Start with the reason given
A denial letter should identify the ground the insurer relies on, and that ground defines the dispute. Common reasons include a policy exclusion, a position that the loss is not the kind of event the policy covers, an argument that notice came too late, or an allegation that the application contained a misstatement. Each is analyzed differently, and some depend heavily on the exact wording of the policy and its endorsements. A denial based on a factual disagreement, such as the cause of damage, calls for evidence, while one based on policy language calls for close reading. If you do not have a complete copy of the policy, including the declarations page and endorsements, request one in writing.
What to keep and what to ask for
Keep the denial letter, every message exchanged with the adjuster, photographs, repair estimates, receipts, and the reports the insurer cited. You can ask the insurer for copies of inspection or engineering reports it relied on, though what it must provide depends on the type of insurance. Many policies contain their own deadline for filing a lawsuit, which can be shorter than the general limitations period and may keep running while you are still corresponding with the adjuster. Some policies also provide for an internal appeal, or for appraisal when the disagreement is only about the amount of the loss. If calls with the insurer were not documented, a dated summary prepared for your lawyer can help fill the gaps.
Paths after a denial
Some denials are reconsidered after the insurer receives additional information or a written response that addresses the stated ground directly. In New York, a policyholder can also file a complaint with the Department of Financial Services, which regulates insurers, although the department does not resolve coverage disputes the way a court does. When those steps do not resolve it, the main legal path is usually a claim for breach of the insurance contract. New York is more restrictive than some states about separate bad faith claims against your own insurer, so the contract claim tends to carry the case. In a first review we read the policy against the denial, find the suit deadline, and discuss which path fits the size of the loss.
