Can Your Insurance Claim Be Denied for Pre-Existing Damage?

Have you filed an insurance claim only to receive a denial or a shockingly low settlement offer because of “pre-existing damage?” You’re not alone. Every year, thousands of Florida property owners have justified insurance claims underpaid or denied because their insurers claim the problems facing their property existed before the event that triggered the claim. 

If that sounds familiar, you still have options for pursuing the compensation you need to repair your property. The first step is to understand how pre-existing damage is handled by most insurance policies.

Is Pre-Existing Damage Covered by Insurance?

No, pre-existing damage is not typically covered by insurance policies. Almost all policies include a clause that excludes it from coverage should the policyholder make a claim. 

On the face of the matter, this makes sense for all parties. By excluding extant problems, insurers prevent property owners from getting policies after a structure has already received damage and then demanding coverage. This allows them to offer lower prices than they could otherwise benefit consumers. 

Furthermore, if a property has been insured from the moment it was constructed, there should be no damage significant enough to require external financial assistance to repair. Owners are expected to account for routine, expected maintenance like updating roofs, appliances, and flooring when they decide to purchase a home or commercial building

However, once pre-existing damage exclusions were introduced, unscrupulous insurers began using them to deny claims that would otherwise be covered. These insurance companies may argue that a problem was pre-existing when it was not to reduce the amount they must pay. If this occurs, you are responsible for seeking a second opinion to receive the coverage you’re due.

How Is Pre-Existing Damage Defined?

Several types of pre-existing damage may be present on your property. These include:

  • Damage your property suffered before you purchased your insurance policy. This is never covered because standard policies only apply to events after the purchase date.
  • Degradation that was caused by natural wear and tear during daily use. This is not covered because it is an expected part of property ownership. 
  • Problems caused by a lack of maintenance or another failure to reasonably protect property from harm. These are usually not covered because the issues are seen as your fault rather than that of a third party or natural events. 

Each of these issues can lead to insurers denying your claim when it would otherwise be covered. Examples may include:

  • Carpets that are stained or damaged by spilled drinks and regular use.
  • A roof that needs replacement because it has reached its expected 25-year lifespan.
  • Unnoticed water damage from a leak that occurred before buying the policy.
  • A termite infestation that was present when the property was purchased.
  • Water damage caused by missing shingles that the owner did not take the time to replace.
  • Destruction was caused by electrical fires because the owner did not bring the wiring up to code. 

These are just a few reasons your insurer may attempt to deny or underpay a claim it should otherwise cover.

Avoiding Pre-Existing Damage Allegations

The best time to prepare for an insurance claim is before the problem happens. By planning ahead, you can reduce the risk of having a claim denied.

The most important thing you can do is document the current condition of your property and any personal belongings within it. Good practices include:

  • Taking pictures of the property’s interior and exterior. Pictures help prove the condition of your living space before disasters strike, helping prove that certain problems were caused by the covered event.
  • Documenting specific problems of which you’re aware. If you know the structure has minor water damage that has already been treated, take detailed pictures and videos of the area to prove what was and was not caused by a future flood. 
  • Keeping receipts for furniture, technology, and other valuables. If an event destroys your personal property, you’ll need receipts or other documentation to prove it existed. 
  • Saving contracts and before-and-after pictures of any renovations. If you raise the quality of the structure, you’ll need to prove that to your insurer before they’ll compensate you for the improvements.
  • Keeping bills for any routine maintenance performed on the structure. Regular maintenance is essential to avoid having claims for faulty HVAC units or other items denied, so keep documents proving you had the maintenance performed.

What to Do If Your Claim is Denied on Grounds of Pre-Existing Damage

Even if you performed your due diligence, some insurers might try to deny your insurance claim unfairly because of alleged pre-existing damage. If this happens, you still have options to pursue full coverage. Here’s how to get started:

  • Consult an Insurance Attorney: Your first step should be to consult a skilled lawyer for your claim. Disputing denials and underpayments is a complex and time-consuming process. Your attorney will handle the communications and negotiations on your behalf and counsel you on the information you need to provide to maximize the likelihood of full coverage.
  • Get a Second Opinion: Some skilled Florida insurance lawyers can act as insurance adjusters and appraisers. Your attorney can inspect the site and give you an unbiased second opinion regarding the damage and what kind of coverage your insurer should offer. 
  • Find Pictures and Evidence: If you documented the condition of your home before the disaster, now is the time to use those pictures. If you did not, you can search through your photos, emails, and other records for incidental pictures demonstrating the condition of your home or property. 

Once you’ve taken these steps, you can file a dispute with your insurer to pursue the compensation you need to repair your property. The Pro Law Group specializes in helping property owners in Miami and throughout Florida seek fair compensation under their insurance policies. Learn more about how we can help you by scheduling your free case review today.

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