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Common Justifications for Homeowner’s Insurance Claim Denial

Fri Dec 21st, 2018 on     Property Insurance,    

In the homeowner’s insurance context, insurers deny claims for a variety of reasons, some reasonable, some not so reasonable.  Fundamentally, insurers are incentivized to deny claims and minimize their payouts.  For example, if you are entitled to recover $100,000 in a homeowner’s insurance claim, but the insurer’s initial denial convinces you not to bother pursuing the insurance claim, then the insurer will have saved a substantial amount of money by simply acting adversely to your interests.

It’s important to understand, however, that if the denial was wrongful, then you may be entitled to challenge their decision and secure the benefits that you’re owed.  Let’s take a closer look at the common justifications underlying a homeowner’s insurance claim denial.

Loss Does Not Exceed the Deductible

Most homeowner’s insurance policies include a deductible for various claims.  If you are attempting to make a “small” claim, the insurer may deny it on the basis that the loss is not significant enough to exceed the deductible amount.

Loss is Not Due to a Sudden Event

Losses caused by long-term issues — maintenance-related and otherwise — are generally not covered by homeowner’s insurance.  For example, if your home develops wood rot, the damage caused is often not accounted for by standard homeowner’s insurance coverage.  You may have to obtain supplemental coverage for such issues.

There is Third-Party Liability

In the event that a third-party is responsible for the damage to your house, your insurer is very likely to deny coverage — it is the third-party who must be held liable against whom you must pursue a claim.  For example, if your home sustains serious damage when a driver rams their car into your garage, then you will have to sue the driver and recover damages (through their insurance coverage or their personal assets directly).

Coverage Exclusion Applies

Homeowner’s insurance policies generally include specific coverage exclusions depending on the region.  In coastal Florida, for example, hurricane coverage is often excluded from default homeowner’s insurance policies (so as to encourage policyholders to purchase supplemental coverage).  Coverage exclusions are not always clear, however.  Fortunately, if the exclusion is written in an ambiguous way, then the law requires that the provision be interpreted in a manner favorable to the policyholder.

Contact an Experienced Miami Property Insurance Lawyer for Assistance in Challenging a Claim Denial

Here at Ver Ploeg & Lumpkin, P.A., our attorneys have decades of experience advocating on behalf of insurance policyholders in difficult disputes with their insurance carriers, including disputes that involve homeowner’s insurance claim denials.

We are a boutique insurance litigation firm that prides itself on the provision of client-focused representation.  As such, we are committed to maintaining open lines of attorney-client communication, and to understanding the contours of your claim in every respect — this thorough, information-centric approach to client engagement ensures that we have the information necessary to take decisive action when an opening presents itself.

Call 305-577-3996 or send us a message through our Contact Us page to schedule a free and confidential consultation with an experienced Miami property insurance lawyer at Ver Ploeg & Lumpkin, P.A.

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