Homeowners Claim Denied: 5 Reasons Why
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- Опубликовано: 5 июн 2024
- We purchase insurance for one reason - to pay for our loss when something bad happens.
But search any insurance company on Google, and you'll see a bunch of complaints from folks whose policies didn't pay. These people are usually mystified and miffed, and ready to tell anyone and everyone how terribly the insurance company treated them.
We've read through a lot of these complaints, and sometimes we immediately know why the claim was denied. We know that it’s difficult to truly understand what your Homeowners insurance policy covers, so today we offer…
The Top 5 Reasons Your Homeowners Claim Could Be Denied
1. Deductible
Every homeowners insurance policy has a deductible, an amount of money YOU agree to pay in a claim. If the amount of damage is LESS than your deductible than your insurance policy would not have coverage for that claim.
The most common homeowners deductible is $1000
Often, there is a different deductible for WIND or HAIL claims. This deductible is likely higher than the deductible for any other type of claim. Make sure to study your policy and understand what both your ALL PERILS deductible and your WIND-HAIL deductible are.
ACTION STEP #1: Ask your agent how much it would cost to have a $1000 deductible
2. Covered Perils
The most common misconception: insurance policies cover any damage to your home.
The reality is this: all Homeowners policies are meant to cover a sudden loss with an immediate source of the damage. The sudden loss is often referred to in your policy as an Occurrence, and the immediate source of damage is called a Peril.
Perils are the source of the bad thing that happened. Lightning, Wind, Fire, & Theft would all be considered perils. DIFFERENT POLICIES COVER DIFFERENT PERILS. Here are the three types of policies and what they cover:
BASIC (HO1 or DP1) - Covers 11 Named Perils or 11 types of bad things that happen
BROAD (HO2 or DP2) - Covers 16 Named Perils or 11 types of bad things that happen
SPECIAL (HO3 or DP3) - Covers ALL PERILS unless they are excluded
For an in-depth breakdown of the 3 types of homeowners policies and what perils they cover go here: bit.ly/2jSs8U6
For a claim to be covered, an insurance company adjuster must be able to see there was an occurrence (or sudden loss) caused by a Peril covered by your type of policy.
ACTION STEP #2: Make sure your policy is an HO3. If not, find a policy that is. Ask for SPECIAL coverage for your dwelling and your personal property.
3. Exclusions
Certain things are limited or specifically excluded in homeowner’s policies. The most common exclusions are floods, earthquakes, and water back up/sump overflow. A common exclusion in coastal states is hurricane/wind and hail. Wildfires are often excluded in areas where wildfires are common. In most cases, the excluded Perils can be covered separately for additional cost.
ACTION STEP #3: Add Water Back-Up Coverage. Consider adding earthquake as well
4. Liability is Elsewhere
Liability coverage is for when bad things happen to other people because of you. But sometimes bad things happen to you or your home because of other people. The most common example is people you hire to do work on your property. Landscapers, house cleaners, and tree trimmers are all examples of people who come onto your property and could cause damage to it. When they cause damage the liability is on them. That's means their insurance policy should pay and yours likely won't
ACTION STEP #4: Only hire service providers that have liability insurance
5. Maintenance VS Occurrence
Homeowners insurance policies don't cover basic maintenance to your home. If your roof is old and leaky, it needs replaced. Your insurance policy won't cover that. If your furnace breaks down, you need a new one. Your insurance policy won't cover that.
Insurance policies cover OCCURRENCES, a single bad event that damages your home.
ACTION STEP #5: Keep up on your home's maintenance
We hope this post was information without being too scary.
Well built insurance policies should have the right coverage when you need it. Just don't get distracted by a low priced policy that's stripped of all the important coverage and you'll be fine.
If you need an agent to help you make sense of it all, we'd be glad to help www.shineinsure.com/contact
It sounds like insurance companies are doing anything they can to stop you from getting the money you spent on your home when you're in a disaster and need help. Shame.
