Denied & Underpaid Insurance Claims
A denial is the carrier's position, not a verdict. So is a number that is too low. Both are reviewable, and there is a defined set of tools for doing it.
Start with the stated reason, in writing
Ask for the denial or the shortfall in writing, with the specific policy provision relied on and the facts it was applied to. A great many disputes turn out to rest on an investigation that did not reach the damage, or a provision that does not say what the letter implies.
Then request the claim file and the carrier's own estimate. Line-item variance is where the argument gets made: omitted items, undercounted quantities, unit prices below prevailing local cost, unsupported depreciation, and repair specified where replacement is required.
The tools available to you
- Supplement. An itemised demand for scope that was omitted or undervalued, with documentation attached.
- Re-inspection. A joint or independent re-inspection of the disputed scope.
- Appraisal. Most property policies contain an appraisal clause: each side names a competent independent appraiser, the two select an umpire, and an award by any two binds as to the amount of loss — not as to coverage. Confirm your policy's clause and your state's rules on its scope before invoking it.
- Department of insurance complaint. Free, and the route for unfair claim-handling conduct.
- Legal advice. Where the dispute is about whether the loss is covered at all, that is a question for an attorney. A public adjuster is not a lawyer.
Deadlines to confirm now
These are set by your policy and by your state, they differ significantly, and a wrong number is worse than no number. Ask your insurer for each in writing and keep the reply: the deadline to submit a signed proof of loss; the deadline to complete repairs and claim recoverable depreciation; and the suit-limitation period in your policy, which is often much shorter than people expect.
Who to call, and what each one costs
Your insurance companyFree
First call, always. They assign an adjuster and issue any advance. The catastrophe adjuster assigned to you may be genuinely helpful — they also work for the insurer, which is a fact about the role, not an accusation about the person.
Your state Department of InsuranceFree
The most underused resource after a loss. They answer coverage questions, take complaints about claim handling, and confirm whether anyone contacting you is actually licensed. No cost, and they take no percentage of your recovery.
A public adjuster (that’s us)Paid
Represents you rather than the insurer, normally for a percentage of the claim agreed in writing before any work begins. Useful on scope disputes, contents inventories and undocumented depreciation — and not worth it on a small claim or a pure coverage dispute. See the questions below.
An attorneyPaid
Attorneys are there to litigate claims. That is the difference: a public adjuster works out the amount of the loss and negotiates it with the carrier; an attorney takes the carrier to court. If the carrier says the loss is not covered at all, or there is a question about causation or accusation, that is litigation and it belongs with a lawyer. A public adjuster is not a lawyer and cannot give legal advice.
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Common questions
Can a denied claim be reopened?
Frequently, yes. A denial reflects the carrier's position on the information it had. New documentation, a re-inspection, or a corrected reading of the policy provision can change it. Start by getting the stated reason in writing.
What is appraisal and should I use it?
Appraisal is a clause in most property policies for resolving disagreement about the amount of loss — not about coverage. Each side appoints an appraiser, they select an umpire, and an award by any two is binding as to amount. Whether it suits your dispute depends on your policy's clause and your state's rules.
Do I need a lawyer or a public adjuster?
Different jobs. If the dispute is about the amount of the loss, that is adjusting work. If the carrier says the loss is not covered at all, or there is a question about causation or accusation, that is legal work. A public adjuster cannot give legal advice.
Request a claim review
Utah properties: contact us to discuss your claim.Kansas: commercial claims only.Send the basics and we will look at where your claim stands and tell you plainly what we see — including if the honest answer is that you are being treated fairly and do not need to hire anyone. There is no charge for the review and nothing to sign to get it.
Who wrote this, and what we get out of it
Public adjusting work is performed by William J. Addis, individually licensed in 18 states. Like nearly all public adjusters, we are paid a percentage of the claim, agreed in writing before any work begins and subject to any applicable state limits. There is no charge for the review itself. You should weigh that interest when reading anything here.
Free help exists too. Every state’s Department of Insurance assists policyholders with claims at no cost and takes no percentage of your recovery, and will confirm whether anyone contacting you is actually licensed — including us. See where we are licensed, and verify any public adjuster before hiring them.
This is general information, not advice. It is not legal advice, not an interpretation of your policy, and we are not a law firm. You have the right to negotiate your own claim directly with your insurer and the right to consult an attorney; you are not required to hire a public adjuster.
Our role, when we are engaged, is to help policyholders reach a fair and reasonable settlement of a covered loss under the terms of their own policy. Each claim turns on its own facts, policy language and jurisdiction. Kansas readers: under K.S.A. 40-5500 et seq., Kansas public adjusters are limited to first-party commercial property claims and may not represent residential homeowners.