Why Was My Property Insurance Claim Was Denied Due to Pre-Existing Damage?

Discovering that your property insurance claim has been denied due to pre-existing damage can be frustrating and confusing. Insurance companies frequently use this reason to avoid paying legitimate claims, but understanding your rights and the law can help you challenge an unfair denial.

What Is Considered Pre-Existing Damage?

Pre-existing damage refers to any damage to your property that existed before the event that triggered your current insurance claim. This could include:

• Old roof damage from previous storms
• Existing cracks in walls or foundations
• Previously damaged plumbing or electrical systems
• Water damage from past leaks
• Structural issues that developed over time

Insurance companies are only obligated to cover new damage caused by covered perils listed in your policy, not damage that existed before you filed your claim.

Why Do Insurance Companies Deny Claims for Pre-Existing Damage?

Insurance carriers deny claims citing pre-existing damage for several reasons:

Cost Reduction: Denying claims based on pre-existing conditions helps insurers minimize payouts and protect their bottom line.

Policy Exclusions: Most homeowners’ insurance policies explicitly exclude coverage for wear and tear, deterioration, or damage that occurred before the policy’s effective date or the covered event.

Lack of Maintenance: Insurers may argue that pre-existing damage resulted from inadequate property maintenance, which is typically the homeowner’s responsibility.

Ambiguous Damage Assessment: When new damage overlaps with old damage, adjusters may claim they cannot distinguish between the two, leading to claim denials.

How Can I Tell If My Claim Denial Is Legitimate?

Not all claim denials for pre-existing damage are valid.

Consider these factors:

• Documentation Review: Examine your insurance policy carefully to understand what is and isn’t covered. Review the denial letter for specific reasons and policy provisions cited.
• Timing of Damage: If you can prove the damage occurred during the covered event (such as a recent hurricane or fire), the denial may be improper.
• Extent of Overlap: Even if some pre-existing damage exists, new damage from a covered event should still be compensated. Insurance companies cannot deny entire claims simply because minor pre-existing issues were present.
• Evidence Standards: The insurance company must provide evidence that the damage was pre-existing. If their assessment lacks documentation or proof, their denial may be challengeable.

What Evidence Do Insurance Companies Use to Prove Pre-Existing Damage?

Insurance adjusters may rely on various evidence to claim that the damage was pre-existing:

• Previous insurance claims filed on the property
• Property inspection reports from before the loss
• Satellite imagery showing roof or structural conditions
• Maintenance records indicating neglect
• Expert opinions from their engineers or contractors
• Photos from real estate listings or assessments

Can I Challenge a Claim Denial for Pre-Existing Damage?

Yes, you can and should challenge a denial if you believe it’s unfair.

Here’s how:

• Document Everything: Take detailed photos and videos of all damage immediately after the covered event. Gather any maintenance records, previous inspection reports, or documentation showing your property’s condition.
• Get an Independent Assessment: Hire your own public adjuster or contractor to assess the damage and provide an expert opinion distinguishing new damage from any pre-existing conditions.
• Review Your Policy: Ensure you understand your coverage, exclusions, and the insurance company’s obligations under your contract.
• File an Appeal: Most insurance companies have a formal appeals process. Submit your appeal with supporting documentation within the timeframe specified in your denial letter.
• Seek Legal Representation: Contact Williams Law Association, P.A.’s expert property insurance attorneys who can evaluate your claim, negotiate with the insurer, and file a lawsuit if necessary.

What Can Williams Law Association, P.A. Do to Help?

At Williams Law Association, P.A., we specialize in fighting wrongful insurance claim denials.

Our attorneys can:

• Review your insurance policy and denial letter
• Investigate the true cause and extent of your property damage
• Hire independent experts to document covered damage
• Negotiate with insurance companies on your behalf
• File a lawsuit if the insurer refuses to pay a valid claim
• Pursue bad faith claims when insurers act unreasonably

We work on a contingency fee basis for most property insurance claims, meaning you don’t pay attorney fees unless we recover compensation for you.