Insurance Claim DisputeAn Insurance Claim Dispute occurs because insurance companies routinely misapply and misinterpret the language in their policies to deny valid claims. Many times, unsuspecting policyholders receive a denial letter citing policy language and therefore assume the insurance company won’t cover the loss. Most of the time, however, a second look is warranted. Insurance adjusters that work for insurance companies are trained to find a reason (or excuse) to deny your claim and often times, they misinterpret the policy and improperly cite exclusions or exceptions to coverage that don’t apply to your situation.

Example of an Insurance Claim Dispute

The following example shows how an insurance company can misinterpret the policy (sometimes on purpose) and wrongfully deny a valid claim. It is taken form a real insurance claim dispute.

A homeowner submits a claim due to an air conditioner leak causes extensive damage to the home. He also discovers cracks in his marble flooring. The insurance company investigates the loss and concludes that the cause of the cracks is “settling of the foundation.” (The specific policy in question excluded coverage for damage resulting from “settling of the foundation”). The insurance company cites this exclusion and summarily denies the claim. However, this particular policy contained an important and overlooked exception to the “settling of the foundation” exclusion. The policy stated that that the “settling” exclusion would not apply to any settling caused by accidental leakage from an air conditioning system. Realizing the difficulty in proving that the settling was not caused by the air conditioner leak, the insurer paid the full value of the damage.

At JP Salas Law we are well versed in the many nuances insurance contracts present and consequently can handle your Insurance Claim Dispute. As illustrated in the above example, an insurance company will often improperly rely on exclusions to deny a valid claim. A closer review of the facts surrounding a loss and the policy language can uncover important provisions that result in a grant of coverage. An experienced and seasoned insurance claims attorney can help you make sense of your insurance policy and explain it to you in a straightforward manner. At JP Salas Law explain your options and work tirelessly to get you every penny you deserve.

Common Excuses from Insurance Companies

Common excuses insurers rely on to deny valid claims include:

  • Pre-Existing Issues/Conditions
  • Wear and Tear
  • Failure to Maintain
  • Neglect
  • Long Term Leaks
  • Minimal damage not covered by the deductible.

Your policy is a powerful tool and can be used to fight back in your Insurance Claim Dispute. It is important that you obtain a copy and review it carefully. If you have questions regarding your loss or the language in your policy, contact JP Salas Law for free consultation.

JP Salas Law represents policyholders with an insurance claim dispute in cases such as: