What the denial letter must tell you

Missouri has claim rules for insurers. One says an insurer cannot deny a claim based on a policy provision, condition or exclusion unless the denial refers to it. The denial must be in writing (20 CSR 100-1.050).

So your letter should name the part of the policy the insurer relied on. It may quote an exclusion. It may say you missed a condition, such as late notice. If the letter gives no reason you can match to the policy, write back and ask for one.

Common reasons property claims are denied

Some denials are correct. Others rest on a reading of the facts or the policy that can be questioned. These are the reasons that come up most:

• An exclusion. Examples are flood, earth movement, mold, or wear and tear. Exclusions often have exceptions. The wording matters.
• Old damage. The insurer says the damage was there before the storm or leak.
• Slow damage. The insurer says a leak or rot happened over time, not all at once. See water damage claims.
• Late notice. The insurer says you reported the loss too late.
• Missing paperwork. The insurer says you did not send a proof of loss or other forms.
• Misstatements. The insurer says something in the application or claim was untrue.

Each reason calls for different proof. Old damage and slow damage are often questions for a roofer, plumber or engineer. Late notice may turn on when you first knew about the loss.

Steps to challenge a denial

1. Get the full policy, including the declarations page and every endorsement. An endorsement is a page that changes the main policy.
2. Match the denial reason to the policy words. Note any exceptions to the exclusion.
3. Gather proof: dated photos, weather reports for storm dates, repair bills, and your own contractor’s written opinion.
4. Write to the insurer. Ask it to reconsider, and send the new proof. Keep a copy.
5. If that fails, consider a complaint to the Missouri Department of Commerce and Insurance.
6. If the insurer still refuses, a lawsuit on the policy may be the next step.

Before a lawsuit, Missouri’s penalty law requires a written demand for payment. The insurer then has 30 days. The vexatious refusal guide explains how that works.

What a state complaint can and cannot do

The Department of Commerce and Insurance takes complaints online, by mail, by fax, or through its Insurance Consumer Hotline at 800-726-7390. It can send your complaint to the insurer and require a response. It then reviews that response under Missouri insurance law.

The Department also lists what it cannot do. It cannot act as your lawyer. It cannot decide the facts of your claim. It cannot decide the value of your claim or how much you are owed. For those questions, the answer comes from the insurer, from appraisal, or from a court.

Deadlines after a denial

A denial does not end your rights. In Missouri, a suit on a contract generally must be filed within five years (RSMo 516.120). Some suits on a written promise to pay money have ten years (RSMo 516.110). Which one applies, and when the clock starts, depends on the facts.

Many policies say you must sue within one or two years. But a Missouri statute says contract terms that limit the time to sue are void (RSMo 431.030). Other policy duties, like giving notice and sending a proof of loss, are separate. Keep meeting them.

Harjot Singh Padda, JD can read the denial with you and explain which deadlines apply to your claim.

Common questions

Related reading

• Property insurance claims overview
• Missouri vexatious refusal law
• Insurance bad faith and coverage disputes
• Breach of contract claims