Hi Tobias Draws. That's definitely one way to look at it. Another is that insurance companies are trying to figure out how to limit the amount of risk they take on when offering insurance. By doing so they keep the price of your insurance policy reasonable and don't go bankrupt.
Shine Insurance I'm in a situation where I've lost hundreds of dollars worth of furniture but I fear I won't make the deductible. There has also been constructional damage, I've suffered a real loss and I'm not sure I'll be able to recover very well.
Tobias you're forgetting to note that the named perils are common occurrences, claims are generally declined on a basis of not complying with "true or false statements" or "change in circumstances" where home owners are negligent in informing the insurer of the damage in a way that clearly outlined what's occurred. Not hard, take care of your home. It's not the insurers home at the end of the day, why are they expected to know your homes condition
yes
@jwathas
Pardon my French......but fuck allsate. They are a headache to work with. We had a friend that looked at our roof after hail. It damage the shingle and now our roof is leaking. allstate sent someone while my father and i we're at work. My mother was the only person home and they came by and said it was a maintenance issue. We filed a dispute on them and they have sent a group of 3 with one being an outsource inspector and then flew in some guy another time. They have denied our claims every time. I have told anyone and everyone never get allsate. YOU ARE NOT IN GOOD HANDS!!!
Beware of State Farm, I lost everything my home and belongings along with a vehicle over 6 months ago and am going through the same thing. Have had 4 adjusters and very little followup. I filed a complaint with the State Insurance Comission and don't know what the next step is...
Have you considered hiring a public adjuster? Generally they are a mistake but when you truly are getting nothing from the company it’s a good option. Look some up in your area and pay close attention to reviews and the amount of your insurance settlement they will take.
I have a current claim open with Allstate for storm damage to my roof. Its been a horrible experience dealing with them to say the least.
While my neighbors around me are getting brand new roofs I am arguing on phone with Allstate.
The same thing happened to me with another company.
I’m an insurance agent. You crushed it with this video. Know what you buy. Unfortunately companies like geico and progressive make that hard.
OUTSTANDING! The information you shared during this commentary was very informative. I don’t think many people delve this deep into the actual covers components of their insurance policy. Will be checking a few items on mine. You’re appreciated!
Appreciate you too! Thanks for watching.
$1000 deductible is a f___g ripoff. These insurance companies know what they are doing. We pay as consumers for all of this protection and what are they giving us back? Nothing!!!!!
Imagine having 10k of roof damage and you have to pay the first 7.5k it’s highways robbery
State farm is no good ether they use every excuse not to pay a claim there should be a video on where can a home owner go when they are broke and there claim is denied
The shower and counter were supplemental. The special adjusters on site first did not check the shower as their dry out crew had plastic up diverting the ( Rain ) into the shower area. They did not adequately cover the holes in the roof and required dry out services 3 times. I could write you a novel on this one.
So sorry you’re dealing with it. Many novels could certainly be written from claim scenarios.
Thank you. I really appreciate your time making this video!
Mai Chou Xiong it's our pleasure. Hope it helped u to understand how it all works!
Really good info. Thank you for this post.🙏
I am a contractor assisting my home owner with STATE FARMS refusal to cover a cracked tile shower and counter top. This was after a snow
laden oak fell on the house. 6 rafters were broken, multiple branch penetrations just to name a few facts. All cracks are horizontal around complete shower pan and dam as well as separation of tile counter and back splash. The coverage is in place, they simply deny that the damage is a result of two tons of tree falling on the structure. There are nail pops in the drywall showing the amount of structure compression and flex. I would appreciate some assistance with this.
Yeah, that connection seems like a no brainer. Was it included in your primary scope or did you find it later and add as a supplemental?
Here's what we'd suggest:
1. Continue to be kind. Straight-forward, clear, but kind. Getting mad isn't going to move them.
2. Ask the adjuster, "what would justify this being included." Stroke their ego a little and let them lead you to a solution. If they say "well if..." then simply build on that.
