CLAIM DENIAL FREE CHECKLIST
Section 1 – Basic Contact Info
REQUIRED
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
State
*
Back
Next
Section 2
1. What of claim was denied?
*
Water
Roof
Hail
Fire/smoke
Mold
Fallen tree
Other
2. What reason did the insurance company give for the denial?
*
Wear and tear
Long-term seepage
Excluded peril
Mechanical damage
Late reporting
Not sure
3. Have you received a written denial letter?
*
Yes
No
Not sure
Submit
Should be Empty: