Common Reasons For Home Warranty Claim Denials
By Victoria Baeker
Claim denial is an incident in which a home warranty company rejects a customer’s request for repair service. Sometimes customer claims are legit and fully entitled to receive services stated as per the contract. Claim denials are considered to be a major reason behind spats between service contract companies and the customer.
While some claims are denied for genuine reasons, some customers argue that companies deny claims on vague grounds often stating fine print from the contract. Yet, there are also cases where the companies were falsely accused of unfair claim denial solely because the customer failed to understand the terms mentioned in the home service contract.
What we need to understand is that not all companies deny claims unfairly because doing so will severely damage their reputation. So unless there is a valid reason, reputable companies will not deny a customer’s claims randomly.
Let’s take a look at some common reasons for claim denials
1. Appliance is not covered
This is often the most common reason for denying a claim. Most service contracts only cover a fixed set of appliances and not everything in your house. If your home service contract provider gives you this reason, go check your contract and make sure that the appliance is indeed not covered. In case you find that it is a covered item, place further calls to the company and let them know that the as per the contract, the item is covered.
No home service contract covers an appliance that has become damaged due to lack of maintenance. Regular wear and tear is not caused due to insufficient maintenance. It is the result of prolonged, proper usage. It is the homeowner’s duty to carry out regular maintenance routines, especially for HVAC appliances. However, if you believe that the damage is not caused due to insufficient maintenance, tell the company that you need to get a second opinion from a different contractor.
3. The damage is pre-existing
Home service contract providers often tell the customer that the damage was one that existed even before the contract was signed and hence it will not be covered. There’s hardly anything you can do about such a denial. However, you can avoid chances for such disputes by making sure that you get a home inspection done prior to signing the contract. That way the home inspector’s report will clearly state about what appliance has what damage. If it is not in the report and if the item is covered, you may be entitled to a repair service.
4. Unusual wear and tear
Wear and tear due to regular usage and wear and tear due to rough handling and careless usage can be distinguished quite easily. If the damage was caused due to the latter kind of wear and tear, your claim stands a chance to be denied. In this scenario too, you can ask for a another contractor to get a second opinion if you disagree on the diagnosis.
5. Code Violations and improper installation
If the appliance was not properly installed and if it violates the codes laid down for safe use and installation, chances are high that your claim may be denied.
What should a customer do when claims are denied?
It goes without saying that the policy booklet, the contract and the inspection report, if any, must be preserved carefully. The moment you realise that your claim has been denied, go through your contract and policy document to make sure that the claim is denied purely based on the terms in the contract. If you have a home inspection report go through that too. If you feel that your claim has been unjustly denied, you can call the home service contract company again and press the issue.
You can also visit review websites and post a review about your experience. HomeWarrantyReviews.com has a feature called the Complaint Resolution Program (CRP) which is a platform for companies and their customers to resolve their issues. The customer merely needs to report his negative experience with HomeWarrantyReviews.com, following this, he will be asked if wants to take part is CRP. If he/she chooses to participate in it, the company will be notified about his/her grievance and will be given 30 days to respond/ sort it out. If the company fails to respond or resolve the issue, the customer’s negative review becomes public. Some review websites allows their users to resolve the issues with the contract provider by communicating with them through a specific platform. The advantage of this system is that if the home service provider fails to resolve the issue for the customer or fail to respond within a time frame, the review becomes public, thereby affecting the rating and reputation of the company. Most companies do not want that.
Whatever the reason could be, we request customers to make things clear before they react to a claim denial. It could be that the company is not at fault here and because of a misunderstanding, their name gets tarnished. Most of the unpleasant scenarios can be avoided if the company you pick is reputable. Hence we cannot stress enough on the importance of picking the right company, a good home service contract provider will always put the interests of the customer first. Remember, good communication is often the solution to the biggest of problems.
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