Summary. How a first-party policy works, what conditions can forfeit a valid claim, when a denial becomes bad faith, and what that is worth.

Part I: The structural problem

In a third-party liability claim, your insurer is on your side — it defends you and pays a stranger. In a first-party claim, the money comes out of the insurer's pocket and goes into yours. The company that wrote the contract also investigates the facts, interprets its own language, decides the claim, and holds the money until it decides otherwise.

That structure is not a scandal; it is how indemnity insurance necessarily works. But it explains the entire body of law that follows. Courts and legislatures responded to the asymmetry by imposing something beyond ordinary contract duties: an implied covenant of good faith and fair dealing with tort consequences, and statutory unfair claims settlement practices regimes in every state.

The regulatory setting matters too. Insurance is regulated principally by the states, a division Congress ratified in the McCarran-Ferguson Act at 15 U.S.C. § 1012, which provides that federal statutes generally do not preempt state laws enacted to regulate insurance unless they specifically relate to it. That is why the answer to almost every first-party question begins with a state name.

Part II: How to read a property policy

Every property policy has the same anatomy, and reading it in the wrong order is why people misunderstand their coverage.

The declarations page. Named insureds, the property, the policy period, the limits by coverage part, the deductibles, and the endorsements. Read the endorsement list. Endorsements modify the form and frequently take away more than the form gives.

The insuring agreement — the grant. In a homeowners policy, Coverage A (dwelling) and B (other structures) are typically written on an all-risk basis: covered for direct physical loss except as excluded. Coverage C (personal property) is often named peril: covered only for listed causes. Coverage D provides additional living expenses or loss of use.

This distinction decides who bears the burden. Under an all-risk grant, the insured proves a direct physical loss and the insurer bears the burden of proving an exclusion applies. Under a named-peril grant, the insured must prove the loss was caused by a listed peril. Knowing which you have changes how you present the claim.

The exclusions. This is where the policy actually lives. The recurring ones:

  • Flood and surface water — excluded in nearly every homeowners policy, which is why separate flood coverage exists and why the wind-versus-water fight follows every hurricane.
  • Earth movement — earthquake, landslide, subsidence, sinkhole.
  • Wear and tear, deterioration, inherent vice, latent defect.
  • Faulty workmanship, design, or materials — often with an "ensuing loss" exception that restores coverage for a covered peril resulting from the excluded cause.
  • Mold, fungus, and rot, usually with a small sublimit.
  • Neglect — failure to protect property after a loss.
  • Ordinance or law — the cost of complying with a building code when rebuilding, unless a specific coverage is purchased.
  • Intentional acts by an insured.

Anti-concurrent causation. Most modern forms say the excluded perils are excluded "regardless of any other cause or event contributing concurrently or in any sequence to the loss." Read that carefully. It means that if an excluded cause contributes at all, the insurer will argue the entire loss is excluded — even where a covered peril also contributed. States differ on enforceability, and it is the single most litigated sentence in property insurance.

The conditions. Duties after loss, proof of loss, examination under oath, appraisal, suit limitation, and subrogation. Conditions forfeit claims, and they do it to people who have perfectly good coverage.

Part III: What the policy pays

Actual cash value (ACV) — replacement cost less depreciation. A ten-year-old roof pays as a ten-year-old roof.

Replacement cost value (RCV) — the cost to repair or replace with like kind and quality, without depreciation.

And here is the trap that surprises nearly everyone: most replacement cost policies pay actual cash value first and release the depreciation holdback only after the work is actually completed and documented — often within a stated deadline, commonly 180 days or a year.

The consequences are concrete. A homeowner who takes the ACV check and does not rebuild forfeits the holdback. A homeowner who rebuilds but never submits the completion documentation forfeits it too. Millions of dollars go unclaimed this way every year.

Other valuation issues that recur:

  • Matching. If half a roof is damaged and the shingles are discontinued, must the insurer replace the whole roof so it matches? States differ, some by statute or regulation, and "line of sight" rules appear in many policies and adjusting practices.
  • Overhead and profit. Where repairs require a general contractor, a contractor's overhead and profit — commonly around twenty percent — is generally owed as part of replacement cost, and insurers routinely omit it from initial estimates.
  • Depreciation of labor. Whether labor may be depreciated is genuinely contested and answered differently by state.
  • Sublimits. Jewelry, firearms, cash, business property, and electronics carry sublimits far below the personal property limit. Scheduling valuable items is the fix, and it must happen before the loss.
  • Additional living expenses cover the increase in living costs, not the total — the difference between what you normally spend and what you now spend.

