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Insurance Claims: How to Protect Yourself


Whether you are a business with widespread operations or an everyday individual just working to make ends meet, chances are good at some point you will find yourself filing a claim for insurance to cover some major loss. Although we entrust our insurance companies to provide us with the coverages we need on promises that we are “in good hands,” or that the insurer is “like a good neighbor,” the reality is that insurance companies, like all businesses, are profit centers, meaning every penny your carrier pays on your claim is a penny that affects its bottom line.

Today, the claims department of the insurer is a key component of the profit-generating machine. This means that when you file a claim, your insurance company can and will look for any opportunity it can to either underpay your claim or else deny it outright. This is not to say that you will always get denied or underpaid; insurers have a heightened duty under the law to provide the coverage guaranteed in their contracts. But that heightened duty generally only applies where the loss is plainly and obviously covered.

In practice, this means that if the claims adjuster or claims representative can find a half-decent excuse to underpay or deny your claim, then he will almost certainly take it. Therefore, it is incumbent upon you, the insured claimant, to take every measure at your disposal to ensure that you do not give the insurer any such excuse.

Maximizing the value of your insurance claim requires diligence, organization, and an acute attention to detail. First, ensure that all major communications with your insurer are in writing. If you get denied or underpaid, no matter the amount of the denial, demand in writing that the insurer provide you with a written letter, explaining why the coverage you have requested is not compensable. If the adjuster has a shaky basis for the denial, he may get squeamish about committing to it in writing, and instead opt to provide the coverage. Otherwise, you get the carrier’s commitment to its basis and you lay the foundation for a later lawsuit, if it becomes necessary.

Second, be promptly responsive to and work with the insurer. Your policy will require you to assist the insurer in collecting all the information needed to assess your claim, which means deadlines. For most insurers, a missed deadline in reporting a loss or offering a basis for coverage is as good a reason as any to deny a claim.

Finally, be organized and detail oriented by preserving each communication with your insurer and fully understanding each communication. Often when filing a claim, we are simultaneously confronted with a catastrophic loss. Such a loss can “put you on your back,” and take you “off your game,” so to speak. But if you miss a critical piece of information and give your insurer the opportunity to deny a claim because of it, the insurer is unlikely to offer sympathy for your predicament. Difficult though it may be, it is more important than ever that you keep it together, and stay on top of all that paperwork associated with your claim.

The attorneys here at Asheville Legal have extensive experience representing claimants against insurance companies. We are well versed in the variety of tactics that adjusters and claims representative use to find–and sometimes even manufacture–opportunities to deny claims for losses that should be covered. If you have an insurance claim and believe you have been unjustly denied, or if you need assistance in the organization and presentation of your claim, we are here to help.

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