What is a Public Adjuster?

A Public Adjuster is someone who helps you with your insurance claim after something like a fire, storm, or water damage happens. They work for you—not the insurance company—to make sure you get the money you deserve to fix the damage.

What’s the difference between a Public Adjuster, Company Adjuster, and Independent Adjuster?

A Public Adjuster works for you and helps you with your claim. A Company Adjuster works for your insurance company and looks out for their interests. An Independent Adjuster is hired by the insurance company but isn’t one of their employees. They still work for the insurance company, not for you.

What should I give my Public Adjuster to help with my claim?

To make things go smoothly, give your Public Adjuster: a full copy of your insurance policy (or at least the Declarations Page), receipts or bills for any repairs you’ve done, and photos or videos showing the damage.

How can a Public Adjuster help me?

Insurance claims can be confusing. A Public Adjuster knows what to do—from filling out paperwork and meeting deadlines to talking with your insurance company. They take care of everything so you don’t have to stress. Most of the time, they also help you get more money than you would on your own.

How much does it cost to hire a Public Adjuster?

Most Public Adjusters don’t charge upfront. Instead, they get paid a percentage of the money they recover for you. For example, in Florida, the fee is usually up to 20%, but only 10% if it’s after a big storm. In Texas, the fee is usually 10%. This setup makes sure they work hard to get you the most money, as quickly as possible.

What’s the difference between hiring a Public Adjuster and an Attorney?

Public Adjusters help right from the start: documenting the damage, making estimates, and talking with your insurance company. If they can’t get the job done, then you might need to hire an Attorney. Public Adjusters usually finish claims in 1 to 4 months. If you bring in an Attorney, it could take a year or longer.

Can a roofer or contractor help me the same way a Public Adjuster can?

No. Roofers and contractors can help fix your home and give estimates, but they can’t talk to your insurance company about your coverage or argue for more money. Only Public Adjusters and Attorneys are allowed to do that. A Public Adjuster can handle your whole claim, start to finish.

How long does a claim take with a Public Adjuster?

Most claims handled by a Public Adjuster are finished in 1 to 4 months. Insurance companies have up to 90 days to look into the claim. The Public Adjuster keeps things moving and pushes to get it done fast. If it takes longer, you might need an Attorney to step in.

What’s the difference between doing a claim myself and hiring a Public Adjuster?

You can do the claim on your own, but it’s hard if you don’t know all the rules and steps. Public Adjusters are trained pros who know how to get the most money. People who hire them often get 50% to 500% more than those who go it alone.

Where do I find my policy or claim number?

You can find it on the Declarations Page, which is usually the first page of your insurance policy. It also has your coverage details, deductible, and contact info for your insurance agent. If you don’t have it, call your Insurance Agent or Company to get a copy.

What to Do If Your Insurance Claim Is Denied: A Step-by-Step Guide

Jan 5

Written By Drew Miles

What to Do if Your Insurance Claim is Denied - Blog Post

Insurance Claim Denied? Don't Give Up! Your Ultimate Guide to Fighting Back

Receiving a claim denial letter from your insurance company can feel like a final, defeating blow. Whether you’re a homeowner grappling with unexpected damage or a business owner facing catastrophic losses, this rejection can be incredibly stressful and financially devastating. Many policyholders feel powerless and overwhelmed, assuming the insurer's word is the final say. However, it’s crucial to understand that a denial is often the beginning of a conversation, not the end of it.

Understanding the intricate reasons why claims are denied and knowing the precise strategic steps to take can dramatically improve your chances of overturning the decision and securing the settlement you deserve.

In this comprehensive guide, we will dive deep into the common pitfalls that lead to denials, illuminate the key differences between residential and commercial claims, and provide a clear roadmap for fighting back. We'll also explain how a professional public adjuster can become your most powerful ally in this fight. If your insurance claim has been denied, take a deep breath. This article is your blueprint for moving forward with confidence and strength.

Why Did My Insurance Claim Get Denied? Unpacking the Common Reasons
Residential vs. Commercial Claims: Understanding the Unique Challenges
Your Step-by-Step Battle Plan: What to Do After a Claim Denial
The Power of a Public Adjuster: Your Advocate in the Fight
Frequently Asked Questions (FAQs) About Claim Denials
Don't Accept 'No' for an Answer

Why Did My Insurance Claim Get Denied? Unpacking the Common Reasons

An insurance policy is a complex legal contract. Insurers may leverage this complexity, leading to denials that can sometimes feel unfair or arbitrary. Understanding the specific reason cited in your denial letter is the first step to building a successful appeal. Here are the most frequent reasons claims are rejected, with deeper insights into each.