Part IV: The conditions that forfeit claims

Prompt notice. Most policies require notice "promptly" or "as soon as practicable." Late notice can defeat a claim, though many states require the insurer to show prejudice from the delay.

Protect the property from further damage. Tarp the roof, extract the water, board the windows. Reasonable emergency expenses are generally reimbursable. Failing to mitigate can forfeit the additional damage.

Do not destroy the evidence. Keep the damaged property, or photograph it exhaustively before disposal. An insurer denied the chance to inspect will say so.

Proof of loss. A sworn statement, usually on the insurer's form, itemizing the loss and its value — commonly due within 60 days of the insurer's request. This is a hard deadline in many states, and a claim can be forfeited for failing to submit a sworn proof of loss even when the loss is plainly covered. If you cannot complete it in time, request an extension in writing and get the agreement in writing.

Examination under oath (EUO). The insurer may require the insured to submit to a recorded, sworn examination, usually conducted by the insurer's lawyer, and to produce documents. Refusal to appear or to produce is a breach of a policy condition and generally defeats the claim. An EUO is not a deposition — there is no judge, the rules of evidence do not apply, and the questioning can be far broader, ranging into finances, prior claims, and personal history.

Take an EUO seriously and bring a lawyer. It is frequently a signal that the insurer is investigating fraud or building a denial, particularly when it follows a claim with any of the classic markers: a recent policy increase, financial distress, a prior loss history, or an unwitnessed fire.

Suit limitation. Many policies shorten the time to sue — commonly to one or two years from the loss. This is enforceable in most states and it is far shorter than the ordinary contract limitations period. It is a leading cause of dead claims.

Part V: Appraisal — the underused off-ramp

Most property policies contain an appraisal clause: if the parties disagree on the amount of loss, either may demand appraisal. Each side appoints an appraiser, the two select an umpire, and an award by any two binds.

What appraisal is good for: valuation disputes. When the insurer says $40,000 and your contractor says $95,000, appraisal resolves it faster and far cheaper than litigation.

What appraisal is not for: coverage disputes. Whether the policy covers the loss at all is generally not an appraisal question, though the line between "amount" and "coverage" blurs constantly — an appraiser who decides that damage was caused by wear rather than wind has effectively decided coverage.

Practical points: demand it in writing citing the clause; choose an appraiser who is competent and genuinely independent (many are contingently compensated, which insurers attack); the umpire usually decides; and an award is difficult to set aside absent fraud or a clear excess of authority.

Part VI: Bad faith

The contract claim is straightforward: the policy covered the loss, the insurer did not pay, and the damages are the benefits owed plus interest.

The bad faith claim is different in kind. In most states, an insurer owes an implied duty of good faith and fair dealing, and breaching it sounds in tort — opening damages beyond the policy limits.

The standard varies but the recurring formulations are: denying a claim without a reasonable basis; knowing there was no reasonable basis or acting in reckless disregard of that fact; and, in some states, unreasonable delay or failure to investigate adequately.

What bad faith looks like in practice:

  • Denying without investigating.
  • Ignoring the insured's evidence while crediting only the insurer's.
  • Retaining an engineer whose report is edited to remove conclusions favoring coverage.
  • Misrepresenting policy provisions or failing to disclose applicable coverage.
  • Unreasonable delay — months of "under review" with no activity.
  • Lowballing with no basis, hoping the insured accepts.
  • Refusing to explain the denial or identify the policy language relied on.
  • Applying an exclusion the insurer knows does not fit.

Statutory unfair claims settlement practices acts exist in every state and enumerate prohibited conduct: misrepresenting policy provisions, failing to acknowledge communications promptly, failing to adopt reasonable standards for investigation, failing to affirm or deny coverage within a reasonable time, and compelling insureds to litigate by offering substantially less than the amount ultimately recovered. Some states allow a private right of action under these statutes; others treat violations only as evidence supporting a common law bad faith claim. Which regime you are in is one of the first things to determine.

Damages for bad faith can include: the policy benefits; consequential damages (the foreclosure that followed the unpaid claim, the business that failed, the mold that spread while the insurer delayed); emotional distress in many states; attorney's fees where a statute provides them; and punitive damages.

