Fight back: Denied insurance claims
Staying on top of a claim with your home insurer takes some quick legal preparation.
By Ellen McGirt with Kate Ashford, George Mannes and Pat Regnier, MONEY Magazine

NEW YORK (MONEY Magazine) - Homeowner premiums jumped by a third between 2001 and 2004, according to J.D. Power & Associates. So you'd think you could get more love, right?

Wrong. You're paying not for service but to make up for losses -- low interest rates, natural disasters and choppy markets have depleted insurers' coffers. Nearly 200,000 people cried foul in 2005, says the National Association of Insurance Commissioners.

Top complaints were delays, denials and lame settlement offers. The steps below will help you with auto insurers too.

How to fight back:

1. Talk like a lawyer

Understanding two simple legal concepts can send a message to your insurer that you've done your homework and you know how the game is played.

Estoppel Ask your agent for the specific provision in the policy that's the basis for the inadequate offer or denial. This puts the insurer in a position where it can't spring a new reason for the denial on you sometime in the future, because everything's in writing. It's a way to make sure you always know the exact wording you're fighting against.

Contracts of adhesion Insurance policies are written by one party (the insurer), with the other (you) having no say. If the aggrieved party (you) makes a case that the language is ambiguous and can be interpreted in different ways, you've got a shot.

"The court typically instructs a jury that the person who wrote the contract loses if the language is ambiguous," says Bob Hunter of the Consumer Federation of America, who is a former Texas insurance commissioner.

Reread your policy. If you read it in a way that can work in your favor, have a lawyer send a letter saying so.

2. Present evidence like a lawyer

If your insurer claims the damage is from a previous storm or accident, or from normal wear and tear, produce:

  • Mechanics' maintenance reports
  • Receipts for home repair
  • Photos taken before the damage

3. Call the law

If you and the insurance agency are at an impasse, put a call in to your state insurance regulator (consult the NAIC at, who can act as your advocate.

Unless your insurer has broken the law, the regulators have no enforcement capabilities, but nobody likes regulators sniffing around, and many states make complaint records public. The threat of looking bad on a state regulator's Web site is often enough to elicit a response.

Next: Dealing with a greedy broker Top of page

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