Insurance claim basics

Quick-reference summaries of the statutes and doctrines that protect homeowners. None of this is legal advice; it's a starting point so you can have a better conversation with your insurer or your attorney.

Insurer must acknowledge your claim
State prompt-payment statutes (e.g., Cal. Ins. Code §790.03, N.Y. Ins. Law §2601)

Once you tell your insurer about the loss, the clock starts. DenialAI calculates the exact deadline for your state and alerts you the moment one is missed.

  • typicalDays: 15
Insurer must decide within a statutory window
State prompt-payment statutes

The insurer doesn't get to investigate forever. Once they have everything they need, the law gives them a fixed window to decide. DenialAI tracks the clock from the day you submit your proof of loss.

Insurer must pay accepted claims quickly
State prompt-payment statutes

An acceptance letter without a check is not compliance. DenialAI flags gaps between acceptance dates and payment dates and calculates statutory penalties when the insurer is late.

Statutory interest and penalties for late payment
State insurance codes (varies by state)

When your insurer drags their feet, the meter is running. DenialAI calculates the statutory interest owed based on your state's rate, the amount unpaid, and the number of days past the deadline.

Misrepresenting what your policy covers
State unfair claims practices acts (modeled on NAIC Model Act §4)

If the adjuster tells you something is excluded but your policy says otherwise, that's a violation. DenialAI cross-references their denial language against your actual policy text and flags contradictions.

Failure to attempt a fair settlement
State unfair claims practices acts

Lowball offers aren't just frustrating. They're often illegal. DenialAI compares the adjuster's scope of loss against independent damage assessment and contractor estimates to quantify the gap and flag potential bad faith.

Failure to explain a denial
State unfair claims practices acts

A vague denial letter isn't enough. The insurer must connect specific policy provisions to the facts of your claim. DenialAI drafts rebuttals that demand the explanation they owe you.

Denial without reasonable investigation
State unfair claims practices acts

If they denied your claim after one quick look, that's a problem. DenialAI helps you document what a reasonable investigation should look like: with photo inventories, scope-of-loss comparisons, and contractor estimates the adjuster should have considered.

Common-law duty of good faith and fair dealing
State common law (recognized in most jurisdictions)

Beyond the written statutes, courts in most states recognize an implied duty of good faith. If your insurer's conduct is unreasonable, even if they technically comply with deadlines, you may have a claim. DenialAI surfaces the pattern so you can discuss it with an attorney.

Statute of limitations on insurance claims
State civil practice codes

The clock is running from the date your insurer denied or underpaid your claim. DenialAI calculates your state's deadlines and warns you well before they expire, so you never lose your right to pursue what you're owed.

Policy appraisal procedure
Standard HO-3 / ISO homeowners policy forms

If you and the insurer agree on coverage but disagree on the dollar amount, you don't have to sue. You can invoke the appraisal clause. It's faster, cheaper, and already in your policy. DenialAI helps you decide when to demand appraisal and drafts the demand letter.

Matching of materials
General insurance principle (recognized in most states)

If your adjuster specs 'repair 3 shingles' but the rest of your roof is discontinued, you're owed a full replacement so the materials match. DenialAI calls this out in the damage assessment gap analysis so you have an argument ready.

Public adjusters: your hired advocate
State insurance codes

A public adjuster is the only professional who can negotiate your claim on your behalf. DenialAI helps you match with licensed, vetted public adjusters in your region when your claim needs an expert on the ground.

When to involve an attorney
State bar associations

DenialAI tracks when your claim crosses thresholds where an attorney makes sense, and can connect you with vetted lawyers in your state who specialize in insurance disputes against your specific carrier.

Need help applying these to a specific situation? Start a free claim review.