Punitive damages have constitutional limits. BMW of North America, Inc. v. Gore established the guideposts: the reprehensibility of the conduct, the ratio between punitive and compensatory damages, and comparable civil or criminal penalties. State Farm Mutual Automobile Insurance Co. v. Campbell — itself an insurance bad faith case — sharpened them, stating that few awards exceeding a single-digit ratio to compensatory damages will satisfy due process, and that a defendant may not be punished for conduct toward non-parties or out-of-state conduct lawful where it occurred.

Part VII: The ERISA hole

If your health, disability, or life insurance comes through an employer, most of this article may not apply to you.

The Employee Retirement Income Security Act preempts state law claims relating to employee benefit plans, and its civil enforcement provision at 29 U.S.C. § 1132 is exclusive. In Pilot Life Insurance Co. v. Dedeaux, the Supreme Court held that state law bad faith claims against an insurer administering an ERISA plan are preempted. No bad faith damages. No punitive damages. No emotional distress. No jury, generally. The remedy is benefits due, and possibly fees.

The saving clause is narrower than it sounds. ERISA saves from preemption state laws that regulate insurance — and Kentucky Association of Health Plans, Inc. v. Miller set the modern two-part test: the law must be specifically directed toward entities engaged in insurance and must substantially affect the risk pooling arrangement. A state law meeting that test can apply to an insured plan — UNUM Life Insurance Co. of America v. Ward upheld California's notice-prejudice rule on that basis — but even a saved law cannot supply a remedy beyond ERISA's exclusive civil enforcement scheme.

The practical consequences are large:

  • Self-funded plans are not "insurance" for saving-clause purposes at all, so state insurance regulation does not reach them.
  • Exhaust the plan's internal appeals, because the administrative record is usually the record on judicial review.
  • Get everything into that record, since courts frequently will not consider evidence outside it.
  • The standard of review may be deferential where the plan grants discretion, making the case far harder.

So the first question in any denied health, disability, or life claim is: is this an ERISA plan? Employer-sponsored generally means yes. Individually purchased, government employee, and church plans are often outside. The answer changes everything. See Appealing a Health Insurance Denial.

Part VIII: Five losses

The hurricane: wind or water?

A coastal home is destroyed. The homeowners policy covers wind and excludes flood; a separate flood policy covers flood with different limits and a different adjuster.

The entire fight is causation, and the anti-concurrent causation clause is the weapon. The wind insurer argues that storm surge — an excluded flood peril — contributed, and that the clause excludes the whole loss "regardless of any other cause contributing concurrently or in any sequence." The flood insurer argues wind did the damage before the water arrived.

What decides these cases:

  • Timing evidence. Weather data showing wind speeds and surge arrival times, hour by hour.
  • Physical evidence. Debris fields, water lines on walls, roof damage patterns, the direction structures fell.
  • Photographs taken before cleanup — which is why the first instruction in every property loss is to photograph everything.
  • An engineer. These cases are won and lost on expert causation opinions, and the insured who waits for the insurer's engineer to be the only expert has already lost.

And a practical note: file with both insurers immediately. Do not let one insurer's position about the other's coverage delay a filing. Each policy has its own notice requirement and its own suit limitation.

The kitchen fire that became an investigation

A fire starts in the kitchen. The insurer's adjuster is pleasant, then the file transfers to a "special investigation unit," and a letter demands a sworn examination under oath, five years of bank statements, tax returns, phone records, and a list of every prior claim.

What is happening. The insurer is investigating arson, exaggeration, or a material misrepresentation in the application. The markers that trigger this are mechanical: recent coverage increase, financial distress, prior claim history, an unwitnessed loss, or a loss shortly after a policy change.

What the insured must do:

  • Appear. Refusing an EUO required by the policy generally forfeits the claim, even a completely legitimate one.
  • Bring a lawyer. An EUO is not a deposition — no judge, no rules of evidence, and questioning far broader than a court would permit.
  • Produce what the policy requires, and object in writing, through counsel, to anything beyond it, rather than simply not producing.
  • Be accurate. A false statement in an EUO can trigger the policy's concealment or fraud condition and void coverage entirely — which is a far worse outcome than a denied claim.

And note the asymmetry. The insurer may take the insured's sworn testimony as a condition of coverage. The insured has no equivalent right before suit. That imbalance is the reason to have counsel present.

The pipe that leaked for eight months

A slow supply line leak under a bathroom floor is discovered when the floor buckles. The insurer denies: the damage resulted from a leak occurring "over a period of weeks, months, or years," which the policy excludes.

