If you’ve ever filed a claim, you know how easy the first step can be (like simply call an 800 number).  What you may not know is how crucial your initial responses can be when you file your report. The details of how you file a claim, like the exact date of loss and how you describe it, can play a crucial role in whether it gets approved or denied.  For example, the difference between an act of god loss and a personal damage loss can have a major impact on whether your  premium is raised or not. That’s why our service goes beyond just helping you file your claim. We’ll also be there to assist you during the initial inspection with the adjuster and review the damages with them to ensure a higher chance of approval. Often, an insurance company will deny the claim outright, or only approve part of it.  This is where mutual will fight for you to make sure you get your property restored to pre-loss condition

Policy Limits: Every insurance policy has coverage limits. If the cost of your claim exceeds these limits, the insurance company will only pay up to that limit.

Deductibles: All insurance policies include a deductible, which is the amount you need to pay out of pocket before the insurance kicks in. If the cost of your claim is close to or less than your deductible, you may see little to no payment from your insurance company.

Depreciation: Typically Some insurance policies pay out the actual cash value (ACV) of an item, which includes depreciation. This means that an item’s value is determined not by what it would cost to replace new, but by its current, potentially depreciated, value. So you won’t get the full replacement value up front (paperwork will have to be filed after the work is completed to receive this, and Mutual can help with that). 

Policy Exclusions: Each insurance policy has certain exclusions. If your claim falls under any of these exclusions, your insurance company is not obligated to pay you.

Incomplete Documentation: Insurers often require detailed documentation of damage and If your documentation is lacking or incomplete, the insurance company may reduce the payout.

Misinterpretation or Disagreement of Policy Terms: Insurance policies can be complex, and there may be disagreement or misunderstanding about what is covered.  You may need the help of a Public Adjuster to assist with this, and Mutual can bring one in as needed.

Here at Mutual Claim Service we understand that coming up with your deductible payment right away might not be possible.  We offer a no credit check, interest-free financing program, with affordable monthly payments of $50 to $100 per month. So keep in mind that when the deductible isn’t paid, that’s not only illegal in Texas, but also increases the likelihood of the contractor taking shortcuts to cover the costs. Visit TDI.gov to learn more about protecting yourself.

Usually this doesn’t affect your claim at all.  What’s important to bear in mind is that an insurance company is responsible for a loss that occurred when a policy was in force, even if you have since switched companies.    So if you recently changed companies, but damage occurred due to a storm event that happened when you were with the prior company, you can file under that company.  And if you want to switch companies in the near future, the same principle applies, so feel free to do so.  This is no way reduces the responsibility of your prior company to cover a loss that occurred when you were with them.

This can happen for several reasons:

Partial Denial: The insurance company might have decided that some of the damage was due to reasons not covered by your policy, like normal wear and tear, or a maintenance issue.

Disagreement on the cost of repair: The insurer’s estimate for the cost of repair or replacement may be lower than your contractor’s estimate. This is quite common in insurance claims. Policy Limits: Your policy has a maximum limit that the insurer will pay for a certain type of claim. If the cost of the damages exceeds these limits, the insurance company will only pay up to that limit. Depreciation: If your policy pays on an actual cash value (ACV) basis, it may account for depreciation. That means the payout is for what the item was worth at the time of the loss, not the cost to replace it new. Deductible: Your policy likely has a deductible, which is the amount you have to pay out-of-pocket before the insurance coverage begins. The insurer deducts this amount from the total claim payout.

Even if some time has passed, it’s still worth exploring your options. In general, it’s best to act quickly after a claim denial to ensure that you have the full range of options available to contest it, but as long as the damage occurred within the last two years, we still have time.

If you dispute a claim, it does not directly cause your premiums to increase because challenging a decision made by the insurance company does not inherently make you a higher risk to insure. So, simply fighting a claim will not be the cause of a premium increase. If the damage was not your direct fault but due to an act of nature (like a storm), your premium will not increase. However, whether you file a claim or not, in general ALL premiums are going up across the board in Texas due to the two recent historic freezes.

Some contractors might advertise that they can “absorb,” “waive,” or “offset” your insurance deductible. Here’s how they might propose to do that:

Inflating the Repair Estimate: The contractor might increase the cost of their repair services to cover the amount of your deductible. This way, it appears to the insurance company that you’ve paid the deductible when in reality, the contractor has increased their prices to cover that cost.

Omitting certain work: The contractor may skip doing some work in the estimate to offset all or part of the deductible.

However, both of these practices are considered insurance fraud in many jurisdictions and can lead to serious consequences. As of September 1, 2019, Texas law (House Bill 2102) makes it clear that it’s illegal for a contractor or roofer to waive an insurance deductible.