you can expect them to take place.
Contact your state’s Department of Insurance
Your state’s Department of Insurance can be a powerful resource. You can easily find their website online and do some research on what a policy typically covers and what you should expect from an insurance company if you have a claim. You can ask them questions or file a formal complaint. If you file a complaint be very clear about what has happened so far, why you are unhappy and what you want to happen next. Include your log of contacts and any written correspondence between you and the insurance company. The Department of Insurance will then contact the company and give them a deadline to give a written response to your complaint. This isn’t a magic bullet, if the company has strong grounds for their decision they just have to explain that to the Department of Insurance. But it will get your complaint listened to and it will get a response.
Contact an Attorney or Public Adjuster
If you are unable to resolve the claim to your satisfaction after fairly considering the insurance company’s position and if the claim is large enough, you can hire an attorney to help you resolve the case. Try to find a reputable attorney that has done similar work for someone you know. Look beyond what they say on their website or in the yellow pages and ask for references. If you have a family attorney, they may be able to handle this for you or refer you to a specialist.
I mention this option last because it can delay the handling of your claim and involve significant costs. However, if you start to think you may need an attorney, considering setting up an introductory appointment and asking for an overview of your rights and responsibilities and an evaluation of your case. Even if you don’t hire the attorney to formally represent you, they may be able to give you some help in effectively presenting your case and help you avoid things that could cause trouble in resolving your claim.