If the Claim Is Denied
A denial is a decision, and the state says it has to come with a reason.
The Department says denials must cite policy language, and that you should file a claim if you have a good-faith basis to believe the policy covers the loss (NYS Department of Financial Services). If your insurer is hard to reach, it suggests checking your policy for contact details, trying your broker or agent, documenting your attempts, and filing a complaint with the Department if needed (NYS Department of Financial Services).
Disputes About the Cause or the Amount
For a disputed denial or amount, the Department says to review the policy, file a complaint with the Department, and seek legal help (NYS Department of Financial Services).
It describes appraisal as a process in homeowners policies for disagreements about the amount of a loss. Each side selects a competent, disinterested appraiser, the two choose an umpire for unresolved value disputes, and you and the insurer split the costs. The Department says appraisal does not resolve a dispute about what caused the damage (NYS Department of Financial Services). NFIP flood policies have their own appeal process (NYS Department of Financial Services).
Public Adjusters and Attorneys
If you reach an impasse, the Department says you can hire an attorney or a licensed public adjuster. It says public adjusters are licensed by the Department, work for you rather than the insurer, and are paid by the policyholder, with a fee that is negotiable but capped at 12.5 percent of the recovery and owed regardless of the outcome (NYS Department of Financial Services).
- Cancelling. You can cancel a public adjuster contract without penalty until midnight of the third business day after signing (NYS Department of Financial Services).
- Calls. Public adjusters may not solicit business between 6 p.m. and 8 a.m. (NYS Department of Financial Services).
- The insurer’s response. The insurer does not have to accept the adjuster’s figures, but it must settle under the policy terms (NYS Department of Financial Services).
H&H does not recommend any adjuster, attorney or firm, and is not one.
Filing a Complaint With the Department
The Department says you can file a complaint through its website, or call its consumer hotline at (800) 342-3736. It says it can help with insurance questions about agents, brokers, adjusters, claims, deductibles, cancellations, non-renewals and living expenses (NYS Department of Financial Services).
Your Mortgage and the Insurance Check
The Department says to check your loan documents and talk to your bank, because the bank is often named on insurance checks and must usually endorse them. It also suggests asking lenders about disaster recovery programs, keeping records, and getting any agreement in writing (NYS Department of Financial Services).
Where H&H Fits
We work directly with your insurance carrier and provide documentation and direct billing for covered losses. Whether a loss is covered depends on your policy and the cause of the damage, and that is for your insurer, and if you disagree, for the steps above. For the water itself, see water damage restoration.
If mold is a concern, see mold services: on a New York mold project, H&H performs either the mold assessment or the mold remediation — never both on the same project.
H&H is based in Saugerties, in Ulster County, and focuses on eight New York counties. Call and tell us where the property is and what happened, and we will confirm availability.