What should I do immediately after my insurance claim is denied?

A claim denial is not the end of the road. Most denials can be appealed, and some are reversed when the policyholder submits additional documentation or challenges the carrier’s interpretation of the policy language.

What does the denial letter actually say?

Read the denial letter in full. Insurers are required to state the specific reason for the denial and cite the policy provision, exclusion, or condition they are relying on. If the letter is vague, write to the carrier and request a specific citation. Pull out the actual policy document and read the section the insurer cited. The key question is whether the exclusion or condition actually applies to the circumstances. Carriers sometimes apply broad exclusions to situations they were not designed to cover, or mischaracterize the cause of loss.

What documentation should you gather before filing an appeal?

Gather all supporting documentation for the loss: photographs, contractor estimates, receipts, weather reports, police reports, or any other evidence relevant to what happened and what it cost. Documentation gaps are a common reason initial claims are denied but later paid on appeal.

For example, a homeowner in Columbus had a water damage claim denied because the carrier cited a maintenance exclusion. After submitting a plumber’s report confirming the failure was sudden and accidental rather than a slow leak, the carrier reversed the denial and paid the claim in full.

Submit a written appeal to the carrier within the timeframe stated in the denial letter. State specifically why the denial was incorrect, cite the policy language being relied on, and attach all supporting documents. Keep copies of everything sent and confirm receipt in writing.

When should a public adjuster be involved?

A licensed public adjuster works for the policyholder, not the carrier. They independently assess the damage, document it thoroughly, and advocate for a fair settlement. Public adjusters charge a percentage of the final settlement, typically 10 to 15 percent, so they make economic sense when the denied or underpaid amount is substantial. For example, a Roswell homeowner whose fire claim was initially denied hired a public adjuster who identified structural damage the carrier’s inspector had missed, resulting in a full reversal and a $47,000 payment.

What options remain if the internal appeal fails?

If the carrier denies the appeal and the denial appears incorrect, additional options include filing a complaint with the Georgia Department of Insurance, consulting a licensed public adjuster, or speaking with an attorney who handles insurance coverage disputes. Understanding the difference between a claim dispute and a DOI complaint helps identify the right track. If the carrier missed its response deadlines during this process, Georgia’s bad faith statute may provide additional remedies. If a denial stems from how coverage is structured, see what qualifies as insurance bad faith in Georgia.

Olive Cover (operated by Olive Insurance Services, LLC) can assist in reviewing the denial, identifying documentation gaps, and communicating with the carrier on your behalf. A coverage review with a licensed advisor is where that process starts.