Three arguments for the insured:

  1. The exclusion's own words. Many forms exclude continuous or repeated seepage but cover a sudden and accidental discharge. Whether an eight-month leak is one or the other is a factual question about the failure mode — a pinhole that opened suddenly and leaked, versus a fitting that wept from installation.
  2. Ensuing loss. Even where the cause is excluded, many policies restore coverage for a resulting covered loss. The classic application: faulty workmanship is excluded, but the water damage that ensues is covered.
  3. Hidden damage provisions. Many forms cover damage from a leak the insured could not reasonably have known about — and the whole point of a leak under a slab or behind a wall is that it is not observable.

What the insured needs: a plumber's written opinion about the failure mechanism and its likely duration, photographs of the failed component, and the component itself preserved.

The total loss the adjuster valued at half

A house burns. The dwelling limit is $400,000. The adjuster's estimate is $212,000. Three contractors say $390,000 to rebuild.

What is usually missing from a low estimate:

  • General contractor's overhead and profit — commonly around twenty percent where multiple trades are required, and routinely omitted from initial estimates.
  • Code upgrade costs — bringing the rebuild to current code, which requires ordinance or law coverage; check whether it was purchased and at what limit.
  • Debris removal, usually a separate coverage.
  • Realistic local labor and material pricing rather than a national database figure.
  • Matching — replacing undamaged but non-matching materials so the result is uniform.
  • Contents at replacement cost, itemized. Contents claims are almost always understated because the insured cannot remember what they owned. Go room by room from photographs.

The mechanism: demand appraisal. This is a dispute about the amount of loss, which is exactly what the appraisal clause exists for, and it resolves in weeks or months rather than years.

And check for a total-loss or valued-policy statute. Several states require payment of the full policy limit on a total loss of a dwelling, regardless of actual repair cost.

The disability claim denied by the employer's carrier

A software engineer with a degenerative spine condition is denied long-term disability by the insurer administering her employer's plan.

The first question is not the merits. It is: is this ERISA? Employer-sponsored generally means yes — and if it is:

  • No bad faith claim. No punitive damages. No emotional distress damages. Pilot Life forecloses them.
  • Exhaust the internal appeals — the plan's own process, on the plan's deadlines.
  • Build the administrative record, because on judicial review the court will usually look only at what was before the administrator. Every treating physician letter, every functional capacity evaluation, every vocational assessment must go in during the appeal.
  • Watch for a discretionary clause, which triggers deferential review and makes the case much harder. Some states ban them by regulation — a ban that can survive as a law regulating insurance under Kentucky Association of Health Plans.
  • Check whether the plan is insured or self-funded. A self-funded plan is not insurance for saving-clause purposes, and state insurance regulation does not reach it at all.

If it is an individually purchased policy, none of that applies: state law governs, bad faith is available, and the leverage is entirely different.

Part IX: Life insurance, auto, and the other first-party lines

Life insurance. Two recurring fights. The contestability period — typically two years — during which the insurer may rescind for a material misrepresentation in the application; after it, generally only for fraud, and in some states not even then. And beneficiary disputes, which turn on the beneficiary designation on file with the insurer rather than on a will. A designation that was never updated after a divorce pays the ex-spouse, and a will saying otherwise usually does not change it. See Administering an Estate.

Auto physical damage. Total loss valuation is the standard dispute: what the vehicle was worth immediately before the loss. Comparable sales, not a database figure, are the currency. Diminished value — the loss in market value of a repaired vehicle — is recoverable in some states in first-party claims and in more states in third-party claims. See Buying a Car.

Uninsured and underinsured motorist coverage is first-party coverage that behaves like a liability claim: your own insurer stands in the shoes of the at-fault driver, and the same insurer that sold you the policy now disputes your injuries. It is the purest form of the structural problem this article opened with, and bad faith law applies. Give notice before settling with the tortfeasor, because settling without consent can forfeit the coverage.

Business interruption. Covers lost income and continuing expenses during a period of restoration, usually only after direct physical loss or damage to covered property — a requirement litigated exhaustively in recent years. The period of restoration and the calculation of lost earnings are where the money is, and forensic accounting is essential.

Title insurance is unusual: it insures against defects existing at the policy date rather than future events, and the duty to defend the insured's title is often more valuable than the indemnity. See Buying and Selling a Home.

Part X: Rescission, misrepresentation, and the application

An insurer that discovers a misstatement in the application may attempt to rescind the policy — to treat it as never having existed and return the premium.

