Appealing Your Flood Insurance Claim – Read This First

After a disaster, Wright Flood hires experienced claims adjusters to put their flood claims experience to work collecting information, estimating damages and processing claims quickly to help your family weather the storm after the storm. Most claims are settled amicably; however, in the event that , you do  not agree with the final decision of your claim there is an appeal process. Wright Flood Insurance reviews issues with policyholders when requested to improve understanding of their claims. FEMA encourages policyholders to work with the adjuster, the adjusting company and your flood policy carrier to request further claims review to resolve.

Since the Federal Emergency Agency (FEMA) oversees the National Flood Insurance Program (NFIP), policyholders can appeal a claim after the insurer issues a final claim decision directly to FEMA. FEMA has an established Claims Appeal Process with important deadlines and conditions to bring a claim to resolution.

To be eligible for appealing a final written claim denial —either in part or in whole—policyholders must file an appeal within 60 days of the insurer’s written final decision and cannot have filed a lawsuit.  If you have filed an appeal you may later choose to file a lawsuit against your insurer, as long as you are still within one year from date of the denial letter, but you can no longer seek appraisal.

FEMA’s formal appeals process for instances like this, can be found below. And for more answers, visit FEMA’s Appeals Process Q&A.

How to File an Appeal

In addition to the name of the insured and the property address, appeal letters should include:

  • The flood insurance policy number (from the policy’s declarations page);
  • Contact information; and
  • If the author of the letter is a representative of the policyholder (e.g., a relative, a public adjuster, or an attorney), he or she should indicate the relationship and provide documents verifying and authorizing the relationship, including a waiver allowing access to personal information under the Privacy Act, 5 U.S.C. § 552a.

Upon receiving an appeal, FEMA requests the claim file from the insurer to make sure it has all current information relied upon by the insurer in adjusting the claim. In order to best address the issue(s) raised in appeal, FEMA encourages policyholders to provide as much detail as possible about the claim.

For example, the appeal should include the names of the individuals who previously handled or were involved with the claim; copies of all relevant documentation concerning the claim; and all other information that may aid in the resolution of the appeal. Policyholders should err on the side of providing excess information. A list of example documentation types appears in the NFIP Claims Manual.

Depending on the circumstances of your claim, FEMA may still need to request additional information, in which case policyholders will have an additional 14 calendar days to supplement the appeal file.

What to Expect After Filing an Appeal

When a policyholder files an appeal, FEMA will review their claim file to determine whether the claim was evaluated and paid properly, applying the rules and criteria in the flood insurance policy.

FEMA begins its process by acknowledging receipt of the appeal in writing to the policyholder and requesting the claim file from their insurance company. Within 90 days of receiving all necessary documentation from the policyholder, FEMA will provide an appeal decision in writing with specific information concerning the resolution of the appeal.

FEMA’s response will address each issue raised on appeal in one of three ways:

  1. If FEMA agrees with the policyholder, FEMA will inform the both the policyholder and the insurer of its determination and recommend appropriate action(s) to the insurer.
  2. If FEMA disagrees with the policyholder, FEMA will explain its rationale in detail.
  3. The policyholder may raise new questions or provide documentation in the appeal that had not been presented to the insurer before the claim was denied. In an effort to preserve the policyholder’s appeal rights, FEMA may recommend submitting any additional documentation the policyholder may have directly to the insurer in support of claims for additional payment.

Two important things to remember:

  1. If you think there is a problem with your claim, Wright Flood Insurance reviews are available by calling the Claims Department at 800-725-9472 . A Wright Flood Insurance Review can be helpful to focus on outstanding issues and even to assist you to file an appeal to FEMA, if necessary.
  2.  To be eligible to appeal a final written claim denial —either in part or in whole—policyholders must file an appeal within 60 days of the insurer’s written final decision and cannot have filed a lawsuit or entered into an appraisal to determine the amount of loss.
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