3. If those don't lead you down a path, say "Look, this is clearly connected with the covered loss. We can bring an independent adjuster in if we have to but no one wants that. If you were in my shoes, what next steps would you take?" Again, stroke their ego, make them feel in charge.
4. Have the homeowner do these same exact things. Adjusters can be more sympathetic to their client than the contractor.
5. If none of that works, you're left with pretty crappy options. The homeowner can hire an independent adjuster but there's time and money involved. The homeowners could complain to your state's department of insurance but that's not going to get the money paid. Finally, a lawyer could be hired but the potential cost there is mush more than what you're trying to get.
Hope this helps! Good job fighting for your client.
I wish I had found this channel when studying for my 220 license. Thank you for this information.
forced gambling and its not roulette or BJ, its Poker because there are tons of ridiculous claims denied and tons of ridiculous claims approved. Lots of strategy on this gambling table. I want to gamble the whole house and not have insurance and pay down my principle quicker then save money quicker then if something bad happens i can take care of it myself. even if i spend all my own money to rebuild im not in debt and im actually spending significantly less on intrest and premiums. Insurance is just to cover someone elses ass not yours
I have found this video helpful...thank you.
I was trying to get my insurance agent to remove jewelry, watches, and fur coverage since that does not apply to me and they would not do it. Said it is the standard policy. I also noticed they are currently not covering my roof nor sewer or septic back up! I need to get that changed!
Totally. If they can't get you roof coverage and water back up, move on. Feel free to reach out to us if you'd like.
As for the jewelry and stuff, that is baked into the policy. Even if they could remove it the price wouldn't go down. So no reason to fret on that. Find an agent that can explain things to you and get a better policy for a great price.
I had Farm Bureau and had water damage from the rain at the french door that leaked into my floor in the living room. The insurance company didn't cover it despite me paying faithfully for 15 plus years. The told me that it was a long term problem. I installed gutters myself and repaired the flooring and french door myself because they wouldn't help me at all. They didn't renew my policy and now I am shopping for another insurance. Thanks to Farm Bureau for no help at all and now I am having a hard time finding a company to insure me because I filed a claim last year. Insurance companies have it all figured out not to pay anything to assist the consumers and they want us to pay a 1000 deductible but they are still aren't going to pay anyway so what's the purpose??????????
Hi Handiable,
Really sorry to hear about this scenario. Both parts stink and it would be great if they would at least explain it to you better.
Here's what we see:
1. The Water Damage
The issue here is likely that the damage happened over time and not in one "occurrence". Insurance policies are set up to respond to specific things like wind, hail, fire, etc. When things happen over time they are likely to be considered more of a maintenance issue. If the water came in all at once then the question would be how did it get in and does your policy cover that. Usually the way water gets in is from wind damage, clogged drains, lightning, etc.
2. The Cancellation
What??! There's no way they should be cancelling you for filing one claim that wasn't even paid. That's not right and you should get a better explanation as to why. What you need to do now is find a local independent agent. Look at reviews on Google and Facebook for good ones. Share your story and ask for their help. Go into it with kindness and they should be willing and able to help.
We're sorry you're experiencing this but hopefully this explanation helped a little. We see people go through claims everyday and experience why insurance is so helpful in the worst moments of your life. There really are good companies and good agents out there.
handiable i agree!!!
I had Farm Bureau too and had water damage to the flooring. They did not pay. They said that it was a long term problem. They are the worst along with some of the other parasites. They just want to fatten their pockets and I don't believe any of them.
Went through the same problem 5 years back. French door FRAME on the second floor got rotten due to water and the bigger problem was that the water seeped overtime through that rott and damaged the french door on the first floor. Contractor was insisting to change both french doors, $3000 each for the doors, and $3000 to install both, so total $9000. And, I insisted on just repairing the 2nd floor frame instead of changing the whole frame and door. So, finally ended up out of pocket $3000+$1500 for the first floor and $400 to repair the rotten frame. Insurance refused to pay saying, they don't pay for the water damage of this sort. 6 years later still there is no problem with that repaired frame. So, also be careful with the contractors, they want you to spend even when there is no need.
