This is another reminder that insurance policies are written agreements. Most policies begin with wording stating that the insurer will provide protection according to the language of the given contract IF the policyholder pays them for providing it. When a loss occurs, it’s ideal if the loss qualifies for coverage, a claim is submitted, and payment is made on a timely basis and subject to any deductible.

In between a loss and how the situation is resolved, a lot may occur. Often when a loss is denied, the parties accept the decision and that’s it. Other times a denial is just the beginning. Conflict may build, disagreements can escalate, and litigation is the result.

Policyholders are at a disadvantage when there’s a disagreement over coverage amount or whether coverage applies. Dealing with losses is a core part of an insurance company’s operations; it has more expertise, time, and resources than policyholders. However, that does not mean that policyholders are powerless. They can and should make the effort to oversee disputes intelligently and efficiently.

The strongest step a policyholder can take is to rely heavily on the insurance policy, the TOTAL policy. That entails becoming familiar with all aspects such as definitions, conditions, and exclusions. Successfully influencing a denial can occur long before a decision to sue is made.

Actions that can reduce the need to go to court are to follow all policy obligations including, as applicable, report losses quickly, share details, and make sure the information is accurate regarding when the loss occurred, extent of damage, persons or property involved, information on what may have contributed to the loss taking place. Report the information in the manner required by the policy. Then, be sure to comply with requests the company makes. Make sure damaged property is available for any inspections the insurer wishes to perform, answer questions quickly and completely. Frequently, denials occur because of poor cooperation, delays, and miscommunication. A policyholder’s adherence to policy provisions creates a stronger chance of a claim being covered.

Another strong action is to pay close attention to why a loss is denied. Does the reason for a rejection align with policy wording? It’s common for insurers to make errors and policyholders that examine their situation, and the policy carefully can cause insurer personnel to reassess a decision. Again, careful communication is important. Take time to lay out your position, make references to relevant parts of the policy, including definitions, various coverage sections and exceptions to exclusions that may be applicable. If there is anything an insurer shares that you don’t understand, you can request clarification.

Litigation may be necessary but it’s productive to make it the last resort. Also, the previous steps taken to resolve a dispute may bolster your chances should things be left for a court to resolve. The position and actions that you take before a lawsuit makes up the basis of your legal argument, so approaching disputes properly, respectfully, and efficiently is always a positive strategy.

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