Your insurance company just denied your claim. There are many things that run through your mind: this is inconvenient, it is going to be expensive, this is infuriating that we are being treated like this, it is not fair. But it's not the final answer. A denial does not mean you are out of options—it means you need to know your rights and review the insurer's reasons for denial. Because here's the thing: insurance companies aren't in the business of handing out money. They expect you to accept their decision and move on.
Don't.
Instead, push back. Challenge their reasoning. Leverage every tool at your disposal to be sure that their denial is valid. Here's how to take control of the process and keep fighting for coverage of your claim.
Step One: Dissect the Denial Letter
Insurance companies won't simply say no and leave it at that. They will cite their reasoning for denying coverage in dense, policy-heavy language, hoping you won't question it or understand it. Your first job is to break it down.
Look for:
- The stated reason for the denial – Vague phrasing like "not covered under your policy" isn't enough. Find out exactly why they're refusing the claim.
- The policy clauses they're citing – Compare them against your policy documents. Do they actually apply?
- Any discrepancies – If their explanation is unclear or contradicts the policy wording or even the facts of your situation and the loss, you have an opening to push back.
Step Two: Build Your Case
An appeal won't go far without evidence. You need hard proof to challenge their decision.
- Photographs and videos – Taken immediately after the incident, with timestamps. If you have pre-damage photos, even better.
- Receipts and maintenance records – If the insurer is claiming neglect, show them proof that your property was properly maintained.
- Professional assessments – A contractor or independent expert can provide a detailed report that refutes the insurer's findings especially if it is an issue of cause of loss. Having a report to determine the true cause of loss can help with the technicalities of exclusion clauses.
- Eyewitness statements – If there were witnesses to the damage, their accounts can strengthen your claim.
Step Three: Speak Their Language
Insurance companies operate in technicalities. The more precise and factual you are, the harder it is for them to dismiss you. Frame your appeal using their terminology.
Instead of saying, "I thought this was covered," state:
"According to Section X of my policy, this damage falls under covered perils. The denial does not align with the policy's stated coverage terms."
The goal is to show that you understand your policy better than they expected, and let them know that you will hold them to a certain standard.
Step Four: Appeal—And Be Relentless
Most insurers have a formal appeals process. Use it.
- Submit a written appeal – Address it to the claims department and reference specific policy wording.
- Attach supporting documents – This isn't the time for emotion. Stick to facts and hard evidence.
- Keep a record of every interaction – Document names, dates, and details of every call and email.
- Follow up consistently – Silence works in their favour. If you don't hear back, call. Then call again.
Step Five: Escalate If Necessary
If your appeal is denied, don't assume the fight is over. There are external avenues that force insurers to justify their decisions.
- File a Complaint – Most jurisdictions have an insurance regulatory body. A formal complaint can trigger a review of your claim.
- Consider Legal Action – If you have reason to believe the insurance company has wrongfully denied your claim, a lawyer specializing in insurance disputes can review your case and advocate on your behalf with the insurance company to try to get coverage. Virani Law specializes in handling insurance claim disputes, ensuring policyholders get the coverage they're entitled to. The courts have looked at the applicability of exclusion clauses in insurance policies, and insurance lawyers understand the standards courts hold insurers to, and how this may benefit your claim. If you believe your claim has been wrongfully denied, it may be worth investing in an insurance lawyer to get a professional opinion on your claim, as there may be room to push.
Final Thought
Insurance companies deny claims because they can. They bank on policyholders not knowing their rights or not having the patience to fight back. But if you're prepared, persistent, and strategic, you can turn a rejection into an approval.
This isn't about arguing—it's about proper documentation, evidence, and an understanding of a complex contract of insurance. Be sure to explore your options before accepting a claim denial if you believe the insurance company is not understanding the issues of your loss.
