How Insurance Companies Delay or Deny Legitimate Claims - What You Can Do About It
When disaster strikes, whether it’s a hurricane, pipe burst, roof leak, or fire…the last thing you expect is for your insurance company to give you the runaround. After all, you’ve paid your premiums for years. So why are they stalling, lowballing, or outright denying your claim?
At VIP Adjusting, we’ve seen behind the curtain. We know how carriers operate. And we know how to fight back.
In this article, we’ll expose 7 common delay and denial tactics used by insurance companies, and how you can protect yourself and your property.
1. The “We Need More Documentation” Loop
Why they do it:
Insurance carriers often ask for documentation in stages, drip-feeding their requests over weeks or even months. This tactic is meant to delay your claim long enough that statutes of limitation, proof-of-loss deadlines, or policyholder patience run out.
How it works:
You submit an invoice. Two weeks later, they ask for moisture readings. Then photos. Then another contractor’s opinion. Then sworn statements. Before you know it, 60+ days have passed, and they still haven’t made a coverage decision.
What to do:
Respond promptly but track all correspondence.
Keep a timeline of requests vs. your responses.
Engage a Public Adjuster early. We can cut through delay tactics and ensure your documentation hits every mark the first time.
2. Misapplying the EMS Cap
Why they do it:
Many policies have a $3,000 Emergency Mitigation Services (EMS) cap. Carriers wrongly apply the cap to entire mitigation bills, even though most of the bill (like demolition and mold remediation) belongs under Coverage A and not the EMS Cap.
How it works:
A $20,000 invoice is chopped to $3,000, citing “EMS limits.” The rest is denied unless challenged.
What to do:
Ensure your mitigation company provides separate invoices (EMS, Mold, Restoration).
Hire a Public Adjuster to challenge misallocation and enforce full policy terms.
3. Blaming Pre-Existing Damage or Wear & Tear
Why they do it:
Carriers may use this as a blanket excuse to avoid payment. “That roof was old.” “The crack was already there.” “It’s wear and tear, not storm damage.”
How it works:
It’s been publicly exposed that some insurance companies send engineers or field adjuster with marching orders to downplay storm impact.
What to do:
Provide pre-loss photos (if available).
Request a second opinion or hire an independent engineer.
Your Public Adjuster can counter their findings with real evidence and expert support.
4. Using Biased Vendors or Engineers
Why they do it:
Many insurers use preferred vendors or third-party engineers who know exactly what the carrier wants to hear.
How it works:
Their “expert” minimizes damage, says no opening was caused by wind, or blames you for the loss. This gives them cover to underpay or deny.
What to do:
Always request a copy of the engineer report.
Don’t be afraid to challenge it with your own licensed engineer or adjuster inspection.
VIP Adjusting partners with unbiased, certified experts.
5. Delaying Coverage Determination
Why they do it:
Florida law requires a coverage decision in a “reasonable” time, but there’s wiggle room. Carriers take advantage by dragging their feet, especially on large or complex claims.
How it works:
You’re told, “We’re still reviewing,” or “It’s under further investigation.” Meanwhile, your rebuild is stalled.
What to do:
Know your Florida rights under §627.70131: insurers must acknowledge receipt in 7 days and decide coverage within 60 days (with few exceptions).
A Public Adjuster can file complaints, demand action, and escalate delays by holding the insurance companies feet to the fire.
6. Lowballing the Estimate
Why they do it:
It’s cheaper. Simple as that.
How it works:
They send you a check for $6,000 when you need $60,000 to rebuild. They hope you’ll take it and walk away.
What to do:
Get your own Public Adjuster to advocate on your behalf. They will present an appropriate estimate via Xactimate (estimating software)
Submit a dispute or invoke Appraisal Clause if applicable.
Don’t cash that check without understanding your rights.
7. Offering “Managed Repair” or Their Own Contractors
Why they do it:
Some policies allow insurers to repair the damage using their preferred contractors, but these contractors often cut corners, use cheap materials, or ignore code upgrades. It saves the insurance company money because they can control the cost and scope.
How it works:
You’re told you must use their vendor, or you won’t be covered.
What to do:
Know your policy language. Most managed repair clauses have exceptions.
A Public Adjuster can help you opt out and preserve your right to choose your contractor.
Always get a second quote.
🛑 The Bottom Line
Insurance companies are for-profit businesses. Their unofficial goal is to pay as little as possible, not what’s fair.
You paid your premium. You deserve full, timely compensation…not stalling, confusion, or manipulation.
That’s why VIP Adjusting exists. We represent you, not the insurer. We break through the red tape, fight back against unfair practices, and maximize your settlement.
✅ What You Can Do Today
Don’t delay—call us early in the claim process.
If you’ve already filed and feel stuck, we can still help.
Reach out for a free claim review.
📞 Call: 833-WITH-VIP
📧 Email: info@vipadjusting.com
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