Insurance claims can run into challenges for several reasons. Some are denied due to disagreements about the cause of loss. Others are delayed because inspections are incomplete or documentation is missing. Underpayment often happens when the scope of repairs does not match the actual damage.
Why insurance claims get denied
Denials may occur when insurers believe the loss was caused by wear and tear, a long-term leak, or an excluded event. Sometimes the denial is based on incomplete inspection notes. A public adjuster reviews the findings to determine whether the decision aligns with the policy and the evidence.
Why claims get delayed
Delays are common when additional inspections are needed, documents are pending, or the insurer has not received a complete claim package. Homes with older materials or layered remodels often require more detailed documentation to move the claim forward.
Why claims get underpaid
Underpayment is often the result of missing line items, incorrect material pricing, limited demolition allowances, or overlooked structural or moisture damage. Repairs in Southern California can be more costly than the initial estimate reflects, especially in older or higher-end homes.
Reopening a claim
Claims can be reopened when new information emerges, such as hidden damage discovered during demolition or updated pricing for materials and labor. Supplemental claims allow the homeowner to address items not captured in the original estimate.
How a public adjuster helps
A public adjuster reviews the insurer’s estimate, compares it to the actual conditions in the home, prepares a corrected scope, and manages negotiations. Their involvement helps ensure the settlement reflects the full cost of repairs.
FAQs
Why do insurance claims get denied?
Claims may be denied due to disputes about the cause of loss, concerns that damage developed over time, or insufficient documentation. Sometimes the denial is based on a misunderstanding of the event or incomplete inspection details. A full review of policy language and evidence often clarifies whether the denial is accurate.
What should I do if my claim is delayed?
Review communication timelines, confirm whether the insurer has all the requested information, and document every conversation. Delays often occur when inspections are incomplete or additional documentation is needed. A public adjuster can help organize the file and request missing steps.
Why are claims underpaid?
Underpayment happens when estimates exclude necessary demolition, overlook hidden structural or moisture damage, use outdated pricing, or fail to include code-required repairs. Homes with layered remodels, mixed materials, or spread-out damage often need more extensive work than the initial inspection suggests.
Can I reopen my claim after it was closed?
Yes. If new damage is uncovered, if demolition reveals additional issues, or if pricing was inaccurate, a supplemental claim can be filed. Many claims expand once repairs begin and hidden conditions come into view.
How does a public adjuster help in disputes?
They evaluate the insurer’s estimate, compare it with the actual conditions in the home, prepare a corrected estimate, and communicate directly with the insurer to resolve discrepancies.
