Reasons for Insurance Denial of Fire or Water Damage Claims

As unfair as it is, your insurance company may retain the right to deny your insurance claims for whatever reason they see fit. But that doesn’t mean you can’t successfully file an appeal and still receive the settlement that you deserve. Here are the common reasons your insurance company may deny fire or water damage claims.

Common Reasons for Fire/Flood Insurance Denial

1. Not filing on time

  • Insurance policy will require that you notify them promptly of any loss
  • Time-sensitive requirements for the filing and documentation of any claim

2. Non-Payment of Premiums

  • Late or missed premium payments give the insurance company reasons to deny your claim.

3. False Statements or Questionable Claims

  • Post-disaster, the insurance company will send its own adjuster to investigate your claim. If they find anything suspicious or questionable involving the original application for coverage or with the claim itself.

4. Insufficient Documentation of the Damage

  • The responsibility as a property owner is to file and prove your claim to the insurance company – it is not the insurance company’s job to prove the claim to themselves. Therefore, it is important that you accurately document the damage done to your property in a detailed manner by taking photographs in the aftermath to submit to help prove your case

5. Damage isn’t Covered

  • Some damages are not covered unless you pay an additional premium for add on such as; such as flooding, mold, replacement costs, scheduled personal property, sewage back-up/sump pump, identity theft, home daycare, earthquake
  • Exclusion Clauses
    • Every property insurance policy comes with its exclusions. If the cause of your property damage is excluded from coverage in your policy, then you can expect your claim to be denied.
  • 3rd Party Liability
    • Electrician mis-wired the electrical outlet causing a fire – the electrician’s business would most likely be held liable for damages

6. Not Taking Sufficient Preventative Measures Following a Loss

  • Following a property loss, the policyholder is required to protect the property from further damage and to mitigate the extent of the loss. Leaving the property exposed to additional loss and not taking reasonable steps to reduce the extent of the loss, could be grounds for denial.

7. Damages from Wear and Tear

  • Insurances won’t cover damage that comes as a result of normal wear and tear such as rusty pipes or old roof.

8. Damage Doesn’t Exceed the Deductible

Tips to Avoid Denial

  • Notify your insurer promptly of any loss and understand the requirements time limits for filing a claim.
  • Pay your premiums on time
  • Know what your policy covers and excludes and obtain adequate coverage if available
  • Following a loss take all reasonable steps to protect the property and to mitigate the damage.
  • Document all damage and file a detailed itemized claim to your insurer.

Fire Insurance Claims

Each fire is investigated by the fire department, to locate the hot spot. The hot spot is the location where the fire began. Insurance companies then get a report from the fire department and most send their own experts to investigate as well.

Reasons for denial of Fire Insurance Claims

1. Misrepresentation of your home

  • By inflating the true value of items or claiming that you lost more than can be proven can jeopardize your entire claim

2. Suspicion of Arson

  • If the insurance company has accused you of arson or insurance fraud, it is best to hire an insurance claim attorney to handle your claim

3. Illegal Activity

  • Any evidence of illegal activity, such as drug manufacturing will allow the insurance company to deny the claim.

4. Work is done without permits/inspections

  • If there’s faulty installation or lack of permit, then the insurance company will deny.

Are your claims denied by your insurance company recently?

The experienced Toronto personal injury, disability and insurance lawyers at Mirian Law Firm are on your side. We’ve helped many clients with their claim denials and we may be able to help you too! Book your free in-person case assessment today to learn more!