Home Insurance Claim Denied or Underpaid?

A denial letter after a loss is hard to read once. Read it twice. Then work through this list in order.

1. 01 Get every reason in writing. California’s fair claims regulations require a written denial that lists all of its bases and cites the policy provision, condition or exclusion it relies on. If you were told a reason on the phone, ask for it in a letter.
2. 02 Read the cited wording against the whole policy. The declarations page, the exclusion, and every endorsement. Endorsements add to the base policy, so read each one.
3. 03 Write down your deadlines. Proof of loss, appraisal and suit each run on their own clock. They’re listed below.
4. 04 Keep documenting. Photos, video, receipts, every letter and every call, with the date and the name of the person you spoke to. Make temporary repairs to stop further damage and keep those receipts too. Don’t throw anything away until it’s measured.
5. 05 Answer in writing, with evidence. Ask the carrier to reconsider. Send what the first inspection missed: contractor estimates, test results, photos. Ask for a reinspection.
6. 06 Ask the California Department of Insurance to review it. Your denial letter has to tell you that you can. File a Request for Assistance at insurance.ca.gov or call (800) 927-4357, and attach the denial letter and your declarations page.
7. 07 Know when it’s a legal question. A fight over coverage, possible bad faith, or a lawsuit belongs with an attorney. More on that below.

Each common reason turns on a different question. This is the one we ask.

• An excluded peril. Flood or earthquake, for example. Cause of loss decides coverage, so the cause has to be documented.
• Wear, tear or neglect. The carrier says the damage was already there. We measure what the event itself damaged.
• Late notice. The standard fire policy asks for written notice of a loss without unnecessary delay. If the letter cites late notice, gather every date you have and talk to an attorney.
• Not enough documentation. What isn’t documented isn’t paid. Evidence answers this one.
• Below the deductible. The carrier’s number came in under your deductible. If the scope was short, so was the number.
• A lapse in coverage. An unpaid premium or a cancelled policy. We can’t fix that, and we’ll tell you so.
• Suspected misrepresentation or fraud. That’s a legal matter. Talk to an attorney.
• An exclusion you didn’t know was there. Like the one below.

The carrier’s estimate prices what its adjuster saw on inspection day. Anything nobody measured never reaches it. So we start from their estimate and measure what it left out.

• Rooms the flames never reached, written up as undamaged.
• Smoke in porous materials the carrier wants cleaned, when they can’t be.
• Water inside walls and under floors, found with moisture mapping.
• Code upgrades the city will require, priced against your ordinance or law coverage.
• Recoverable depreciation. If your policy pays replacement cost, the carrier can hold back depreciation from the first payment. California gives you at least 12 months from the first actual cash value payment to collect it, or 36 months when the loss is tied to a declared state of emergency.
• Fine art priced like furniture. Contents and valuables
• The rental ends before the rebuild does. Additional living expenses

Results reflect specific losses and policies. Past results don’t guarantee a similar outcome.

Already have an offer or a first check? It’s usually not too late. We can reopen scope before you accept. In California, our fee can never leave you with less than your insurer had already paid before you hired us.

On a small gap, or when the offer is already fair, our fee may outweigh what we add. We’ll tell you so at the free review, before you sign anything.