1. Incomplete, Incorrect, or Late Documentation This is the most common and often most preventable reason for a denial. Insurance companies operate on meticulous paperwork. A missing signature, an incorrect date, or a failure to file within the policy's stipulated timeframe can trigger an automatic rejection.

The Issue: Insurers have strict protocols. They require a "Proof of Loss" form, often within 60 or 90 days, that is perfectly completed. Late reporting is a frequent justification for denial, as insurers will argue that the delay hindered their ability to investigate the loss properly.
Pro Tip: Treat claim submission like a legal proceeding. Document the exact date and time you reported the claim. Send all correspondence via certified mail or email to create a paper trail. Keep digital and physical copies of every single document, photo, and receipt you submit.

2. Policy Exclusions and Limitations Your policy covers specific perils, but it also contains a list of exclusions. A denial often comes down to the insurer’s interpretation of whether your damage falls under a covered event or an excluded one.

The Issue: A classic example is water damage. Your policy might cover damage from a sudden pipe burst but exclude damage from a gradual leak, seepage, or a flood (which requires separate flood insurance). Similarly, damage from "wear and tear" or lack of maintenance (e.g., an old, unmaintained roof) is almost always excluded.
Pro Tip: Request a certified copy of your full insurance policy (not just the declarations page). Read the "Exclusions" and "Duties After a Loss" sections carefully. The language is often dense, but it contains the rules of the game.

3. Insufficient Proof of Loss You can't simply state that something was damaged; you must prove its existence, its pre-loss condition, and its value. A weak or poorly documented Proof of Loss is an open invitation for a denial or a lowball offer.

The Issue: The burden of proof is on you, the policyholder. If your business claims lost inventory in a fire, you need inventory records, receipts, and photos. If your roof is damaged, you need clear photos of the damage before any temporary repairs are made, along with professional assessments.
Pro Tip: Create a thorough inventory of all damaged property. For high-value items, find original receipts or credit card statements. Take hundreds of photos and videos from various angles, both close-up and wide, to create a visual record of the damage.

4. Suspected Misrepresentation or Fraud Insurers are vigilant about fraud. Any perceived inconsistency or exaggeration in your claim can lead them to deny it on the grounds of "material misrepresentation." This could be as simple as misstating the date of loss or as serious as inflating the value of damaged items.

The Issue: Even unintentional mistakes can be flagged. If you can't remember the exact purchase date of a television and make a guess, the insurer might discover the real date and use that discrepancy to question the entire claim's validity.
Pro Tip: Be honest and precise. If you don't know something, say so. It's better to admit uncertainty than to provide incorrect information that could jeopardize your entire claim.

Residential vs. Commercial Claims: Understanding the Unique Challenges

While the core principles are similar, the complexity and stakes differ significantly between residential and commercial claims.

Residential Claims For homeowners, claims often involve personal and emotionally charged losses. Denials can stem from issues the homeowner wasn't even aware of.

Common Scenarios: Roof leak claims are often denied if the insurer determines the damage is from age and deterioration rather than a specific storm event. Mold claims are frequently rejected based on policy exclusions or because the mold resulted from a slow, unreported leak.
The Challenge: The emotional stress can make it difficult for homeowners to navigate the complex, impersonal process. Insurers may use the homeowner's lack of expertise to their advantage, offering low settlements or denying claims based on ambiguous policy language.

Commercial Claims Commercial claims are a different beast entirely. They are exponentially more complex, involving larger sums of money and intricate coverage types like Business Interruption.

Common Scenarios: A Business Interruption (BI) claim is a prime example. To get paid for lost income, a business must provide extensive financial records—profit and loss statements, tax returns, payroll records, and sales projections. A denial can easily result from insufficient proof of the financial loss or disputes over the "period of restoration."
The Challenge: The documentation requirements are immense. Commercial policies are also highly nuanced. A dispute might arise over the interpretation of a single clause that could mean the difference of hundreds of thousands of dollars. These claims require a level of financial and legal expertise that most business owners do not possess.

Your Step-by-Step Battle Plan: What to Do After a Claim Denial

A denial letter is a challenge, not a defeat. Here is your strategic plan of action.

