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See Why You Really Are The EnemyRon Cercone answers Insurance Claim Questions With Help and Advice on Auto, Home, Business Claims for Fire, Wind, Water, Flood Damage, etc. and Denied Claims
 

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Denied Insurance Claims Advice for Home and Business

Deluxe With Appendix

 

 

 

 

 

This 157 page reference gives expert advice to help you get coverage if you have a denied insurance claim, in part or in full (or reduced to some token policy limit, such as with most mold claims). You can reopen denied claims that are several years old, even if you signed a Proof of Loss or a Release. The Appendix is highlighted along with valuable comments by Ron Cercone, a semi retired public adjuster and court approved insurance claims expert witness.                                   

View more details and eBook DOWNLOAD page (click here)

 

 

Denied Insurance Claims Advice Table of Contents

                                                                      

TABLE OF CONTENTS............................................................................................................................ 1

INTRODUCTION.....................................................................................................................................3

Reopen Old and Denied Claims........................................................................................................ 4

My Favorite Denied Claim Story........................................................................................................4

About the Adjuster’s Attitude and Morale.........................................................................................5

BATTLE     PREPARATIONS.................................................................................................................... 5

“Battle Gear”..................................................................................................................................... 5

General Battle Principals.................................................................................................................. 6

“Negligence” (by the insurer, their vendors and others)......................................................................... 7

“Estoppel”......................................................................................................................................... 7

YOUR FIRST MOVES.............................................................................................................................. 8

Your Right to Know versus Attorney Client Privilege and Attorney Work Product.......................... 9

About Experts ..................................................................................................................................10

INSURER’S FAVORITE DENIAL TECHNIQUES....................................................................................... 11

Delay................................................................................................................................................ 11

Unreasonable Demands................................................................................................................... 11

Examination Under Oath (as a denial technique)................................................................................ 11

Declaratory Relief Action................................................................................................................. 12

“ENTIRE POLICY VOID” DENIAL.......................................................................................................... 12

“POLICY OUT OF FORCE” (for alleged non payment of premium)............................................................ 12

BUILDING STRUCTURE or OTHER ITEM  “NOT SCHEDULED” (on an existing policy)............................... 13

YOUR ADDITIONAL “TO DO” LIST....................................................................................................... 13

“BREACH OF CONTRACT”  (for alleged arson, fraud, misrepresentation, missing or faulty “Proof of  Loss”, “failure to cooperate” by the insured)...

SELECTED “EXCLUDED PERIL” DENIED CLAIMS.................................................................................. 15

MOLD................................................................................................................................................ 15

WATER DAMAGE................................................................................................................................ 16

CAUSE OF THE LOSS  (how to recover lost dollars from “cause of loss” not being covered)....................... 17

CONCURRENT CAUSE OF LOSS NOT COVERED...................................................................................... 17

“VACANT STRUCTURE”....................................................................................................................... 17

CODE IMPROVEMENTS – (how to get coverage without an endorsement).............................................. 17

SPECIAL ITEMS OF CONCERN (that help set up a denial)................................................................... 19

‘Proof of Loss’ (form)........................................................................................................................ 19

Tape Recorded Statement............................................................................................................... 20

READING YOUR POLICY (the quick and easy way).............................................................................. 21

Special Considerations When Reading Your Policy.......................................................................... 22

About Policy Form Numbers and Edition Years................................................................................ 23

“BURDEN OF PROOF” (is it on you or the insurer?)............................................................................. 23

USING THE LAW TO HELP YOU.............................................................................................................. 23

HARD BALL TACTICS............................................................................................................................. 25

1.    Small Claims Court...................................................................................................................... 25

2.    Better Business Bureau Sponsored Arbitration......................................................................... 26

3.    News Media................................................................................................................................. 26

4.    Picketing..................................................................................................................................... 26

5.    Other Guerilla tactics.................................................................................................................. 26

6.    Litigation..................................................................................................................................... 26

PROFESSIONAL HELP  (Public Adjusters)............................................................................................. 27

FINAL NOTE........................................................................................................................................... 27

APPENDIX.............................................................................................................................................. 28

These appendix documents are samples of insurance claims documents that I have critiqued. My notes are handwritten in the margins as well as in blue text boxes. My notes are followed by my initials “rc”. These documents may not be the latest versions and should only be used as a guide to show you how to critique your own unique documents.

A - Policy Cancellation Documents Critiqued.......................................................................................

A1 - Insurance policies are overridden by State Law................................................................................

A2 - “Certification Page” sample of a certified policy................................................................................

A3 - Sample document request letter to insurer......................................................................................

A4 - Case study “Number 1”, policy wrongly cancelled, insurer had incorrect mail address (5 pages).

A5 - Case study “Number 2”, policy wrongly cancelled, insurer had incorrect mail addresses on both insured and mortgagee (9 pages)

A6 - Sample letter seeking attorney to litigate........................................................................................

A7 - Case study “Number 3”, building wrongly not listed on policy, insurer had insufficient address, inspection, etc inc. sample documents and correspondence (16 pages)............

A8 - Case law regarding cancellation notices (6 pages)............................................................................

B – Insurer’s Expert Report Documents Critiqued..............................................................................

B1 - Sample structural engineer report critiqued and correspondence (13 pages)......................................

B2 - Sample mold engineer report rejected by Insurer (8 pages).............................................................

B3 - Sample mold engineer report critiqued (30 pages)..........................................................................

C – Proof of Loss and Release Forms Critiqued.................................................................................

C1 – Proof  of Loss Forms with Releases incorporated on one paper, deceptive practice (8 pages)..............

C2 – Proof of Loss form with no release................................................................................................

D – Declaratory Relief Actions Critiqued............................................................................................

D - 1 Sample Declaratory Relief action used properly (3 pages)...............................................................

D - 2 Sample Declaratory Relief action used improperly by insurer (7 pages)...........................................

D - 3 Sample attorney “set up” letter to insurer for Declaratory Relief (10 pages).....................................


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