Five Tips to Help Avoid a Denial on Your Insurance Claim

A woman's nose grows like Pinocchio's while she's on the phone.

(Image credit: Getty Images)

By Karl Susman, CPCU, LUTCF, CIC, CSFP, CFS, CPIA, AAI-M, PLCS

published 27 December 2024

Having your insurance claim denied is at the top of the list of things that upset us the most. It’s right up there with paying taxes, dealing with a car salesperson or being told you need a root canal. We hear it happens and dread the possibility. There are things you can do to avoid finding yourself in the position of receiving the dreaded letter of denial from your insurer or receiving that phone call where you can just tell from the deep sigh of the claims adjuster on the other line that the news is not good.

Here are five tips to help ensure your claim won’t be denied. You can also watch my video about this:

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1. Report your claim as soon as possible

Most insurance policies have a provision that states that you should let the insurer know about a loss as soon as it is reasonably possible to do so. This isn’t an attempt to mess with you or find an excuse later for non-compliance. The reason behind this is sound.

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Sometimes, after we have had a loss, we’re not always in the best headspace. I mean, we literally just had something bad happen. In those times, we may not always make the same choices we would normally make. That may mean forgetting some obvious things, like taking measures to prevent further loss from happening, or getting caught by some third party who promises us the sun, moon and the stars if we just sign over the business to them to help handle the claim.

Karl Susman

Karl is an insurance agency owner, insurance expert witness in state, federal and criminal courts, and radio talk show host. For more than 30 years, Karl has helped consumers understand the complex world of insurance. He provides actionable advice and distills complex insurance concepts into understandable options. He appears regularly in the media, offering commentary and analysis of insurance industry news, and advises lawmakers on legislation, programs and policies.

We pay to have an insurance company behind us in the event of a loss, and the only way we can truly get our money’s worth is to report the claim and let them take the wheel.

2. Don’t fix any of the damage before the insurer can see it

I don’t know about you, but my middle name is Impatient. Actually, it is David, but you get the idea. When something bad happens and we have a loss, it is only natural that we want to do what we can to get things back to the way they were before. Remember, a loss means just that — something you have is no longer, so of course, let’s get on that ASAP.

However, if we’re looking to have our insurer pay for the loss, we have to give them the opportunity to see it. Verify it. Adjust it. If you have damage and fix it and then just send the receipts to the insurance company, they have no way of even knowing there was a loss to begin with. They're just getting bills to pay. Not gonna work, my friends. You need to let the folks see what they are paying for.

3. Don’t take out your frustration at the loss on the claims adjuster

I get it, something bad happened, or you wouldn’t be filing a claim to begin with. At the same time, there is an actual human being assigned to help you make the repairs or replacements and act as the arm of the insurance company.

Day in and day out, they deal with people who have suffered from a loss. They get it, too. This doesn’t give you free rein to be a jerk. Claims adjusters are people, too — with friends, families and, yes, even feelings. They aren’t responsible for what happened to you. Far from it. They’d prefer it never happened, I promise you that.

Remember the Golden Rule when working with your insurance company’s assigned claims adjuster: Treat others the way you would like to be treated.

4. Don’t take advantage of the situation

You’ve been paying for your insurance policy, and you have a claim. Time to see what you get for forking over those bucks over the years, right? Except, this isn’t payback; this isn’t your opportunity to get back the money you have paid. It is a contractual obligation that you created when you purchased your insurance policy, and now the insurer will do their part and work with you.

Don’t exaggerate the loss because you feel you have something more coming, or because you’re upset about what happened. Be clear on what you are entitled to in the insurance policy and expect just that.

5. Don’t lie

“I don’t lie, ever,” said literally every person who ever lived. Everyone lies sometimes, but the time to lie is most definitely not when you are working with your insurance company on a claim.

What may seem like a minor extra to you, such as adding a pair of shoes you never purchased (almost did, but didn’t) to your inventory list of items lost, is actually a big deal. It is such a big deal it has a big, scary name: insurance fraud. Lying about your claim to your insurer is a surefire way to get the entire claim denied — the legit aspects and the parts you embellished. Don’t do it.

It sucks having a claim. Nobody likes it. A claim means something bad happened to you. Ergo, the use of the word “loss.” Losses require you to file a claim. You would certainly be happier to not have suffered a loss. Your claims adjuster would love to not have to deal with you in your most prickly time of neediness, and your insurer? Yes, you know they would sleep better at night if you didn’t have a loss leading to filing a claim.

When in doubt, remember that you catch more flies with honey than vinegar.

Want to learn more about insurance? Visit KarlSusman.com.

Disclaimer

This article was written by and presents the views of our contributing adviser, not the Kiplinger editorial staff. You can check adviser records with the SEC or with FINRA.

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Karl Susman is an insurance agency owner, insurance expert witness in state, federal and criminal courts, and radio talk show host. For more than 30 years, Karl has helped consumers understand the complex world of insurance. He provides actionable advice and distills complex insurance concepts into understandable options. He appears regularly in the media, offering commentary and analysis of insurance industry news, and advises lawmakers on legislation, programs and policies.