Analyze the Denial Letter: Do not just skim it. Read it carefully multiple times. The letter is legally required to state the specific reason(s) for the denial and reference the exact policy language they are using to justify it. This is the foundation of your appeal.
Review Your Policy Again: With the denial letter in hand, pull out your full insurance policy. Find the sections and exclusions the insurer cited. Do you interpret them differently? Sometimes, the language is ambiguous and open to interpretation, which can be a key point in your appeal.
Gather Counter-Evidence: Now it's time to build your case. If they denied a roof claim due to "wear and tear," get an independent report from a licensed roofer who can attest that the damage was caused by a recent wind or hail storm. If they question the value of your lost property, find receipts, appraisals, or online listings for comparable items.
Write and File a Formal Appeal: Draft a professional, evidence-based letter of appeal. Do not make it an emotional rant.
- State clearly that you are appealing their decision.
- Systematically address each reason for their denial.
- Present your counter-evidence in a logical, organized manner.
- Reference your policy language to support your position.
- End the letter by stating the specific outcome you are seeking.
- Send the appeal via certified mail to ensure it is received and logged.
Hire a Public Adjuster: If the process feels overwhelming, the claim is complex, or the insurer is refusing to budge, it's time to bring in a professional. A Public Adjuster is an insurance expert licensed by the state who works exclusively for you, the policyholder.

The Power of a Public Adjuster: Your Advocate in the Fight

You wouldn't go to court without a lawyer. Why would you fight an insurance company—an institution with vast legal and financial resources—without an expert on your side?

Expert Policy Analysis: Public Adjusters live and breathe insurance policies. They can quickly spot misinterpretations, errors, or wrongful applications of exclusions by the insurance company.
Strategic Documentation and Evidence Gathering: They know exactly what insurers need to see to approve a claim. They will help you compile airtight documentation, bring in engineers or contractors for expert reports, and build a compelling evidence package.
Masterful Negotiation: A Public Adjuster, like the experts at Shoreline Public Adjusters, LLC, handles all communication and negotiation with the insurer. They speak the same language as the company adjuster and can counter their arguments effectively, removing the stress from your shoulders.
Maximizing Your Settlement: The insurance company's adjuster works to protect the company's bottom line. A Public Adjuster works to protect yours. Their goal is to ensure you receive the maximum, fair settlement you are entitled to under your policy. Studies have shown that policyholders who hire a public adjuster often receive significantly higher settlements than those who do not.

Frequently Asked Questions (FAQs) About Claim Denials

1. How long do I have to appeal an insurance claim denial? This varies by state and policy, but you typically have a limited window, often from 30 days to one year, to formally challenge the decision. Check your denial letter and policy, as deadlines are strict.

2. Can I reopen a denied claim? Yes. If you can provide significant new evidence that was not included in the original claim, you can request to have the claim reopened and re-evaluated.

3. What does a Public Adjuster cost? Most reputable Public Adjusters work on a contingency fee basis. This means they only get paid a small, agreed-upon percentage of the settlement they recover for you. If they don't win you a settlement, you pay nothing. This ensures their goals are perfectly aligned with yours.

4. What if the insurance company is acting in "bad faith"? "Bad faith" occurs when an insurer fails to uphold its contractual obligations without a reasonable basis—for example, by not conducting a proper investigation or intentionally misinterpreting its own policy to avoid paying a claim. If you suspect bad faith, it is critical to consult with a Public Adjuster or an attorney, as you may be entitled to damages beyond your original claim amount.

Don't Accept 'No' for an Answer

Having your insurance claim denied is a serious setback, but it is not the end of the road. By understanding the reasons for the denial, meticulously gathering your evidence, and knowing when to call for professional help, you can effectively fight back and challenge the insurer's decision.

At Shoreline Public Adjusters, LLC, we are dedicated to leveling the playing field for policyholders. We specialize in helping homeowners and businesses in Florida (FL), Minnesota (MN), and Wisconsin (WI) overturn unjust denials and secure the full, fair settlements they deserve.

Don’t let a denial letter intimidate you. Contact us today for a free, no-obligation consultation and take the first powerful step toward resolving your claim.

Help with Your Claim

Shoreline Public Adjusters, LLC
780 Fifth Avenue South
Suite #200
Naples, FL 34102

Email: hello@teamshoreline.com
Phone: 954-546-1899
Fax: 239-778-9889

Denied Insurance Claim

Drew Miles