San Diego Home Inspections — Claimed denied by your insurance company? Try this!

Claimed denied by your insurance company?
Try this!

A Client from March 2007 called me recently about his furnace not working. With the arrival of cold weather (of course, cold to us here in San Diego is anything less than 65°F), many people are using their furnaces for the first time this year.

I always love it when a Client from yesteryear calls me with an insurance-related problem because that tells me several things:

1. They remember me.
2. They trust me.
3. They remember what I told them about insurance.

Insurance companies don't make money by paying claims, so their first line of defense is quite often just to deny the claim outright. Sometimes they won't even give you a reason. Other times they'll say that the __________ is not covered, or has pre-existing conditions. Their thinking is that you'll accept their decision and go on your merry little way.

If they deny your claim for whatever reason, ask them to reconsider. The second time around your claim will actually get "processed," meaning that you'll probably get more action than just a computer-generated letter denying your claim.

If they send someone out to look at things and then deny your claim because of "pre-existing conditions," well, that phrase is standard denial language. Call them on it with this little tidbit that has worked for me and my Clients:

Dear Insurance Company:

You had the opportunity to inspect the __________ prior to issuing a policy and accepting my premium payments. Because you did not do that, the fact that you issued a policy and accepted my premium payments mean that you warranted that the __________ was in insurable condition. Please forward to me at [address] either a check for [repair/replacement] of the __________ or a refund of all my premium payments from [date of coverage commencement to current date]. Thank you.

Sincerely,

Modify as necessary.

Now send it by overnight mail to the insurance company and a copy, also by overnight mail, to the insurance commissioner in your state. Make sure that the copy you send to the insurance company notes that a copy has been sent to the insurance commissioner.

Insurance is regulated in all 50 states, so while you might not have an "insurance commissioner," there is some Top Dog somewhere who is in charge of your state's insurance industry.

Even if your policy excludes pre-existing conditions, if the insurance company didn't send anyone out to look at everything prior to issuing you a policy, they can be held accountable. Once they understand that they have a serious and knowledgeable Client on their hands, it's far less expensive to just send you a check and be done with it.

Every time I do that for one of my Clients, the insurance company sings a new tune. In fact, sometimes, a check arrives in their mailboxes a couple of days later, also by overnight delivery.

Of course, all of this is predicated on you repairing any problems that were noted in your home inspection report, and that you actually read the fine print in your home insurance policy. Nonetheless, it doesn't hurt to try.

My greatest success so far was a check for $11,950 for plumbing problems. All she had to pay was her $50 deductible, which had been deducted from the $12,000 plumber's invoice.

In this most recent episode, the insurance company agreed that the furnace was covered under their policy and that it would be repaired if possible, or replaced if repair was not possible. My Client's deductible is $100.

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