The elements, roughly, and they vary by state: a misrepresentation of fact; materiality, meaning the insurer would not have issued the policy or would have issued it on different terms had it known the truth; and in many states reliance, and in some, an intent to deceive.

Where it comes up: health history on a life or disability application; prior losses or claims on a property application; the identity of the actual occupant or the property's use; who actually drives the insured vehicle; and business operations on a commercial policy.

The defenses:

  • The contestability period has run on a life policy.
  • The insurer knew or should have known — a fact appearing in records it obtained, or a question it never asked.
  • The misstatement was not material to the risk that actually caused the loss, in states applying a causal connection requirement.
  • The agent filled in the form, and the insured told the agent the truth. Many states impute the agent's knowledge to the insurer.
  • Waiver, where the insurer continued to accept premium after learning the facts.

Practical advice at application time: answer every question completely and keep a copy of the completed application. The application people never keep is the document that decides whether coverage exists at the worst possible moment.

Part XI: Practical claim handling

  1. Report promptly, and confirm in writing with a claim number.
  2. Photograph and video everything before cleanup, including serial numbers and the contents of every room.
  3. Mitigate — tarp, extract, board — and keep receipts.
  4. Do not throw anything away until the adjuster has inspected or you have documented it exhaustively.
  5. Keep a claim diary: every call, date, time, name, and what was said.
  6. Request the full policy, including all endorsements. You are entitled to it and most people have never read it.
  7. Get your own estimates from licensed contractors. The adjuster's estimate is an opening position.
  8. Ask, in writing, for the specific policy language relied on for any denial or limitation.
  9. Submit the sworn proof of loss on time, or get an extension in writing.
  10. Track the depreciation holdback and submit completion documentation before the deadline.
  11. Consider a public adjuster for a large or complex loss — they work for a percentage, they are licensed and regulated, and they know the process. Check the contract's percentage and cancellation terms carefully.
  12. Calendar the suit limitation period the week the claim opens.

Part XII: Building and proving a bad faith case

A bad faith case is not proven by showing the insurer was wrong. Insurers are wrong all the time without being liable in tort. It is proven by showing the denial had no reasonable basis and that the insurer knew it or was reckless about it.

The evidence that does the work:

1. The claim file. In most states the insured is entitled to it in discovery, and it is where bad faith lives: the adjuster's activity log, the reserve entries, internal emails, supervisory reviews, and the notes recording what was actually decided and when. A file showing a reserve set at the full claim value alongside a $12,000 offer tells its own story.

2. The timeline. A chronology of every communication, request, and response. Unreasonable delay is itself actionable in many states, and the way delay is proven is a table showing thirty-day gaps with no activity in the file.

3. The investigation, or its absence. Who was interviewed. What was inspected, and when. Whether the insurer obtained the insured's evidence and considered it. An insurer that credits only its own expert and never addresses the insured's is describing its own unreasonableness.

4. The engineer's drafts. Where an engineering report supports the denial, the drafts and the correspondence about them matter enormously. Reports edited at the insurer's request to remove conclusions favorable to coverage have been the centerpiece of major bad faith verdicts.

5. The claims manual and the training materials. Discoverable in many jurisdictions, and often containing standards the adjuster plainly did not follow.

6. Compensation and evaluation structures. Whether adjusters were measured on closure rates, average payments, or savings against reserves.

7. The statutory list. Compare the conduct item by item against the state's unfair claims settlement practices act. Whether that statute supplies a private right of action or only evidence for a common law claim, walking the list is how the argument gets organized.

What the insurer will argue: the genuine dispute or fairly debatable doctrine. If there was a legitimate dispute about coverage or amount, a denial is not bad faith even if the insurer ultimately loses the contract claim. This defeats most bad faith claims, and the answer is not to argue the insurer was wrong — it is to show the dispute was manufactured: that the insurer never investigated, ignored evidence, misread its own policy, or applied an exclusion it knew did not fit.

On damages, remember the constitutional ceiling. State Farm v. Campbell indicated that few punitive awards exceeding a single-digit ratio to compensatory damages will satisfy due process, and that a defendant may not be punished for out-of-state conduct lawful where it occurred or for harm to non-parties. The practical consequence: build the compensatory damages carefully, because they set the ceiling. The foreclosure that followed the unpaid claim, the business that failed, the medical consequences of eight months in a mold-filled house — these are what make the case, and they are proven with records rather than adjectives.

Part XIII: Buying coverage that will actually pay

Every dispute above is easier to avoid than to win, and the avoidance happens at renewal, when nobody is paying attention.

