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If you have ever felt that your, or any, insurance agent will not fight for you if you have a claim that is denied by your insurance company, think again.  If there is any doubt that an insurance company is in the wrong when they deny a claim, talk it over with your miami home insurance agent.  As an insured you may have a basic understanding of your policy but your agent will have a greater knowledge about what you are and are not covered for.

One example of a claim that was originally denied happened right here in Florida.  The insured was the owner and occupant of a townhouse which was in the same building as seven other townhouses.  In the unit next to the insured the roof sustained damage from strong winds that allowed water to make its way into their townhouse.  They reported the claim and the insurance company’s initial response was that they were not covered.

As part of their denial the insurance company cited from the policy that “the inside of a building; or the property we cover contained in a building caused by: 1. Rain; 2. Snow; 3. Sleet; 4. Hail; 5. Sand; or 6. Dust; if the direct force of the windstorm or hail first damages the building, causing an opening through which the rain, snow, sleet, hail, sand or dust enters and causes damage.”  The insurance company took the position that coverage did not exist because the building the insured lives in did not have an opening.

One could argue that if water is finding its way inside, there has to be an opening somewhere.  The insured may have felt this way, their insurance agent was in agreement with them and they decided to challenge the insurance company’s decision.  The argument that they were going to use was that the word ‘building’ is not defined in the insured’s policy.  Before moving forward, though, the insurance agent discussed the situation with a claims manager.  The claims manager agreed with the agent and then discussed it with three other people who also agreed.  They sent their comments to the agent and he included them in his argument to the insurance company as to why the claim’s status of denied should be changed to approved.

In the end, the company changed their decision and paid the insured’s claim as well as claims for two other units in the same building (their claims had also been originally denied) that were in the exact same predicament.  The other two units may not have had the same insurance agent but the company did the right thing by acknowledging that if 1 of 3 claims was proven to be wrongfully denied then all of them were wrongfully denied.

When the claim was denied the insurance company cited text from the policy to explain why there was no coverage.  If you file a claim and it is denied, do not be bashful about challenging it if you and/or your insurance agent feel the insurance company is incorrect.  But, before challenging it, make sure your agent gets from the company in writing the denial and exact text from the policy that keeps you from being covered.  Even if the insurance company is right, they should at least send a letter saying your claim is denied, why it is denied and cite the text that proves it.

The world of insurance can be a complicated place that has the potential to cause feelings of frustration and/or anger if a claim is denied.  As your miami insurance agent we are here to help you in any way we can.  If you have any questions or are in need of help with anything please feel free to give us a call at 305-270-2100.

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At Filer Insurance, Inc., we have been serving Miami and South Florida since 1919.  We specialize in miami home insurance as well as miami auto insurance, miami life insurance and miami business insurance.  Please give us call or come by our office for a free miami home insurance quote.

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Posted 8:27 AM

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Miami, FL 33156
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