Insurance Claim Problems
How can we help?
Damage occurred and a claim was opened, but payment, coverage, or the repair scope is now disputed.
Common situations
- claim delayed without clear decision
- payment far below repair estimate
- coverage denied
- repeated document requests without progress
- insurer approves part of the claim only
- repairs cannot begin due to insufficient funds
- adjuster and contractor estimates conflict
- communication with the insurer has stalled
What happens next
The policy, claim file, and communications are reviewed first to determine coverage and leverage.
How these disputes usually start
Insurance disputes rarely begin as legal disputes.
They begin after a loss — water damage, fire, storm damage, structural failure, or another property event. The claim is reported. An adjuster inspects. Documents are requested.
Then the process slows.
Payment is partial, delayed, or denied. Estimates differ significantly. The property cannot be repaired with the funds provided.
The immediate problem becomes practical: the property remains damaged while the claim remains unresolved.
Many policyholders are unsure whether the insurer’s conduct is normal claim handling or a coverage problem. Legal involvement typically begins when the claim stops moving toward resolution.
The real legal issue
Insurance cases are contract disputes governed by the policy.
The issue is not whether damage occurred.
The issue is whether the policy requires payment for it and in what amount.
Typical disputes involve:
- whether the loss is covered
- whether exclusions apply
- scope of repair
- valuation of damage
- delay in making a decision
A claim may be acknowledged but still underpaid. An insurer may request repeated documentation without issuing a final determination. In other cases, coverage is denied based on a policy provision the property owner did not anticipate.
The legal question is whether the insurer complied with its contractual obligations and claim-handling duties.
What I review first
Initial review usually includes:
- the insurance policy
- coverage letters or denial letters
- adjuster reports
- repair estimates
- photographs and inspection findings
- communications with the insurer
The purpose is to determine what the policy actually promises and whether the claim handling matches those obligations.
What legal action can accomplish
Legal action may:
- compel payment required by the policy
- correct an undervalued claim
- resolve scope-of-repair disputes
- obtain interest or additional damages where allowed
- conclude a stalled claim
The objective is not filing a lawsuit for its own sake.
It is moving the claim from an open-ended process to a defined resolution.
How resolution usually happens
Most insurance disputes follow a progression:
- Policy analysis — determine coverage position
- Formal demand — present documented claim valuation
- Negotiation — many claims resolve here
- Litigation if necessary — enforce policy obligations
- Payment and repair — implement the result
Many matters resolve after a structured demand clarifies the legal position and supporting documentation.
Litigation becomes necessary when the insurer maintains a denial or unreasonable valuation.
Underpayment and delay
Not all disputes involve a full denial.
Common patterns include:
- approval of coverage but insufficient payment
- ongoing requests for documentation without resolution
- scope disagreements between adjuster and contractor
The practical consequence is the same: repairs cannot be completed.
Legal involvement often focuses on defining scope and valuation rather than arguing about whether damage occurred.
Timing and avoidable mistakes
Common errors that weaken claims:
- starting permanent repairs before documentation
- discarding damaged materials too early
- failing to keep written communication records
- missing deadlines in insurer correspondence
- assuming continued delay means denial
Early evaluation preserves evidence and negotiation leverage.
Waiting can complicate both coverage positions and repair costs.
FAQ
Does hiring a lawyer mean filing a lawsuit?
No. Many claims resolve after policy analysis and formal demand.
Can the insurer delay indefinitely?
No. Claims must be handled within contractual and legal standards.
Should I accept partial payment?
Sometimes. The answer depends on policy terms and whether additional recovery is still possible.
Next step
If a property insurance claim has stalled, been underpaid, or denied, a consultation determines coverage position and practical options before escalation.
Call 720-588-3529 or request a consultation.