When Does Insurance Not Cover It? Understanding Exclusions

Pre-existing Damage: When Insurance Won’t Pay

One of the most common exclusions in an insurance policy is pre-existing damage. Insurance is meant to cover unexpected, sudden events, not damages that occurred prior to obtaining coverage or that were neglected over time.

How This Impacts You:

If your property sustained damage before your insurance policy took effect, your insurer is unlikely to cover it. This exclusion is in place to prevent people from purchasing insurance with the intention of claiming damages they were already responsible for. For instance, if your home has a leaky roof when you buy a new homeowner's policy, any damage resulting from that leak may not be covered unless the roof is repaired first.

How Nuclaim, Inc. Can Help:

Our experienced team of public adjusters can help you review your policy to identify any clauses related to pre-existing damage and advise you on how to handle claims where this exclusion may be a factor. We’ll also work to ensure that you get the coverage you deserve for damages that should legitimately be covered under your policy.

Acts of God: Natural Disasters and Policy Exclusions

While many people assume that insurance will cover natural disasters, that’s not always the case. Coverage varies greatly depending on the type of policy you have and the specific event.

What You Should Know:

Some policies specifically exclude damage from natural disasters, commonly known as "acts of God." These can include events like earthquakes, floods, and hurricanes. For example, standard homeowner’s insurance policies typically don’t cover flood damage. To receive coverage for floods, you would need to purchase a separate flood insurance policy. The same often goes for earthquake damage.

How Nuclaim, Inc. Can Help:

Understanding what is and isn’t covered can be confusing, especially after a natural disaster when you're in the process of filing a claim. Our public adjusters can review your policy to determine what natural disaster exclusions might exist and help you navigate the complexities of submitting claims for related damages.

Negligence and Lack of Maintenance: A Major Exclusion

Another significant exclusion found in most insurance policies relates to negligence or lack of maintenance. Insurance companies expect property owners to maintain their properties to a reasonable standard. If they believe your negligence contributed to the damage, they may deny your claim.

Examples Include:

• Failing to replace worn-out plumbing that eventually leads to water damage.
• Ignoring small roof leaks that worsen over time, leading to extensive damage.
• Not fixing electrical issues that result in a fire.
• In these cases, your insurance company may argue that the damage was preventable and deny your claim based on lack of maintenance or negligence.

How Nuclaim, Inc. Can Help:

As public adjusters, we can help present your case in the best light possible. We understand how insurers use this exclusion to deny claims and can assist you in gathering the evidence needed to prove that the damage was not caused by negligence but rather by unforeseen circumstances.

Business Interruption: When It's Not Covered

If you're a business owner, you may rely on business interruption insurance to cover lost income during unexpected closures. However, not all interruptions are covered, and many policies include exclusions for specific events or circumstances.

Common Exclusions:

• Pandemics: Many businesses learned during the COVID-19 pandemic that their policies excluded losses caused by viruses or pandemics.
• Power Outages: Some business interruption policies exclude losses caused by utility outages unless the outage was directly tied to damage to the insured property.
• Deliberate Shutdowns: If your business was shut down voluntarily or by government order, your business interruption insurance may not cover the loss.

How Nuclaim, Inc. Can Help:

Our team can help review your business interruption policy to clarify exactly what is and isn’t covered. In the event of a claim denial, we can work with you to challenge the exclusion and seek the compensation your business needs to recover.

Intentional Acts: Insurance Won't Cover Fraud or Malicious Intent

Insurance policies are designed to cover unforeseen accidents and mishaps, not deliberate or intentional acts. If an insurer determines that the damage was caused intentionally—whether it's arson, fraud, or another malicious act—the claim will be denied.



Examples of Intentional Acts:

• Setting fire to your property in order to collect on a claim.
• Faking theft or vandalism to receive a payout.
• Insurance fraud is a serious crime, and insurance companies have detailed investigative processes in place to detect it. If they suspect fraud, they won’t just deny your claim—they could also take legal action.

How Nuclaim, Inc. Can Help:

If your insurance company accuses you of fraud or claims the damage was intentional, Nuclaim, Inc. can provide expert representation. We’ll help gather the necessary documentation and evidence to support your claim and ensure that you’re treated fairly throughout the process.

Contact Nuclaim, Inc. Public Adjusters for Help with Your Insurance Claim in Houston, TX

Insurance policies can be complex and full of exclusions that aren’t always clear. At Nuclaim, Inc. Public Adjusters, we specialize in helping policyholders like you understand the fine print of their policies and navigate the claims process. Whether you’ve experienced property damage, business interruption, or another issue, our team of professional public adjusters in Houston, TX, is here to help.

If your claim has been denied, or you need assistance interpreting your policy, contact us today at (713) 999-2529. Some of the claims we process include storm damage, commercial, residential, deliberate property damage, and more. Our goal is to make sure you get the compensation you deserve without the hassle of dealing with the insurance company on your own.

FAQ