Rot, deterioration, disrepair is an exclusion on every insurance policy. Slow leaks, drips, or anything occuring over a period of time is also a very specific exclusion on all insurance policies. As in, no insurance policy will ever cove it no matter the carrier, period.
As the homeowner in obligations you are expected to keep your home maintained and in repair at your own cost.
Insurance is for accidental direct physical loss - fire, tornado, damaging hail of 1" or bigger minimum, tree falling onto your house, sudden discharge of water (broken/frozen pipe), wind exceeding 70mph.
Excellent! More Please.
Deductible: The claim isn't denied it just did not exceed the deductible. The Homeowner may have a valid claim (not a denied claim) but if it doesn't exceed the deductible than no payment is due. That's why policies have deductibles. So insurance companies aren't called for every little thing.
NICE thanks a lot, none of no one's business what happened to me but so FAR my ins co is working with me on the damage but I want to do most of the work myself and did not say so for a long time wondering if I should have said nothing on that issue lol
Get your ins. estimate for repairs.Get estimates from contractors.There estimates will be more.Get to an agreed to cost for repairs before any work starts.Easier said than done.Work for the contractor.The insurance pays RCV minus deductible.You mitigate further damage only.Dont get screwed bro
With 20 years adjusting experiece the #1 reason people are dissapointed with a claim is that they do not understand the coverage they have and assume they are covered for anything that happens and no policy covers everything
Many people never read the policy or only read it after a loss happens.
Undertand that the policy is a contract that outlines a specific amount of coverage in return for a specific amount of money. Like most things you get what you pay for, cheap policies provide cheap coverage.
At the end its up to you to buy the best insurance you can afford but keep in mind no policy covers everything, if this did exist nobody could afford insurance.
And keep in mind all coverage is on a sudden and accidental basis, its an insurance contract not a maintenaince contract.
This is a little bizarre. In CA we have 7 HO-forms and three DP forms. We have HO-8 covers same as HO-3 (or old homes) HO-2 Broad form with named perils, HO-3 special form which covers all HO-2 perils plus other structures (not covering earth movement or flood), HO-4 which is renters and its a personal prop damage only, ho-7 is mobile homes and manufactured homes, HO-6 which is for condos, and HO-5which is comprehensive forms/open peril forms.
This helped me sooo much!! Thank you.❤️❤️❤️❤️❤️💯💯
So glad! Appreciate you.
So I farmers homeowners insurance long story short I live in a townhouse and I live in Illinois and currently we're getting major rain and in my "basement " or main floor room there's water coming in through the window from the outside. This townhouse was built in 2018 and I think it was pour caulking job. But now I see water coming from the side of window and I believe to fix the issue is that a company has to come out and take the whole window and window track and reseal and install it. What's your opinion?
What about when your home gets broken into and vandalized causing loss of use?
When the liability falls on someone else do you go through your insurance at all or directly to the others? How do you process that? Do they have to file it themselves? Will this then count against your policy increasing your rate. Thank you for the very informative video was very helpful.
on my policy, we just found out that we have a 1% portion on the deductible which we were not understanding or I consider informed on initially. What can you do once it’s already in place? Other than just changing it. I feel like our agent did not really inform us well just put something together and it was on us. I guess to read it more closely, but we trusted their judgment, now we’re paying the price. First we were told they are not covered. Then they went to the 1% in the end it was a liability from someone who damaged your home they do have liability insurance but according to my agent, they only have to cover what are coverage would have covered, leaving us with a humongous debt
Insurance Burden of Proof: HO1 and HO2 are Dwelling Polices which means, you the Homeowner has the Burden of Prove that you have suffered a Covered Peril or Damage to your home (Dwelling). Special form insurance HO3 is different. The Burden of Proof falls on the Insurance Company. They have to prove to you that no Covered Peril or Damage occurred to your home. Next, and very important. All insurance polices are an agreement between You and the Insurance Company. You agreed that the insurance company has the option to repair the damaged property first. If the property can not be repaired then it is replaced. Insurance is a business not a friendship unless you're the selling agent. Finally, not all Adjusters are well trained nor experienced.
