When property damage strikes, filing a first-party insurance claim can be the key to recovering your losses.
A first-party insurance claim is filed by a policyholder directly with their own insurance company. It allows you to seek compensation for covered damages. This typically applies to real property, such as a home or business, and is commonly pursued after events like roof damage caused by high winds or hailstorms.
However, attempting to go through the process alone can be complicated. You need an experienced attorney to help you understand the process, protect your interests, and make sure you get back on track faster.
At SJP Sifers Jensen Palmer, we can guide you through this process and help you overcome any challenges you’re likely to face. Our experienced attorneys work with clients throughout Kansas City and Springfield, Missouri, Kansas, Arkansas, Texas and New Mexico.
An Overview of First-Party Insurance Claims:
First-party insurance claims arise when a policyholder seeks compensation from their own insurance provider for a covered loss. These claims differ from third-party claims, where another party’s insurance is responsible for damages. Common first-party claims include:
Property damage from storms, fires, or vandalism
Business interruption due to unforeseen events
Water damage caused by plumbing failures or natural disasters
Since policyholders deal directly with their own insurer, they need to understand the terms of the policy and the obligations involved.
A detailed review of the insurance policy is the first step when preparing to file a claim. Your policy will specify the types of losses covered, coverage limits, exclusions, and deadlines for filing. Understanding these details helps set realistic expectations and avoids misunderstandings about what the policy covers.
Paying close attention to exclusions and conditions can prevent surprises during the claims process. If a policy includes additional endorsements or riders, reviewing those terms can clarify the extent of coverage available.
Comprehensive documentation is critical when filing a first-party insurance claim. Accurate records demonstrate the extent of the damage and support the valuation of the loss. Policyholders should document the damage by:
Taking photographs and videos from multiple angles
Creating a detailed inventory of damaged or lost items
Retaining receipts and invoices related to repairs or replacements
Maintaining a timeline of events, including when the damage occurred and when it was reported, can also help strengthen the claim.
Prompt notification to the insurance company is a key step in the claims process. Most policies require policyholders to report damage within a specific timeframe. Delaying notification can jeopardize the claim or limit the amount of compensation available.
When notifying the insurer, it’s important to provide a clear and concise description of the damage. Including preliminary documentation can help initiate the claims process more smoothly.
After a claim is filed, the insurance company assigns an adjuster to assess the damage and determine the value of the claim. The adjuster’s evaluation plays a significant role in how much compensation the policyholder receives. To facilitate this process, policyholders should:
Be present during the inspection to answer questions
Provide all necessary documentation to support the claim
Point out areas of concern that may not be immediately visible
Being proactive during the adjuster’s visit can help make sure that all damage is accurately documented and considered in the claim.
Insurance companies often provide an initial settlement offer after assessing the damage. While this offer may seem reasonable, it’s important to evaluate whether it fully accounts for the loss.
Policyholders should compare the offer to their own assessment of the damage and consider whether additional compensation may be warranted.
If the initial offer appears inadequate, requesting a detailed explanation of how the amount was calculated can help identify potential discrepancies.
When disagreements arise over the value of a claim, seeking a second opinion may be beneficial. Independent appraisers or contractors can provide a fresh perspective on the extent of the damage and the estimated cost of repairs. This information can be used to negotiate a fair settlement with the insurance company.
In some cases, policyholders may invoke the appraisal clause in their policy to resolve disputes over the value of a claim. This process involves hiring independent appraisers to determine the appropriate compensation.
Insurance policies often contain limitations and exclusions that impact the amount of compensation available. Policyholders should review these provisions carefully to understand what is covered and what isn’t. For example, standard policies may exclude certain types of water damage or limit coverage for high-value items.
Understanding these limitations can help policyholders determine whether they need to pursue additional endorsements or riders to fill gaps in coverage.
Most insurance policies require policyholders to take reasonable steps to prevent further damage after a loss occurs. Failing to mitigate additional damage can reduce the amount of compensation available. Actions to mitigate damage may include:
Covering exposed areas to prevent water intrusion
Removing damaged materials to prevent mold growth
Temporarily securing property to protect against theft
Documenting these efforts can demonstrate compliance with policy requirements and support the claim.
Negotiating with an insurance company may be necessary when the initial settlement offer doesn’t adequately cover the loss. Policyholders can strengthen their negotiating position by:
Presenting detailed documentation of the damage
Providing independent assessments of repair costs
Citing relevant policy provisions to justify the claim
Remaining persistent and advocating for fair compensation can improve the likelihood of achieving a satisfactory outcome.
Filing a first-party insurance claim involves several steps, and missteps can weaken the claim. Common pitfalls include:
Failing to report damage within the required timeframe
Accepting a settlement offer without fully evaluating the loss
Neglecting to document damage and mitigation efforts
Overlooking policy exclusions and limitations
Being mindful of these issues can help policyholders protect their interests and avoid complications.
Staying informed about the status of a claim helps policyholders respond to requests from the insurance company and address any concerns that arise. Maintaining open communication and requesting regular updates can help keep the process on track.
Reviewing correspondence and documents carefully keeps policyholders aware of their rights and obligations.
Before accepting a settlement, policyholders should review the agreement carefully to confirm that it reflects the terms discussed and provides appropriate compensation. Accepting a settlement often releases the insurer from further liability, so it’s important to be certain that the amount offered fully accounts for the loss.
If any terms in the agreement seem unclear, seeking legal advice can help clarify the implications before signing.
When disputes over claim value or coverage arise, alternative dispute resolution methods may offer a path to resolution. Mediation or arbitration can provide an opportunity for both parties to present their perspectives and work toward a mutually acceptable outcome. These processes can sometimes lead to quicker resolutions than formal litigation.
Insurance companies have a duty to act in good faith when handling claims. When an insurer denies a valid claim or delays payment without justification, policyholders may have grounds for a bad faith claim. Pursuing a bad faith claim can result in compensation for damages beyond the original claim amount.
After resolving a first-party insurance claim, policyholders should take steps to protect their interests moving forward. Regularly reviewing insurance policies, updating coverage as needed, and maintaining accurate records can help prevent disputes and make sure that adequate protection is in place for future events.
Filing first-party insurance claims can be a critical step in recovering from property damage or business interruption. SJP Law Firm, LLC serves clients in Kansas City and Springfield, Missouri, Kansas, Arkansas, Texas and New Mexico. Our dedicated attorneys advocate with integrity, putting your best interests first. Allow us to guide you through your legal journey with care and attention. Call today to learn how we can help with your insurance claims.
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