Insurance companies generally do not pay policies if they determine that covered property has pre-existing damage. The determination of pre-existing damage is made through appraisals and investigations by the insurance company.
Pre-existing damage to insured property does not always mean that insured losses are fully extinguished on the claim. In some cases, the insurance company may only deny the part of the claim that has to do with what the insurance company considers to be pre-existing conditions. however, this may only be a small fraction of the loss suffered by the insured person.
however, just because the insurance company denies a claim due to pre-existing damage doesn’t mean you can’t contest the finding. The insurance company’s definition of pre-existing damage can be questioned, as well as the type of damage that is included in a pre-existing damage exclusion clause in the policy. The insurance company’s denial can also be a tactic to delay or deny a claim, or as a tactic to force the insured to settle for less than the amount that could have been paid under the policy.
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Property owners, who have sustained damage to insured property and then attempt to make an insurance claim on the same property, may have a more difficult time proving that the damage is not pre-existing. For example, if John owns a house with an attached garage and part of the garage burns down in a fire. John makes an insurance claim on him to repair the garage. if he doesn’t completely repair the garage, or doesn’t repair the garage to the condition it was in before, it could affect the amount he gets back if the garage is destroyed in another accident.
Property owners must also take steps to ensure that the property is well maintained and that all repairs and maintenance records are kept. this can help counter an insurance company’s denial based on the condition of the property. it can also help counter an insurance company’s investigative conclusions about the nature of any pre-existing property damage.
It also helps if an insured person routinely takes photographs of the property to document the condition of the property before the damage.
A denial of an insurance claim based on pre-existing damage is also possible based on fraud. This happens when the insurance company claims that the insured person is knowingly making a false claim about the nature of the damage suffered. If a person knowingly makes a false claim for pre-existing damages in order to receive insurance benefits, it is insurance fraud and is a criminal offense in Pennsylvania.
contact us for legal advice
If you have suffered a property loss and your insurance company denies your claim based on pre-existing damage, do not accept the denial or an amount less than the policy allows before speaking with an experienced attorney about how you can fight the claim. denial contact luis s. schwartz and his team at consumerlaw pa.com for more information.