Thanks to effective claims management, my client’s profits remained intact, and we successfully avoided legal action and payment deductions.
Insurance companies have strict time frames for claims submission and appeals, making it critical to fully understand your policy. I recently helped a subcontractor client successfully overturn a denied general liability claim that could have cost them $250,000.
My client suffered a property loss while a building was under construction. Unfortunately, heavy rain only worsened the situation. The general contractor, already behind schedule, didn’t want to wait for the insurance payout and chose to cover the loss out of pocket. Nearly a year after the project’s completion, the general contractor billed my client $250,000 for the damages.
When my client submitted this bill to the insurance company, the claim was denied due to late notification and failure to properly inform the carrier of the incident. Adding to the problem, my client hadn't provided a full account of the situation, making the denial seem final.
Devastated at the thought of paying the $250,000 out of pocket, my client reached out to me for help. I immediately got to work, appealing the denial. I gathered all the necessary documentation—photos, emails, invoices, and subcontractor details—and constructed a compelling five-page narrative explaining why the claim should be accepted.
I emphasized that both my client and the general contractor acted in good faith to avoid legal disputes, which would have been detrimental for everyone involved. Most importantly, I pointed out a key clause in the policy that directly challenged the insurance company's denial.
After a 7-month process, the insurance company overturned their decision and issued a check for $200,000 (general liability policies often exclude labor costs). My client paid only their $5,000 deductible, and the general contractor received the remaining $200,000. Thanks to effective claims management, my client’s profits remained intact, and we successfully avoided legal action and payment deductions.
This case showcases the importance of understanding policy details, acting promptly, and knowing how to advocate for your clients. My expertise in claims management saved my client from a significant financial hit, and we successfully secured the coverage they were entitled to.
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