Insurhi Research
Insurance data & claims research
Insurhi is an independent insurance data and claims research organization. We publish the Insurhi Rating Framework (IRF), structured coverage research, claim documentation playbooks, and anonymized case studies—not quotes, sales, or claim filing services. We help readers understand coverage, prepare complete claim files, and evaluate carriers using published methodology—not marketing copy or paid placement.
- Playbooks
- 43 Claim Playbooks
- Case studies
- 6 documented
- IRF products
- 60 scored
- IRF providers
- 40 scored
Research snapshot
Published data at a glance
Live counts from the Insurhi CMS snapshot—case library depth, IRF coverage, and recent editorial activity.
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Late notice, liability disputes, and incomplete evidence packages
Common denial patterns
- Late notice / prejudice arguments when FNOL exceeds policy windows
- Comparative negligence reservations on UM/UIM after liability limits tender
- Total-loss valuation gaps without comparable vehicle data
- Supplement denials for teardown damage not on the initial estimate
Documentation gaps
- Scene photos without embedded timestamps or metadata
- Missing police report or witness statements on disputed fault
- Repair estimates that omit line-item parts and labor codes
- No written follow-up when adjuster promises phone-only updates
FNOL & documentationDenial & appealUM / UIM & liabilityTotal loss valuation
Home
Gradual damage, depreciation holdbacks, and mitigation disputes
Common denial patterns
- Gradual vs. sudden water damage classification
- Recoverable depreciation withheld pending completion docs
- Mold/fungi sub-limits applied after a covered water event
- Ordinance-and-law upgrades denied without code citations
Documentation gaps
- No plumber cause-and-origin report for pipe failures
- Missing moisture logs during drying
- Incomplete lien waivers blocking depreciation release
- Contractor scopes that do not match carrier line items
Water & moistureHail & windFire & smokeMold & fungi
Life
Contestability reviews and beneficiary documentation delays
Common denial patterns
- Contestability denials citing pharmacy or APS mismatches
- Material misrepresentation allegations on health disclosures
- Beneficiary disputes when probate or multiple heirs are involved
- Accelerated benefit denials for incomplete physician statements
Documentation gaps
- Medical records not organized chronologically
- Medication lists that do not match application answers
- Missing certified death certificates or claim forms
- No written response to each underwriting request item
Life contestabilityBeneficiary & probateDenial & appeal
Medicare & supplement
Billing errors, prior auth, and network disputes
Common denial patterns
- Duplicate CPT lines on hospital outpatient bills
- Prior authorization denials for DME or procedures
- Skilled nursing coinsurance billed to the wrong payer
- Out-of-network emergency charges without mediation
Documentation gaps
- Itemized bills missing revenue codes or modifiers
- No written appeal to the provider billing office first
- Missing physician orders supporting medical necessity
- EOB comparisons without crossover payment proof
Billing & coding disputePrior authorizationSub-limits & caps
Pet
Pre-existing, waiting periods, and mixed invoices
Common denial patterns
- Pre-existing condition denials from wellness note mentions
- Illness waiting-period denials on ER visits
- Bilateral or breed-specific exclusions applied broadly
- Dental or wellness lines denied on combined invoices
Documentation gaps
- Incomplete vet records from prior clinics
- No veterinarian letter distinguishing acute vs. chronic
- Invoices without diagnosis and procedure separation
- Missing enrollment and waiting-period confirmation dates
Pre-existing & waiting periodEmergency careDenial & appeal
Renters
Theft proof gaps, mold caps, and sub-limits
Common denial patterns
- Theft claims denied for insufficient ownership proof
- Mold remediation capped or excluded after water events
- Roommate property excluded from named insured coverage
- Loss-of-use disputes without habitability documentation
Documentation gaps
- Police reports filed outside 24–48 hour windows
- Inventories without bank or cloud serial backup
- No landlord correspondence on repair access
- Proof-of-loss forms missing sub-limit categories
Theft & proof of ownershipMold & fungiSub-limits & capsDenial & appeal
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Primary research surfaces for journalists, advocates, and informed policyholders.
Claims playbooksFNOL workflows, document checklists, and denial patterns.OpenCase studiesAnonymized scenarios with documented lessons.OpenIRF dataPublished scoring rubric and carrier ratings.OpenDenial patterns report2026 flagship brief on denial reasons and documentation gaps.OpenPress & citationsMedia briefs, expert directory, and citation formats.Open