What Are Some Reasons Why Home Insurance Claims Get Denied?

“What Are Some Reasons Why Home Insurance Claims Get Denied?” A blog article that was written by SWAT Public Adjusters – Thanks for reading this article. We want to ensure your property storm damage insurance claim is handled properly the first time.

SWAT Public Adjusters work for you not the insurance company and we want to help you get all the money you are entitled to. The SWAT Public Adjusting firm has been proudly serving the Lousiana area for a long time. We want to share simple ways to help you plan, prepare and get ready for a hurricane claim to your storm-damaged Louisiana property.

What Are Some Reasons Why Home Insurance Claims Get Denied? Blog article was written by SWATJOB.com

First off it is important to understand that dealing with damage to your property is a frustrating time for anyone really. So when your insurance claim gets rejected, it drives even a reasonably calm person to completely blow a gasket.

Did you know there are several reasons claims get denied? Some of these reasons are actually easily avoidable and most all of them are when you use a certified highly trained public adjuster – like us at SWATJob.com. Understanding your policy helps prevent denied claims and gives confidence in actions to repair your home. That is where we come in to help you get every dollar you are entitled to.

Reasons Why Claims Get Denied explained by SWAT Public Adjusters.

Reason #1 – Misrepresenting the damage – What Are Some Reasons Why Home Insurance Claims Get Denied?

Lying or being intentionally misleading regarding the true extent of the damages done to your property is a definite no-no. Not only will your claim be denied, but you could be liable for up to $15,000 to $50,000 in fines and four to seven years in prison.

Application fraud happens when you knowingly and intentionally provide false information on an insurance application. It is generally the most common form of insurance fraud, being responsible for up to two-thirds of all denied life insurance claims alone. It’s always best to be as detailed and accurate as possible with your claim – keeps you out of trouble and helps ensure your claim gets approved.

What is Homeowners Insurance Fraud?

This type of fraud takes place when someone knowingly submits an inflated claim on their homeowners or renters policy for more than the actual value of the loss or damage. Submitting a false or misleading claim to receive undeserved compensation is also considered homeowners fraud.

Here are the most common types of homeowners insurance fraud involve:

  • overstating the value of stolen items in a burglary of a home or vehicle
  • lying about the extent, cause, date or location of damage
  • intentionally damaging property to make a claim
  • staging a phony burglary or vehicle break–in and faking the theft or damage of property
  • asking a repairman to “cover the deductible” by increasing their estimate or bill
  • fabricating supporting evidence, such as repair bills or receipts, often in collusion with a crooked contractor, plumber, repairman or insurance adjuster
  • concealing that a residence is used as a rental or in a commercial business

Reason #2 – The damage is not covered – What Are Some Reasons Why Home Insurance Claims Get Denied?

Did you know, your homeowner’s insurance doesn’t cover every type of damage. Fire, lightning, and wind damage are examples of standard covered perils. But there are many optional add-ons like mold and water backup damage that are not covered unless you pay an additional premium. Other types of damage not included unless you pay extra:

  1. Flooding
  2. Mold
  3. Replacement Costs
  4. Personal Umbrella
  5. Scheduled Personal Property
  6. Sewage Back-up
  7. Sump Pump
  8. Indentity Theft
  9. Home Daycare
  10. Earthquake
  11. Lateral Lines Coverage
  12. Home Sharing

Some perils require separate policies for coverage, like flood damage. If one of these perils damages your house and you don’t have coverage, expect a denied claim.

But keep in mind that homeowners are covered for perils in case of theft, fire, lightning, explosion, vandalism, riot, and even falling aircraft. They are not covered for damage by wind or disease. Liability covers homeowners against lawsuits for bodily injury or property damage that policyholders or family members cause to other people. It also pays for damage caused by pets.

Keep in mind that liability can also muddle up claims. For instance, if an electrician miswired the electrical outlets in your house and caused a fire, then the electrician’s business will be held liable for the damages instead of your homeowner’s insurance policy.

Every policy has exclusions or types of damage that are not covered in any situation. A few of these events are ground movement, war, and nuclear hazards. If war or rioting broke out and your house was damaged, you would be unable to file a claim. Here are some standard exclusions:

  1. Polutants
  2. War
  3. Cracking
  4. Damage By The Government
  5. Wear & Tear
  6. Vandalism on Vacant Property
  7. Snow on Outdoor Property
  8. Birds
  9. Vermin
  10. Insects
  11. Power Interruption
  12. Intential Losses
  13. Vacant / Freezing
  14. Nuclear Hazard

Neglect is a significant exclusion to note as well because it’s easily preventable. There are many forms of property neglect. As an example, neglect could mean that the homeowner should have replaced their shingles before the roof shingles began to leak over the course of a year or two, causing roof rot to set in and water damage to the interior of the house. If your house is damaged and you fail to take proper actions to prevent further damage, your claim can result in a $0 payout. Always do what you reasonably can to protect your house after any disaster.

What Are Some Reasons Why Home Insurance Claims Get Denied? Blog article was written by SWATJOB.com

Reason #3 – Damage from wear and tear – What Are Some Reasons Why Home Insurance Claims Get Denied?


Houses are built to last, but that doesn’t mean that they are impervious to the effects of time. Wear and tear can be defined further as deterioration that can be reasonably expected to occur. It is normal, for example, for there to be some scuffs in the paint after a tenant moves out of a unit. The scuffs in the paint would be considered normal wear and tear. The hole in the wall would be considered damaged.

