Flood insurance claim denied? Don’t panic -- appeal
Having a flood insurance policy is a relief if you've suffered water damage. But it doesn't guarantee that your troubles are over, because your claim could be underpaid or denied.
If you've read your policy thoroughly and believe your claim should be covered, it's worth pursuing an appeal.
If you have a National Flood Insurance Program policy, you can appeal a denial with the Federal Emergency Management Agency, which administers the NFIP. If you have a private flood policy, you'll appeal to the insurer directly.
Here's how to start a FEMA appeal and more information about why your claim could be denied.
How to appeal a denied NFIP claim
If your flood claim is denied, you'll receive a notice from the insurer that administers your NFIP policy. FEMA encourages policyholders to discuss disputes with their insurer first. During the appeal process, keep a detailed record of every call you make to your insurer, including the name and title of everyone you spoke with, what you spoke about and the dates and times of each conversation.
You must file your appeal within 60 days of the date of the insurer's written denial.
Step 1: Contact your adjuster
This person should be able to clarify why your claim was rejected or how the settlement amount was determined.
Step 2: Contact the adjuster's supervisor
If your adjuster can't provide answers or the answers are unsatisfactory, ask for his or her supervisor's contact information. Restate your questions and concerns, in writing if possible.
Step 3: Contact your insurer's claim representative
If the supervisor isn't helpful, contact your insurer's claim representative. Restate your questions and explain the steps you've already taken. Your agent might be able to offer assistance.
Step 4: If steps 1-3 DON'T reSOLVE THE ISSUE, contact FEMA
If you're the person named on the policy, you can send FEMA a letter about the issue. If you're not, the policyholder or a legal representative should send the letter to:
Federal Insurance and Mitigation Administration
Federal Insurance Administrator
1800 South Bell Street
Arlington, VA 20598-3010
The letter should include:
· The NFIP policy number, found on the declarations page of the policy
· Your name
· The flooded property's address
· The best way for FEMA to contact you
· A detailed description of your questions and concerns
· Names and contact information for everyone you've spoken with about these concerns before contacting FEMA
· Documentation to support your appeal, such as a copy of the written claim denial, a copy of the proof of loss statement and photographs confirming the damage.
This FEMA brochure has a list of documents you can use to support your claim.
What to expect after your appeal
First, FEMA will acknowledge in writing that it has received your appeal. Next, it will request the claim file from your insurer. It might also ask for more information or request that your property be inspected again. Requests for more information will likely have a 14-day deadline.
FEMA should provide a written appeal decision within 90 days of receiving all necessary information.
If it agrees with the appeal, FEMA will inform both you and your insurer and recommend actions for the insurer to take. If it disagrees, FEMA will explain why in detail.
If the appeal raises new questions or reveals documentation you hadn't provided to your insurer before it denied the claim, FEMA might tell you to submit this information directly to the insurance company to get additional payment.
Reasons your claim could be denied
In some cases, your insurer might have a legitimate reason for denying your claim — and in that case, it's probably not worth the time it takes to appeal.
You're inside the 30-day waiting period: If you buy last-minute flood insurance and have flood damage before the waiting period is over, insurance won't help you.
You missed the proof of loss filing deadline: You have 60 days from the time of damage to file a flood insurance claim. Wait any longer, even if you're displaced, and your claim could be denied. Sometimes this deadline is waived after a severe disaster, but not always.
There was earth movement: Damage due to movement of the earth is excluded from a flood insurance payout, even if the earth moved because of the flooding. If your insurer denies your claim because of this exclusion, consider hiring a licensed professional engineer to determine the exact cause of damage. Make sure the engineer has experience with flood damage. If he or she determines damage was caused by hydrostatic pressure, which typically is covered, rather than earth movement, submit the findings in your appeal.
You had pre-existing damage: If water damage is confined to your home, was preventable — like a slow water leak — or occurred before you were insured, it's generally excluded from NFIP flood insurance policies.
You have basement damage that's not covered: NFIP policies provide some coverage for basement areas, but it's limited and often doesn't include the contents of a finished basement or basement improvements.
