According to a recent Weiss Rating analysis, you are less likely to have your claims reimbursed if you carry Citizens home insurance. Thousands of individuals who claimed damages in the past year got nothing. According to this study, Citizens Insurance now pays claims with the worst statewide rate. Citizens received 17,000 claims last year, and of them, slightly over half were refused.
Insurance claims are not always approved; there are various reasons why insurers can routinely decline payments. Knowing these causes can help policyholders stay clear of typical mistakes and raise their chances of a successful claim.
Policy Exclusions
Claim denial typically results from events or damage falling under policy exclusions rather than from anything else. For instance, unless extra coverage is bought, normal home insurance usually excludes damage from floods and earthquakes. Likewise, some company policies could reject claims about particular natural disasters or cyberattacks. Should a claim call for an excluded event, the insurance will not pay damages.
Failure to Meet Policy Conditions
Insurance policies provide particular requirements that have to be satisfied. Denial could result from not reporting an incident within the mandated period or from neglecting to act reasonably to stop more damage after an occurrence. Policyholders expected by insurance companies to meet these requirements will help to validate their claims.
Not Enough Documentation
Many times, claims call for thorough evidence to support losses. Denial results from missing records such as receipts, pictures, or repair estimates. For a high-value item alleged as stolen, for example, the insurer may deny the claim if the homeowner cannot prove ownership.
Misrepresentation or Fraud
Should an insurer believe fraud or misrepresentation, they could reject claims. Denying a claim may follow from providing misleading information during the application procedure or overstretching the scope of damage claimed. Claiming pre-existing harm, for instance, as part of a new incident, can invalidate the claim.
Pre-Existing Damage
Often denied are claims for damage existing before the coverage began. Only events occurring within the active policy period are under insurance responsibility. Avoiding conflicts depends on an accurate record of the state of the property at the time of policy development.
Inadequate Coverage
Should the claimed amount be more than the coverage, underinsurance or policy restrictions may cause partial payouts or outright denial. For a $150,000 claim, for example, a homeowner with a policy covering just $100,000 in losses might not get paid.
Arguments Regarding Damage Cause
Should the cause of the damage remain unknown, insurance companies could reject claims. For instance, the claim may be refused if a roof collapse alleged to be caused by a storm is attributed to wear and tear by the insurer.
Conclusion
Policyholders who want to lower their risk of denial should keep correct records, know their coverage, and have open, honest communication with their insurers. Knowing insurance terms and conditions will enable one to negotiate the claims procedure more successfully.