Denied Insurance Claim in PA: What to Do

Facing a denied insurance claim in PA can be stressful and frustrating. As a homeowner, you expect your insurance policy to provide financial protection when disaster strikes. But when your claim is denied, it can leave you wondering what went wrong and what to do next.

The good news is that a denial isn’t always final. Many claims can be challenged and even overturned with the right approach. In this guide, we’ll cover how often home insurance claims get denied, the most common mistakes that lead to denials, and what steps you can take if your claim has been rejected. If you’re dealing with a denied claim in Pennsylvania, knowing your options is the first step toward getting the coverage you deserve.

How Often Do Home Insurance Claims Get Denied?

Home insurance claims are an essential safety net for homeowners facing unexpected damages. However, understanding the likelihood of a claim being denied can help set realistic expectations.

Nationally, about 5.8% of insured homes experienced a claim between 2018 and 2022. The most common claims were for wind and hail (2.8%), followed by water damage and freezing (1.6%). While specific denial rates can vary by insurer and state, it’s noteworthy that some major insurers have reported denial rates as high as 48% in recent years.

In Pennsylvania, the frequency of paid homeowners insurance claims was 4.07 per 100 insured homes in 2013, slightly lower than the national average of 5.03. While this data indicates claim frequency, it underscores the importance of understanding the factors that can lead to a denied insurance claim in PA.

What Are the 3 Most Common Mistakes on a Claim That Will Cause Denials?

Filing a home insurance claim might seem straightforward, but even small mistakes can lead to a denied insurance claim in PA. Many homeowners don’t realize that the claims process requires careful attention to detail, and missing a step could cost them the coverage they need.

Here are three of the most common mistakes that lead to denied claims:

1. Delaying the Claim

Insurance companies expect homeowners to report damage as soon as possible. If you wait too long, they may argue that the damage got worse over time due to neglect, leading to a denial. Most policies have specific deadlines for filing claims, so acting quickly is essential.

2. Not Documenting the Damage Properly

A lack of evidence is one of the top reasons for a denied insurance claim in PA. Insurers require proof of the damage and its cause, and without detailed photos, videos, or written records, they may deny the claim due to “insufficient documentation.” Before making any repairs, take clear, timestamped photos of everything and keep receipts for any emergency fixes.

3. Misunderstanding Policy Coverage

Many homeowners assume their policy covers all types of damage, but exclusions and limitations exist. For example, most standard policies do not cover flood or earthquake damage. If a homeowner files a claim for something not covered, it will be denied. Understanding the details of your policy—before you need to file a claim—can prevent this issue.

Avoiding these mistakes can increase the chances of your claim being approved. But if you’ve already received a denied insurance claim in PA, don’t assume the decision is final. In the next section, we’ll go over the steps you can take to challenge a denial and fight for the coverage you deserve.

Receiving a denied insurance claim in PA can be frustrating, but a denial doesn’t necessarily mean you’re out of options. Insurance companies can make mistakes, and many denials can be overturned with the right approach. If your homeowners insurance claim has been rejected, here’s what you can do next.

1. Review the Denial Letter Carefully

Insurance companies are required to explain why they denied your claim. Read the denial letter thoroughly and look for specific reasons—whether it’s missing documentation, an exclusion in your policy, or something else. Understanding the insurer’s reasoning is the first step in deciding how to respond.

2. Compare the Denial to Your Policy

Go back to your homeowners insurance policy and check whether the reason for denial aligns with the terms of your coverage. Sometimes, insurers misinterpret policy language or apply exclusions incorrectly. If you believe the denial was unfair, you may have grounds to appeal.

3. Gather Additional Evidence

If your claim was denied due to “insufficient proof” or a dispute over the cause of damage, gather more evidence. Take additional photos, collect contractor estimates, and obtain expert opinions if needed. The more supporting documentation you have, the stronger your appeal will be.

4. File an Appeal with Your Insurance Company

Most insurers have a formal appeals process where you can dispute a claim denial. Write a detailed letter explaining why you believe the claim should be covered, attach all necessary documentation, and request a reconsideration. Be clear, factual, and professional in your communication.

5. Consult a Public Adjuster or Insurance Expert

If you’re struggling to get a fair settlement, working with a public adjuster—like Alliance Adjustment Group—can make a big difference. Public adjusters represent homeowners, not insurance companies, and they know how to negotiate to get you the best possible payout. They can review your policy, gather evidence, and communicate with the insurer on your behalf.

6. Consider Legal Action as a Last Resort

If all else fails and you believe your insurer is acting in bad faith, you may need to explore legal options. In Pennsylvania, homeowners can take legal action against insurers who wrongfully deny claims. Before going down this path, consult with an attorney who specializes in insurance disputes.

A denied claim is not the final word. With the right approach, many homeowners successfully challenge insurance denials and get the coverage they deserve. In the next section, we’ll cover whether you can sue your insurance company for denying your claim and what that process looks like.

Can I Sue My Insurance for Denying My Claim?

If you’ve gone through the appeals process and your denied insurance claim in PA still hasn’t been resolved, you may be wondering if you can take legal action. The answer depends on why your claim was denied and whether the insurance company acted in bad faith.

What Is Insurance Bad Faith?

Insurance companies are legally required to handle claims fairly and in good faith. If they wrongfully deny a valid claim, delay payments without reason, or fail to properly investigate damages, they may be acting in bad faith. In Pennsylvania, bad faith insurance practices can result in serious legal consequences for insurers.

When Can You Sue Your Insurance Company?

You may have grounds for a lawsuit if your insurance company:

Denies a valid claim without a reasonable explanation

Fails to investigate the claim properly or in a timely manner

Misinterprets policy language to avoid paying

Pressures you into accepting a low settlement

Delays payment without justification

If you believe your insurer is engaging in any of these practices, consulting an insurance dispute attorney is a smart next step.

Steps to Take Before Filing a Lawsuit

Lawsuits can be time-consuming and expensive, so it’s important to exhaust other options first. Before suing, make sure you have:

Reviewed Your Policy – Double-check that your claim is valid under your coverage.

Appealed the Denial – Follow your insurer’s internal appeal process and provide additional evidence.

Consulted a Public Adjuster – Professionals like Alliance Adjustment Group can often negotiate a better settlement without the need for legal action.

Spoken with an Insurance Attorney – A lawyer can review your case and advise on whether legal action is the right move.

What Happens If You Sue?

If you decide to take legal action, your attorney will likely file a bad faith insurance claim against your provider. If successful, you could recover:

The full amount of your original claim

Additional damages (such as attorney fees and court costs)

In some cases, punitive damages for severe misconduct

Pennsylvania has strong consumer protection laws that hold insurance companies accountable for wrongful denials. However, litigation should always be a last resort after other efforts have failed.

Get Expert Help with Your Denied Insurance Claim in PA

Dealing with a denied insurance claim in PA can be overwhelming, but you don’t have to go through it alone. Whether your claim was denied due to an error, lack of documentation, or a bad-faith decision by your insurer, there are steps you can take to fight back—and we’re here to help.

At Alliance Adjustment Group, we specialize in helping homeowners get the insurance payouts they rightfully deserve. Our team of experienced public adjusters understands the complexities of Pennsylvania insurance claims and knows how to negotiate with insurance companies on your behalf. We’ll review your denial, gather the necessary evidence, and work to overturn the decision—without the stress of handling it alone.

Don’t let a denied claim stand in the way of your home’s recovery. Contact Alliance Adjustment Group today for a consultation and take the first step toward getting your claim resolved.

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