Move to New Zealand for insurance that's all I can say plus the NZ to US exchange rate is 65c on the US dollar so you get more bang for your buck just saying if moving here from the US
What is the time frame to contact the insurance company back after completing a claim for the depreciation value? We completed a kitchen remodel after the waste plumbing ruptured. We never contacted the insurance agent back after completing the work.
So it's different for each company. You may be able to find the actual rules of your policy by searching for the "Duty to Report" section. A better approach though is to reach out to the insurance company and share that you finished the work and would love to know how to best submit the receipts. Sometimes going into it with the assumption that they will do what you're asking helps. Best of luck and let us know how it goes.
Under-deductible claims are not denied claims; the damages were paid, but did not reach the deductible amount and the insured was responsible for the first XXX dollars (depending on the deductible). A denied claim declares there is no coverage for the loss. If this were a hurricane claim with a $5,000 deductible and the covered damages reached $4,000 the insured (customer) would pay for the loss, but get credit for paying the first $4,000 of a $5,000 deductible. If a 2nd hurricane or qualifying storm occurred in the same calendar year, and the new covered damages were $10,000, the insured would only be responsible for $1,000 and the insurance company would pay $9,000. If the first claim was "denied" there would be no $4,000 credit towards the deductible and the second claim would only pay $5,000.
What coverage would cover demo and land clean up for total loss home?
Generally, demolition costs are included in your policy and lined out in the policy. Great question to ask to adjuster on the claim.
I just buy home insurance as per agent advise. Can not understand complex insurance document.
Hey Patel Vidhu, having an agent definitely helps and putting your trust in a good one is reasonable. That's something we do for many aspects of our financial and business world. At the same time, having a basic understanding and being willing to talk through the options is key. Your agent likely knows a lot about insurance but s/he doesn't know your risk tolerance, financial picture, etc. To put an insurance policy together properly, it's a conversation (even if that conversation is short and to the point).
An all peril Homeowner Policy will cover earthquake damage IF a fire starts in your home due to the earthquake (a gas line breaks, etc). So if your home collapses due to earthquake (and you don't have earthquake insurance) if your home miraculously catches fire your homeowner's policy will cover it (at least in CA). Just a side note!
NEED HELP WITH A QUESTION PLEASE ! I bought a duplex. Well i just bought half lol. So what happens if my neighbor has an electrical issue or leaves the stove on and now the whole duplex is on fire ? Am I out of luck because liability is elsewhere?
We missed this comment. How did it turn out. You shouldn’t have been out of luck. Let us know the outcome.
What about foundation? I’m in Texas and the ground moves. How does that work?
Why is nobody noticingTWIA has not been paying any claims at all since the hurricane. Roofers are actually out of work. When will they start paying claims? Will they ever start paying claims? The only roofs being repaired are where homeowners are paying for the repairs themselves. No other residential roofs are being repaired anywhere in the Corpus Christi to Rockport area. See for yourself. Go drive around and try to find a roof under repair. What difference does it make whether your claim is denied or granted if it's not going to be paid anyway?
Bob Stratton, Jeremy here. Totally understand where you’re coming from and very sorry that you and your town are experiencing this.
I don’t live in either of these two towns so can’t speak directly to your concern. The insight I have about how claims are being paid in Texas and Florida is from many online forums with fellows independent insurance agency owners who live and work in areas hit by these storms. Their experience has been that some companies are responding better than others but NONE of them have had problems with the company not paying for what is covered under the policy terms. It’s well documented that billions of dollars are being paid out right now in insurance claims. Most companies are writIng checks within a day or two of the claim being filed.
