How to get an insurance claim denied

Published Date: 10/18/2025

How to Get an Insurance Claim Denied — And How to Avoid It

Nobody ever plans on having an insurance claim denied. But every year, thousands of homeowners, drivers, and business owners find out the hard way that insurance coverage isn’t guaranteed — it’s conditional.

When you buy insurance, you’re not just purchasing peace of mind. You’re entering into a contract. That contract spells out not only what your policy covers, but also what you’re obligated to do when something goes wrong.

Yet, time and again, claims fall apart because of simple, preventable mistakes.

In this post, we’ll explore five common missteps that lead to claim denials, what insurers are really looking for during the process, and how you can protect yourself from losing coverage when you need it most.

1. Waiting Too Long to Report a Claim

One of the easiest ways to get your claim denied is to delay reporting it.

Most insurance policies require prompt notification of any loss, accident, or damage. That means as soon as it’s safe and practical, you should contact your insurer — not a week or month later.

Why does timing matter? Because insurance companies rely on immediate information to:

• Verify the cause of the loss (before evidence disappears or changes).
• Inspect physical damage before repairs alter the scene.
• Determine coverage applicability based on when the event occurred.

If too much time passes, crucial details — photos, weather conditions, witness accounts — can’t be verified. That gives the insurer legitimate grounds to deny the claim.

Even if you’re unsure whether a situation is covered, it’s always better to report it early. You can decide later, with guidance, whether to proceed formally.

Pro Tip: Document every communication. Record dates, names, and summaries of conversations with your agent or claims representative. A clear paper trail can protect you if there’s ever a dispute over timing.

2. Repairing Everything Before the Adjuster Arrives

It’s human nature: when something breaks, we want to fix it right away. But when it comes to insurance claims, that instinct can backfire.

If you repair or replace damaged property before the adjuster inspects it, you may unintentionally destroy the evidence the insurer needs to validate your loss.

For example:

• A homeowner replaces a flooded carpet before documenting it.
• A driver repairs their car bumper after a hit-and-run without photos.
• A business replaces stolen inventory before the insurer can confirm quantities or values.

In each case, the insurer can’t independently verify what was lost, when, or how — and may deny or drastically reduce the claim amount.

Instead, make temporary repairs to prevent further damage (as required under most policies), but leave permanent work until after inspection.

Pro Tip: Take comprehensive photos and videos before touching anything. Capture multiple angles and timestamps — digital evidence can save your claim.

3. Treating the Adjuster as the Enemy

It’s easy to feel frustrated during a claim. You’re stressed, your property is damaged, and the process feels slow. But one of the biggest mistakes policyholders make is taking out that frustration on the claims adjuster.

Adjusters are often viewed as “the face of the insurance company.” But in reality, their role is to evaluate, not antagonize. They’re responsible for:

• Assessing damages.
• Verifying policy terms.
• Ensuring fair payouts based on documentation.

When claimants are rude, hostile, or uncooperative, communication breaks down — and that can delay or complicate your claim.

Insurance is a collaborative process. The adjuster needs information from you to complete their report, and you need transparency from them to understand the settlement.

Pro Tip: Keep all interactions courteous and professional. Treat your adjuster like a partner in solving a shared problem — because ultimately, both of you want the same thing: resolution.

4. Exaggerating or Inflating Your Loss

Few mistakes can derail a claim faster than exaggeration.

It may seem harmless to “round up” the cost of repairs or include a few extra items in a theft claim, but insurers have sophisticated systems — and legal obligations — to detect fraud or misrepresentation.

Every claim you file becomes part of your Comprehensive Loss Underwriting Exchange (CLUE) report, a national database used by insurers to assess risk. False or inflated claims can lead not only to denial but to policy cancellation or even criminal investigation in serious cases.

Forsaking accuracy can also hurt your credibility in legitimate disputes. If one part of your claim appears inflated, insurers may question the rest of it — leading to longer investigations or reduced settlements.

Pro Tip: Stick to the facts. Provide receipts, estimates, or photos whenever possible. If something’s uncertain — like an item’s age or value — say so honestly and let the adjuster verify it.

5. Not Understanding What Your Policy Actually Covers

Perhaps the most common reason for denied claims isn’t negligence — it’s assumption.

Many policyholders believe their insurance covers “everything,” only to discover exclusions buried in the fine print. Common surprises include:

• Flood and earthquake damage, which are excluded from standard homeowners policies.
• Wear and tear or neglect, which insurers classify as maintenance issues, not sudden losses.
• Business use of property, like operating a home-based business without separate coverage.
• Unlisted drivers or unauthorized vehicle use under auto insurance.

These gaps don’t mean your insurer is being unfair; they reflect how policies are structured to cover sudden, accidental losses, not foreseeable or long-term issues.

Reading your policy may feel tedious, but it’s your strongest protection. Knowing what’s excluded lets you purchase endorsements or supplemental policies — like flood, earthquake, or business coverage — before disaster strikes.

Pro Tip: Review your policy at least once a year. Major life changes — a remodel, new car, or home-based business — may require coverage adjustments.

6. Ignoring the Documentation Trail

Insurance claims are built on proof — not assumptions or verbal assurances. The more detailed your documentation, the harder it is for an insurer to dispute it.

Strong documentation includes:

• Photos or videos of the damage.
• Receipts, appraisals, or invoices for lost items.
• Police or fire department reports (if applicable).
• Written communication logs with dates and names.

A single missing document can cause weeks of delay or outright denial. Don’t rely on memory; maintain a claim file with all correspondence and evidence.

Pro Tip: Create a “pre-loss inventory.” Use your phone to record a video walkthrough of your home or business annually. It’s invaluable when proving what you owned and its condition.

7. Forgetting the Duty to Mitigate

Many policyholders don’t realize they have a duty to mitigate — meaning they must take reasonable steps to prevent further damage after an incident.

For example:

• If your roof leaks, you must cover it with a tarp to prevent more water damage.
• If a pipe bursts, you’re expected to shut off the water supply immediately.

Failing to do so gives insurers a valid reason to reduce or deny coverage for additional losses, claiming negligence.

Pro Tip: Take swift action after any loss, but keep receipts for temporary repairs and materials — those costs are often reimbursable.

8. Not Asking for Clarification

Insurance contracts are filled with technical terms — “perils,” “endorsements,” “exclusions.” If you don’t understand something, ask.

Many denials stem from misunderstandings that could have been resolved early. Your agent or broker is there to interpret your coverage and advocate on your behalf. Don’t wait until after a denial to seek clarification.

Pro Tip: If your claim is denied, request a written explanation citing the exact policy language. This helps you determine whether to appeal, provide more evidence, or seek legal guidance.

9. Why Claim Denials Are Rising

In today’s insurance environment, claim scrutiny is tighter than ever. Inflation, rising repair costs, and widespread fraud have made insurers more cautious.

That doesn’t mean companies are out to deny claims — it means they’re under financial pressure to verify every dollar. Policyholders who document thoroughly, communicate early, and follow procedures stand the best chance of smooth approval.

As one claims expert put it:

“Insurers don’t deny claims because they can. They deny them because they must — when policy obligations aren’t met.”

Understanding that dynamic can transform frustration into strategy.

Final Thoughts

Insurance is a promise — but it’s also a partnership. Both sides have responsibilities.

Most denials aren’t acts of bad faith; they’re the predictable outcome of missed steps, unclear communication, or policy misunderstandings.

The key takeaway? Know your coverage, document everything, communicate promptly, and treat every claim as a business transaction — because it is one.

That’s how you keep your claim from becoming another statistic.