Managing your insurance can be difficult, especially since insurance companies have become notorious for highly priced premiums, large deductibles, rises in cost each year, and being reluctant to pay out money.
When investing in an insurance agreement policy, we are investing our trust that whenever we suffer a loss, our insurance company will reciprocate and give us a “just claims settlement.” As we have entered a lawful agreement and dutifully pay our part, we expect them to pay a claim that deserves to be paid – especially since most residential owners or commercial property owners only file a claim VERY infrequently (maybe once or twice in a lifetime?)
The question most are left with is “why has my claim been denied and where do I go from there?”
The truth of the matter is that many people don’t know what to do if an insurance company denies your claim. Certainly, it is unexpected when you receive a denial letter with no easily understandable reason for the denial given. Some of the most common sources of denial are:

TECHNICAL LANGUAGE
Often the technical language used when the insurance company interviews the client after the damage, causes for confusion and misunderstanding. The use of confusing and legal jargon often results in the client reporting the claim incorrectly and thereby the claim is denied.

EXCLUSIONS
Often the insurance company will refer to an exclusion that is not necessarily applicable in the particular situation, which makes having a public adjuster, who knows the legalities, crucial to redeeming the compensation you deserve.

REQUIRED DOCUMENTS
Filing an insurance claim requires many forms and documents to provide proof and to abide by certain legalities for compensation. Sometimes the insurance company asks for documents that the homeowner can’t find or is late in sending, which can cause a denial.

POLICY COVERAGE LAPSE
There are times the policy has lapsed and there may not be coverage at the moment, but it is possible there was coverage during the time of damage.

WE CAN HELP!
Depending on the property damage, each claim is different, and this consequently results in a multitude of potential reasons for denial. Due to the complexities of each claim, it’s crucial to have someone who can clarify the situation by going through the sequence of events to determine the reasons for the insurance company rejecting the claim.
Our team of experts can oftentimes turn around a denied claim by clarifying the facts with the insurance company and sending the correct forms in. We know the tricks of the trade and have developed expertise in the requirements and determining what is incorrect or missing in each claim.
We have handled many denials and have been able to secure the funds our client was looking forward to. Nine out of ten times a denial will get paid – Most times with more money than the property owner ever expected to receive.

​DB Solomon Public Adjusters is happy to review your case and read your letter of denial to see what would be the best course to take.

1. You’re Being Asked to Provide Documentation to File Your Claim
 When you have a significant claim as a result of catastrophic damage to your home, your insurance company will ask you to document your claim with reports, receipts, and pictures. Make no mistake. This is a crucial step in the claims process, and the insurance company won’t be helping you to prepare your claim. The entire process will be up to you unless you hire a public adjuster. Documenting your catastrophic losses is an enormous task that really only seasoned experts can do correctly. Otherwise, you risk missing out on a portion of the amount you are due; either through omission or undervaluing your losses.

​2. The Insurance Policy Language or Claims Process is Confusing to You
 Insurance policies are often written in legalese that is challenging for the average person to fully understand. Even the supposed “user-friendly” versions may contain confusing language like Period of Restoration, Business Interruption Coverage, Actual Cash Value, and Replacement Costs. These industry terms can be hard to fully grasp. Not only that, but you may have received a significant amount of information about the actual claims process over the phone, where it’s impossible to accurately write everything down that the insurance representative told you. If you are feeling overwhelmed with the complexity of the policy or the claims process, this is a clear sign you should hire a public adjuster to handle the claim on your behalf.

3. You Lack The Time To Handle The Insurance Claims Process Yourself
 When you suffer a major loss to your business or home, there’s a big challenge ahead. Not only are you expected to carry on your family life and work responsibilities; now you are tasked with the full-time job of handling the monumental claims process. Frankly, this can feel like a second full-time job, and there are only so many hours in a day. The stress of dealing with the emotional crisis following a major loss combined with the stress of trying to submit an accurate claim can feel like its own catastrophe. If you’re in this position, you can immediately alleviate the burden simply by picking up the phone and hiring a public adjuster.

4. You Feel Like You’re Getting the Runaround From Your Insurance Company
 Many home insurance companies strive to give the best customer service they can. Unfortunately, things don’t always happen as they should. What sometimes happens is that the homeowner’s phone calls aren’t returned in a timely manner, or there’s a “disconnect” in communications. If you suspect that you aren’t getting the right attention from your insurance company, it’s definitely time to call in the services of a public adjuster. 