Whether your home has an old roof in need of repair, rusty pipes, or a room that needs recarpeting, your homeowners’ insurance won’t cover damage that comes as a result of normal wear and tear.

Is wear and tear considered damage?

Normal wear and tear is damage that naturally occurs in an apartment due to aging and regular use. It typically results from a resident living in the property and is considered normal depreciation. It is not caused by neglect or abuse of the property.

What is considered normal wear and tear on a property?

The typical definition of ordinary wear and tear is: “That deterioration which occurs based upon the use of which the home or rental unit is intended and without negligence, carelessness, accident, or misuse, or abuse of the premises or contents by the Tenant or members of his/her household, or their invitees or guests.”

Reason #4 – Identifying the correct cause of damage and reporting it – What Are Some Reasons Why Home Insurance Claims Get Denied?


Many claims get rejected because they are misreported by the person filing the claim. It is essential to understand the correct peril that caused the damage so that the claim is evaluated accurately by the insurance carriers. At times, if the exact cause of the loss is uncertain, the carrier may reject the claim.

Reason #5 – Missing the deadline to file a claim – What Are Some Reasons Why Home Insurance Claims Get Denied?

If you’re not careful, you could have your claim denied because you failed to file on time. It’s crucial to start your claim process as soon as possible to ensure coverage. Deadlines can vary between 180 days to a year, depending on your insurance policy. Knowing how much time you have to file is vital to ensure your claim doesn’t get denied.

Here are the five most common causes of homeowner’s insurance claims based on the percentage of claims sourced from Travelers related to each cause:

  • Exterior wind damage 25%
  • Non-weather-related water damage (i.e. plumbing and appliance issues) 19%
  • Hail 15%
  • Weather-related water damage 11%
  • Theft 6%

Reason #6 – The damage doesn’t exceed the deductible – What Are Some Reasons Why Home Insurance Claims Get Denied?

Perhaps the most common reason for a denied claim is that the damage simply isn’t expensive enough for a claim. Keep in mind that there’s no standard deductible for homeowners insurance. However, most companies offer deductibles of $1,000 and up. Many companies offer smaller homeowners insurance deductibles of $500 and even $250. Companies rarely offer no-deductible policies, but when they do, policies come with higher premiums.

How a Deductible defined?

A deductible is an amount of money that you yourself are responsible for paying toward an insured loss. When a disaster strikes your home, the amount of the deductible is subtracted, or “deducted,” from your claim payment. Deductibles are the way in which risk is shared between you, the policyholder, and your insurer. Generally speaking, the larger the deductible, the less you pay in premiums for an insurance policy.

A deductible can be either a specific dollar amount or a percentage of the total amount of insurance on a policy. The amount is established by the terms of your coverage and can be found on the declarations (or front) page of standard homeowners and auto insurance policies.

State insurance regulations strictly dictate the way deductibles are incorporated into the language of a policy and how deductibles are implemented, and please be aware that these laws can vary from state to state.

So, therefore, let’s say you have a $1,000 deductible in your homeowners’ insurance policy, and a burst pipe costs $900 to fix, then your insurance won’t pay anything on the claim. You have to pay the deductible first before your insurance company covers the damage. Pay special attention to your deductible for wind/hail claims or hurricane claims as they can have separate hidden deductibles.

Reason #7 – Not paying the premium – What Are Some Reasons Why Home Insurance Claims Get Denied?

Sometimes homeowners will forget to pay the premium, causing them to lose coverage when they need it most. It’s essential to make sure you pay your premiums on time so that your house remains protected.

What happens when you don’t pay home insurance?

Missing even one payment can result in a loss of coverage for your home. If you don’t pay, your insurance won’t cover you in the case of any type of claim. You have to pay for all of that—the damage to your house, and/or any liability costs (which can be exorbitant) and court expenses—all out of pocket.

Aside from staying covered, there are other reasons to pay your premium on time. Missing payments can lead to a damaged credit rating and even more expensive premiums in the future.

Is there a grace period on homeowners insurance?

Most types of insurance, including homeowners insurance, have a grace period for your premiums. The period varies from one insurer to another and maybe as little as 10 days or as high as 45 days be on the carries. As long as you bring your premiums up to current during the grace period, your insurance will not lapse or be canceled.

Can you backdate home insurance?

The simple answer is no because most insurance companies will not offer it. Backdated insurance requests coverage for something that happened prior to purchasing the policy. If you need to backdate an insurance claim, it means you need coverage for property damage that occurred before you paid for the policy. Backdated insurance is something most homeowners insurance companies do not offer.

Thanks for reading What Are Some Reasons Why Home Insurance Claims Get Denied?

Public adjusting solutions are possible with S.W.A.T., we work for you. We hope you have learned a little bit from this blog article and if you liked it – we have many more like this one to share with you. Remember to follow us on Facebook!

A little bit about us, we can work with people in support of any claim adjusting issues through our custom insurance claims public adjusting approach. This can be achieved through a blend of professional service offerings, as well as through outsourcing, data analysis, and the development of customized solutions focused on gaining a greater understanding of the program
issues and the overall program cost reduction potential. We know this sounds confusing but when it comes to getting the outcome that you desire from the insurance company – we work on many different public adjusting strategies to get it done.

Our team also can focus on medical treatment and medical costs, helping a small business owner develop strategies, address cost drivers, and integrate solutions into its workers’ compensation while the small business is closed due to hurricane storm damage issues. So reach out to us today via our contact page to get started.

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