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Can My Home Owners Insurance Agent Deny My Claim Without Presenting To The Insurance Company?

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Can My Home Owners Insurance Agent Deny My Claim Without Presenting To The Insurance Company?

Postby Kelle » Mon Jan 19, 2015 9:52 pm

I made a claim via email and phone to my agent and he first said I was coverfed and then two days later he in an email that my homeowner's policy didn't cover that peril.
I checked with my Insurance company later and they said I never made a claim.
Is it legal for an agent to deny my claim without submitting it to the company?
Kelle
 
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Can My Home Owners Insurance Agent Deny My Claim Without Presenting To The Insurance Company?

Postby Donovan » Thu Jan 22, 2015 9:19 am

Laws vary by state.
You agent should have put in the claim and let the claims department tell you if your issue is covered or not.


Agents walk a fine line in not putting in a claim.
Sometimes they try to advise customers about the issues involved that may make putting in a claim a bad idea, such as how much your deductible is and you loose a claims free discount, ect.


But it is always the customers choice to put in a claim or not and not the agents.
Agents are not suppose to tell customers not to put in a claim or advise against it.
However, I think it is important that customers have ALL the information in deciding whether to put in a claim and then the customer can make an educated choice.
But it is always the customers choice.

But agents walk a fine line when trying to help a customer too.
Donovan
 
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Can My Home Owners Insurance Agent Deny My Claim Without Presenting To The Insurance Company?

Postby bartolome34 » Thu Jan 22, 2015 7:41 pm

No.
Ethically, he's bound to forward every claim you report to him, to the insurance company.
Yes, I've known agents that do this anyway.

Do you still have that email? You need to forward it to your state insurance commissioner, with a formal complaint.
Especially if it turns out that it IS a covered claim.

And, obviously, when your policy renews, you need to move it to a different agent.
bartolome34
 
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Can My Home Owners Insurance Agent Deny My Claim Without Presenting To The Insurance Company?

Postby Atagulkalu » Fri Jan 23, 2015 12:04 am

The agent can offer broad and general advice when it comes to coverage.

For example, if you called and asked your agent if fire damage was covered. The agent could respond, "Fire is a listed peril on your policy, subject to the terms and conditions." But the agent can not make a claims decision based on what happened to your property. Only the company can determine if there is coverage.

Call your insurance company and submit a first notice of loss and have them investigate if there is coverage. Worst case scenario, it isn't covered. But, at least you'll know for sure.
Atagulkalu
 
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Can My Home Owners Insurance Agent Deny My Claim Without Presenting To The Insurance Company?

Postby Jasmin » Fri Jan 23, 2015 7:02 am

What your agent did is unethical at least and may be illegal at worst depending on your state laws and Fair Claim Practices Act.

I assume you reported the claim to the insurance company. The agent had no business not turning the claim. It's OK for them to tell you that it likely won't be covered but they still have to turn the claim in.

After your claim is resolved with the company whether they pay you or not you need to dump this agent.
Jasmin
 
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Can My Home Owners Insurance Agent Deny My Claim Without Presenting To The Insurance Company?

Postby Tristyn » Mon Jan 26, 2015 3:05 am

David,

Just call your agent back and tell him you want the claim submitted to the company. He is probably right but if you insist he will certainly submit so you can have your claim denied by the company.
Tristyn
 
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Joined: Wed Jan 15, 2014 7:09 am


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