Are there examples of bad actors? Definitely. But I wanted to share that, at least from the perspective of insurance agents in your area, companies definitely are paying when coverage applies. If they weren’t, the local agent would know about it because we’re the first person a homeowner comes to when there’s an issue.
You can check out our hurricane coverage video to get a better sense of how a policy does and doesn’t cover this damage.
You should look up Joe Radcliff, he spearheaded a similar case against Allstate. You can look him up through the National Insurance Restoration Contractors Association
Insurance companies are like parasites sucking all of the money out of your escrow and they make it difficult for you to get any damages paid unless you come up with $1000 upfront.
Thank you so much
Happy to help!
Great !
insurance is worked out through politicians and lawyers need I say more
Will insurance cover void on a service let accomodation
Don’t quite understand the question here. Happy to help. Can you explain a little more?
The whole insurance industry in US sucks. My home insurance spent 2 years on my claim. It was a roof damage. Who can leave their roof unrepaired for 2 years waiting for the claim? fk.
That's totally ridiculous! This kind of claim should be resolved easily and quickly. Sorry you're dealing with that.
@@ShineInsurance They said they need to send somebody to check the damage and give an estimation. But the guy was in SC when I filed the claim, and took him 2 months to go to my state: VA. Then the estimation he gave was not accepted by the contractor in their system. They just keep kicking me around between the estimation and the contractor....
@@ShineInsurance there should be a website to show consumers the bad guys by grading system like hotels. At least that would be a guide.
@@saraswatkin9226 that’s a great idea!
That is exactly what I did today. They were all over it like biscuits and gravy. I can let you know the outcome if ya like knowing that may take a while.
Absolutely. Let’s us know how it turns out.
We are always professional, and tolerant of their obvious ignorance. Im now looking for another authority to help my customer. This does not affect me either way. I really do not
want to see this lady thrown under the bus by these people.
Yeah, it's hard to understand why the insurance company would deny a clearly connected supplemental. Have you tried to enlist the local State Farm agent? They really aren't very helpful on the claim side but it's possible they could pull some strings. Or ask for a higher up. Beyond that, she should really call a local independent adjuster and see how much it would cost to get them involved.
#6: Inspector is blind, can't see obvious damage.
It all makes sense they have to pay office rent pay employees pay taxes and still make billions of dollars. Where do you think all that money came from.
Aldo Malaj , damn - you’ve given billions to insurance companies? You’re ballin, congrats!!
@@ShineInsurance I meant insurance company's make billions of dollars not that I give them billions of dollars.
@@aldomalaj1322 Ahhh, we were like, "Dang! You get it Aldo. Can we fly in your heli?"
@@ShineInsurance Retardation is the biggest problem the world is facing.
Nice video
Is it “occurrence” ? drain copper pipe from underneath sink was leaking because worn out pipe inside wall damaging wood floors and cabinets for how long who knows!
Or maintenance? Covered or not?
Exactly, .Had a slow leak behind the wall in our bathroom from the shower piping. Because it was a
" slow" leak vice a major one and took a long time to finally reveal itself we were denied.
STAY AWAY from Allstate.
Try $7800 in louisiana
I think it's wrong placing endorsements or notices that are hard to read and contradictory. Just like not covering burst pipe and removal in a freeze. That's a sudden occurrence and you can't even live in your home with out repairing the pipes so you can have water for cooking, flushing commodes, using sinks to wash dishes. That should be covered and mandatory! Ins. Co's sure have gotten chicken shit and unethical!
Yeah, the back and forth between people trying to get money for anything and everything and insurance companies trying to defend themselves with confusing language gets real annoying real fast. Sorry you're dealing with it.
5% of 157,000 = $7800
I am sorry but my like for you video has been denied. You must first meet your deductible and prove that it was not a preexisting need for a like.
Be careful. Progressive Insurance will continue to automatically withdraw money from your bank account after you switch to another insurance company and will then make you go through hell battling their big-buisness doublespeak legalese in order to get your money refunded back to you.
1 natural disasters
Bla Blah Blah
Insurance is a fucking scam