Your insurance company has just denied your complaint. There are a lot of things that cross your mind: it’s annoying, it will be expensive, it is exasperating that we are treated like that, it is not fair. But this is not the final answer. A denial does not mean that you are not on options – this means that you must know your rights and review the reasons for the insurer’s denial. Because here is the thing: insurance companies are not in order to distribute money. They expect you to accept their decision and move on.
Don’t do it.
Instead, push back. Challenge their reasoning. Take advantage of each tool at your disposal to ensure that their refusal is valid. Here’s how to take control of the process and continue to fight for the cover of your complaint.
First step: dissecting the denial letter
Insurance companies will not simply say no and do not remain it. They will quote their reasoning to refuse the cover in a dense and heavy language, hoping that you do not question it or will not understand it. Your first job is to break it down.
To research:
- The declared reason for denial – A phrasing wave like “not covered by your policy” is not enough. Find out exactly why they refuse the complaint.
- The political clauses they cite – Compare them with your policy documents. Do they really apply?
- All divergence – If their explanation is not clear or contradicts the wording of the policy or even the facts of your situation and the loss, you have an opening to repel.
Second step: Build your case
A call will not go far without evidence. You need difficult evidence to challenge their decision.
- Photographs and videos – Taken immediately after the incident, with horodatages. If you have pre-damage photos, even better.
- Maintenance receipts and records – If the insurer requests negligence, show them that your property has been properly maintained.
- Professional assessments – An independent entrepreneur or expert can provide a detailed report that refutes the insurer’s conclusions, in particular if it is a question of the cause of loss. Having a report to determine the real cause of loss can help with the technical details of the exclusion clauses.
- Declarations of eye witnesses – If there were damage witnesses, their accounts can strengthen your complaint.
Third step: speak their language
Insurance companies operate in technical details. The more precise and factual you are, the more difficult it is for them to reject you. Supervise your call using their terminology.
Instead of saying, “I thought it was covered,” State:
“According to section X of my policy, this damage is a matter of covered perils. The refusal does not correspond to the conditions of coverage indicated by the policy.”
The goal is to show that you understand your policy better than expected and let them know that you will keep them to a certain standard.
Fourth step: call – and be relentless
Most insurers have an official call process. Use it.
- Submit a written call – Address it to the complaints department and referencing the wording of specific policy.
- Attach documents to support – It’s not the moment of emotion. Getting care for the facts and tangible evidence.
- Keep a trace of each interaction – Names, dates and details of documents of each call and e-mail.
- Coherently monitoring – Silence works in their favor. If you don’t hear, call. Then call again.
Fifth step: climb if necessary
If your call is refused, do not presume that the fight is over. There are external avenues that force insurers to justify their decisions.
- File a complaint – Most jurisdictions have an insurance regulatory organization. An official complaint can trigger an examination of your complaint.
- Take legal action – If you have reasons to believe that the insurance company has wrongly denied your complaint, a lawyer specializing in insurance disputes can examine your case and defend in your name with the insurance company to try to obtain coverage. Virani Law specializes in the processing of insurance complaints disputes, guaranteeing the policyholders to obtain the coverage to which they are entitled. The courts have examined the applicability of exclusion clauses in insurance policies, and insurance lawyers understand that the courts are insurers and how it can benefit your complaint. If you think your complaint has been wrongly refused, it may be useful to invest in an insurance lawyer to obtain a professional opinion on your complaint, because there may be room to push.
Final thought
Insurance companies deny complaints because they can. They bank insured persons not to know their rights or not have the patience to retaliate. But if you are ready, persistent and strategic, you can transform a rejection into approval.
It is not a question of discussing – these are appropriate documents, evidence and an understanding of a complex insurance contract. Make sure to explore your options before accepting a complaint refusal if you think the insurance company does not understand the problems of your loss.