Read the declarations page once a year. Five minutes. Confirm the dwelling limit, the personal property limit, the deductibles — including any separate wind, hail, hurricane, or named-storm deductible, which is often a percentage of the dwelling limit rather than a flat amount and can be an order of magnitude larger than the standard deductible.

Check whether you have replacement cost or actual cash value on the dwelling and separately on personal property. Many policies are replacement cost on the structure and actual cash value on contents, which is a nasty surprise after a fire.

Ask about these specific endorsements, because their absence is the source of most uncovered losses:

  • Ordinance or law coverage. Without it, code upgrades required to rebuild are not covered — and codes change constantly.
  • Extended or guaranteed replacement cost, which pays above the dwelling limit when construction costs spike after a widespread disaster.
  • Water backup and sump overflow, which is excluded by default and is one of the most common losses there is.
  • Service line coverage, for the buried water, sewer, and electrical lines you own but never think about.
  • Scheduled personal property for jewelry, firearms, art, instruments, and collectibles, which carry sublimits far below the personal property limit.
  • Home business coverage, because a homeowners policy excludes most business property and liability.
  • Flood, which is a separate policy in nearly all cases — and note that flood coverage typically has a waiting period before it takes effect, so buying it as a storm approaches does nothing.
  • Earthquake, likewise separate, with its own percentage deductible.

Do a contents inventory now. Walk the house with a phone camera, room by room, opening drawers and closets, narrating what things are and roughly what they cost. Store it off-site or in the cloud. The single largest avoidable loss in a total-loss claim is the contents nobody can remember owning.

Photograph the exterior, roof, and mechanical systems annually, which pre-empts the "this was pre-existing damage" argument.

Keep the application copy, the full policy, and every endorsement in the same off-site place.

And check your limits against reality. Replacement cost is not market value and is not the purchase price. Construction costs move; a limit set at purchase five years ago may be badly short. Ask the insurer for its replacement cost estimate and sanity-check it against a local builder's per-square-foot figure.

Part XIV: The regulator, and what a complaint accomplishes

Every state has an insurance department, and it is the most underused tool in first-party claims.

What a department of insurance complaint does: it requires the insurer to respond, in writing, to the regulator, within a deadline, explaining its position and the policy language it relies on. That response is frequently the first clear statement of the insurer's actual reasoning — which is useful whether or not the department takes further action.

What it does not do: it does not adjudicate the claim, it does not award damages, and it does not toll the policy's suit limitation period. File it in addition to, not instead of, protecting your legal deadlines.

Why it is worth doing anyway:

  • Complaint ratios are published and matter to insurers.
  • Market conduct examinations grow out of complaint patterns.
  • Some departments mediate individual disputes with real results.
  • The written response becomes part of your record, and an insurer's inconsistent positions — one to you, another to the regulator — are extremely useful later.

How to write one: the same discipline as everything else. Policy number, dates, the loss, what was requested, what the insurer did, what policy language it cited, and what relief you seek. Attach the denial letter, the estimates, and the correspondence. A complaint with exhibits gets a substantive response; a narrative gets a form letter.

Also consider: the state attorney general where a pattern of practice is involved, and — after a declared disaster — the emergency claim-handling rules many states impose, which frequently extend deadlines, require expedited handling, and prohibit certain practices. After a catastrophe, look up the emergency orders in effect. They can override the policy's own deadlines in the insured's favor, and almost nobody checks.

Frequently asked questions

Is flood covered by my homeowners policy? Almost never. Flood requires separate coverage, and the wind-versus-water dispute follows every major storm.

What is the depreciation holdback? The difference between actual cash value and replacement cost, released only after the work is completed and documented — often within a deadline. Claim it.

Do I have to sit for an examination under oath? If the policy requires it, yes — refusal generally forfeits the claim. Bring a lawyer; an EUO usually signals a serious investigation.

What is appraisal? A contractual process for resolving disputes about the amount of loss, not coverage. Faster and cheaper than suit.

How long do I have to sue? Often only one or two years under the policy's suit limitation clause — far shorter than the ordinary contract period. Check it immediately.

My disability insurance came through work and they denied it. It is probably an ERISA plan, which means no bad faith or punitive damages. Exhaust the internal appeals and build the administrative record.

Related documents

This article is educational and not legal advice. Insurance is state law and policy language controls. Read your own policy, including endorsements, and calendar the suit limitation period.