Can you keep the money from an insurance claim?

Posted By Dick Law Firm || 8-Dec-2020

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What to do if an adjuster refuses to cooperate?

It would help if you asked the adjuster to offer a written description of the insurance company's reasons for denying the claim, including references to particular policy clauses excluding coverage. Doing this will show if the adjuster is only bluffing and allowing you to respond more directly to the reasons for the denial. If the adjuster does not agree to send you a written explanation, write a letter to the adjuster verifying your conversation, rejecting coverage, and refusing to explain in writing.

This letter will press the adjuster to send you the details, as a claims supervisor won't like to have such a note in the insurance company's file. If you go to the insurance commission or file a lawsuit to press your claim, the existence of such a letter in the claim file will indicate the insurance company's lack of cooperation (and could suggest improper negotiation tactics or even "bad faith"). If the other side insurer refuses coverage, ask the claims adjuster to provide you with a copy of the insured's policy—or at least the parts the adjuster depends on to refuse coverage—so you can read it for yourself.

If the adjuster declines, write an adjuster letter stating the rejection, so it becomes part of your claim file. Then if the adjuster still refuses to settle with you, you'll have to use other pressures to move negotiations. In some instances, an adjuster will initially say no coverage.

However, if you show that you will not abandon your lawsuit, the adjuster will still start negotiating a settlement. If you can't find fair compensation after that because of the coverage issue (or some other issue), you'll have to switch to other settlement negotiation techniques. Suppose the adjuster seems correct that there is no compensation whatsoever and refuses to discuss a settlement. In that case, you will be forced to turn to insurance covering someone else liable for the accident.

For example, assume you file a sewage-overflow loss caused by the City of Houston. Your insurance company could avoid coverage, hoping that you will seek your house repairs from the municipality instead.

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How do adjusters determine damage?

Property insurance adjusters are trained to push an agenda of consumer fraud, such as customers seeking to report previous harm on a current claim or passing off old damage from a water loss as recent damage covered by extensive weather damage. Since the insurance company will save money if that can say its insured committed fraud, adjusters make dishonest allegations of fraud. You may want to consider speaking with an experienced home insurance attorney when making your claim to ensure your adjuster includes all the existing damages in the inspection report.

Insurance firms don't want to compensate for damages that already happened to your house and will only pay for damages caused in the incident that you reported. House insurance adjusters request proof of past incident damage and repairs. Adjusters claim many items are wear and tear, low maintenance, or another indication of damage before the recent accident.

Your insurance company aims to offer coverage and will fix harm by providing you the lowest payout possible. Minimizing litigation costs when collecting insurance premiums is the leading way insurance firms make money. Consequently, adjusters can misrepresent some of your home's damage as pre-existing or unrelated to the incident.

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What if insurance check is more than repairs?

You must be fully sure the insurance provider overpaid your claim. For example, if you had property damage to your house due to a hailstorm, you want to speak with an experienced home insurance attorney. There is a possibility that your insurance carrier gave a low evaluation. You think the amount is high because you are unfamiliar with proper pricing.

If a natural disaster has destroyed your house, speak to a highly qualified contractor about the likelihood of potential repairs. After exhausting these choices, you should contact an experienced insurance attorney. Otherwise, you may want to call the insurance provider to inform them that insurance checks are more than fixes.

In some instances, the insurance company can allow you to retain the funds if you incur other claim-related losses. However, they can even ask you to fill out a form returning excess money to their organization. How each insurance provider treats overpayment varies case-by-case.

If an insurance check is more than a fix, don't just keep the money. If the insurance company discovers their mistake without warning, they could allege that you committed insurance fraud. It's better to be careful rather than criminal risk charges—insurance companies heavily Texas politicians and use the Texas Department of Insurance to prosecute consumers they can allege committed insurance fraud.

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