Your rights
The insurer has rules.
Learn them.
An insurance policy is a contract, and every state regulates how insurers handle claims. These are the protections most policyholders have. The details, deadlines, and remedies depend on your state and your policy.
Rights most policyholders have
A complete copy of your policy
Ask in writing for a complete copy of your policy, including the declarations page and every endorsement. You can’t hold an insurer to a contract you haven’t read, and some states require insurers to provide it on request.
Timely acknowledgment and a timely decision
State claim-handling laws, most modeled on the NAIC Unfair Claims Settlement Practices Act, require insurers to acknowledge claims and act on them promptly. Many states set specific deadlines in days.
A reasonable investigation before a denial
Refusing to pay a claim without a reasonable investigation is listed as an unfair claims practice in the NAIC model law that most states have adopted in some form.
The reason for a denial, in writing
If all or part of your claim is denied, you are entitled to a reasonable explanation of the basis in the policy, the facts, or the law. Ask for the specific policy language relied on.
The truth about your coverage
Misrepresenting facts or policy provisions about the coverage at issue is an unfair claims practice under state laws based on the NAIC model.
To dispute the amount
Most property policies include an appraisal provision for disagreements over the amount of loss. You can also submit your own estimates, reports, and evidence at any time.
To choose who repairs your property
Your policy is a contract to pay for covered loss. In most cases it doesn’t require you to use the insurer’s preferred contractor. Read your policy; some endorsements and programs differ.
To get help
You can hire a licensed public adjuster or an attorney to represent you, and you can file a complaint with your state Department of Insurance at no cost.
Your side of the contract
Meet your duties, and take away their excuses
Most property policies contain a “Duties After Loss” section. A missed duty can be a reason to reduce or deny a claim. Typical duties include:
- Give the insurer prompt notice of the loss.
- Protect the property from further damage and keep receipts for reasonable emergency repairs.
- Document damaged property and keep it, where practical, until the insurer has had a chance to inspect.
- Provide records and documents the insurer reasonably requests, and a signed, sworn proof of loss if the policy requires one.
- If the policy requires it and the insurer asks, submit to an examination under oath.
Go deeper: the law
Statutes, regulations, and case law, cited section by section.
When it goes wrong
Your options when the claim is delayed, denied, or underpaid.
- Claim Denied or Lowballed? A Step-by-Step Plan for What to Do Next
- The Appraisal Clause: How It Works and When to Use It
- How to File a Department of Insurance Complaint That Gets Read
- Public Adjuster vs. Attorney vs. Appraiser: Who Do You Need?
- Recorded Statements, EUOs, and Proof of Loss: Know the Difference