Claim Problem
Partial Approval
Your claim was approved for some items but not others. Understand the gap and what you can do about it.
What This Means
A partial approval means the carrier has agreed to pay for some of the claimed damage but has excluded or denied other portions. This can occur when the carrier determines that certain items are not covered, were pre-existing, or are outside the scope of the covered event.
Why It Happens
- Mixed causation: Some damage is from a covered event and some is from a non-covered cause.
- Scope limitation: The adjuster included some areas but missed or excluded others.
- Sub-limits: Certain coverage types (e.g., fencing, detached structures) have lower limits.
- Documentation gaps: Some claimed items lacked sufficient evidence.
What to Check
- Request an itemized list of what was approved and what was excluded, with reasons.
- Compare excluded items against your policy to verify whether coverage should apply.
- Determine if the excluded damage was caused by the same covered peril.
- Check for sub-limits or scheduled property that may apply.
What Should Happen Next
Submit a Supplement for Excluded Items
A supplement is a formal request to revise the estimate scope or pricing. Submit with supporting documentation showing the excluded items are covered.
Challenge the Causation Determination
If the carrier claims certain damage is pre-existing or from a non-covered cause, provide evidence linking the damage to the covered event (inspection reports, weather data, expert opinions).
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