⚠️ The Uncomfortable Truth
Insurance companies make money by collecting premiums and not paying claims. Adjusters are often trained to minimize payouts. Here are the tactics they use—and how to fight back.
7 Common Claim Denial Tactics
1. The Quick Lowball Offer
They offer fast payment—at 30-50% of fair value—hoping you'll accept before realizing your claim is worth more.
Fight back: Never accept the first offer. Get your own repair estimates. Ask how they calculated the amount in writing.
2. Delay, Delay, Delay
They "lose" paperwork, need "more documentation," or are "still investigating"—hoping you'll give up or accept less just to end it.
Fight back: Document every communication. Send follow-ups in writing. Know your state's claim response deadlines and cite them.
3. "Pre-Existing Damage" Claim
They claim the damage existed before the covered event, even when it clearly didn't. Common with roof and water damage claims.
Fight back: Provide dated photos from before the incident. Get an independent inspection. Demand their evidence in writing.
4. Policy Language Games
They interpret vague policy language in their favor, or cite exclusions that don't actually apply to your situation.
Fight back: Request the specific policy language they're citing. Ambiguous terms are legally interpreted in favor of the policyholder.
5. The Recorded Statement Trap
They ask for a recorded statement, then use anything you say—even innocent mistakes—to deny or reduce your claim.
Fight back: You're not required to give a recorded statement to the other party's insurer. For your own insurer, prepare carefully and stick to facts.
6. Depreciation Abuse
They over-depreciate items, claiming your 3-year-old roof or 2-year-old appliance is worth almost nothing.
Fight back: Challenge their depreciation calculations. Provide actual market values. Ensure you have replacement cost coverage, not ACV.
7. The "Friendly" Adjuster
They act like they're on your side, build rapport, then use that trust to get you to accept less or admit something damaging.
Fight back: Be polite but remember: the adjuster works for the insurance company, not you. Everything is business.
Your Rights as a Policyholder
đź“‹ Right to Written Explanation
Insurers must provide written reasons for any denial. Demand it—vague phone explanations aren't enough.
⏱️ Right to Timely Response
Most states require insurers to acknowledge claims within 15-30 days and make decisions within 30-45 days.
🔄 Right to Appeal
Denials aren't final. You can appeal internally, hire a public adjuster, or file a complaint with your state insurance department.
⚖️ Right to Sue for Bad Faith
If an insurer unreasonably denies or delays a valid claim, you may have grounds for a bad faith lawsuit with additional damages.
The Bottom Line
Insurance companies have a playbook for minimizing claims. Your defense: document everything, get independent estimates, communicate in writing, and know your rights. Never accept the first offer, and don't be afraid to escalate to your state insurance department or an attorney if you're being treated unfairly.