5. The Insurance Company is undervaluing you claim
 If your insurance company has underpaid your claim or they are taking far too long to assess your claim, then this could be a sign that it is time to call in a public adjuster. An insurance claim can be a lengthy process. If you feel you are being neglected by your insurance company, or they are not responding to your calls in a timely manner, it would be wise to expand your team to include a public adjuster. ​

6. Knowledge and Professional Standards
 Claim adjusting is art, not science. If you rely completely on your insurance company to calculate the amount of damage and what you’re owed, you’re unlikely to recover a full or fair settlement. The insurance company sends out their own staff adjuster or “independent” adjuster, and their handpicked contractor, whose job it is to define a scope of the damage and estimate the costs to repair or rebuild your home. They measure the loss for the insurance company, not for you. This matters because big dollars are at stake and your financial goals and the insurers’ financial goals are not the same. You want your loss to be accurately measured, you want to maximize your insurance coverage and recover every dime you’re owed. Many people hire their own experts/contractors to measure and value damage independently from the insurance company.

In Closing
 Documenting and navigating a catastrophic property loss is time-consuming and burdensome to even the most sophisticated insured. It is hard for you, the insured, to know whether you are getting all that is owed under your insurance policy. Your policy may actually give you extended coverages beyond the stated dollar limits on the policy and way more than the insurer offers you. An experienced claim advocate on your side can be a strong voice for you in the process and give you much more input and negotiating leverage on your final insurance settlement than you’d have on your own. Instead of relying on the insurance company to decide how much you get to rebuild your home, hiring a good public adjuster can help you receive the best possible settlement.

• You can claim reimbursement from your insurance company for Additional Living Expenses (“ALE”) you incurred due to the loss of use of your home because of a mandatory evacuation order or damage that makes it uninhabitable.  Check the “Loss of Use” section of your policy. Common wording that covers evacuation costs is “prohibited use due to civil authority.”  A deductible may or may not apply to your ALE claim, depending on your policy’s wording.  If your expenses are modest, you may be better off paying them out of pocket to avoid filing a claim that can impact your premiums.

• Heavy smoke, nearby flames and extreme heat can cause visible or hidden damage, impact a home’s air quality and/or create health hazards you may not be able to see or smell.

• Indoor air quality and home environment health standards vary and there is not one official, clear and established set of guidelines for smoke, soot and ash contamination and proper cleaning methods.

• If there are members of your household who have chemical sensitivities, a history of respiratory illness, or are immunosuppressed, notify your insurer and consult with a physician before moving back in.

• Unless an insurance company adjuster has special training and conducts appropriate testing, he/she is not qualified to determine whether there are harmful particulates or hydrocarbons in your home or whether your home is habitable.

• A reputable and qualified Certified Industrial Hygienist (CIH) can inspect and test the air, surfaces and “soft goods” (furniture, rugs, curtains, etc.) in your home.  If you are hiring one yourself, check qualifications and references carefully. If you are reviewing a report prepared by an expert hired by your insurer, do the same. Visit:  American Board of Industrial Hygiene and National Registry of Environmental Professionals.

• Communicate with your insurer in writing if you believe your home is not safe to live in and provide them with supporting documentation.  Request that they cover the cost of appropriate inspection, testing and remediation and ALE. Be prepared to enforce your rights if an adjuster or insurer rejects your request to cover necessary costs.

Bottom line:  Protect your property and the health of your household members by being cautious about moving back in, and by taking steps to have your home properly inspected and cleaned, repaired, or restored.
The information presented in this publication is for general informational purposes, and is not a substitute for legal advice.

Insurance policies are usually divided into four or five main sections or categories by what is covered and the maximum amounts the insurer will pay in the event of a loss.  Typically there’s Coverage A, (Structure), B (Other structures; garages, outbuildings), C (Contents) and D (Loss of Use/Additional Living Expenses).  Here’s a basic summary of the main types of coverage in a typical homeowner’s policy.

Your declaration page (often called a “dec” page) states your name and address, policy number, dollar amounts of coverages and “endorsement” codes. You can think of your dec page as the body of a car. The wording inside is the engine, the parts, the wheels, etc. Your dec page states the dollar amounts/limits for your main coverage categories, but what you see is not always what you’ve got. There are extensions, limits and exclusions for certain items. For example, many policies contain a “sub-limit” for valuable papers, computer equipment and jewelry.

​You’ll need to do some math and piecing together to figure out what your policy limits actually are. Don’t rely solely on your insurer’s calculations.
Use our tips and the sample declaration page in this PDF to figure out what’s in your policy and how to collect what you’re owed.
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Special note for California: There is a Residential Property Insurance Disclosure law that requires insurers to provide every customer with a form that alerts you to the specific types of coverage you have bought, plus the ones you could have bought.

Appended from United Policy Holders: First Steps After a Wildfire - United Policyholders (uphelp.org)