Understanding Insurance Coverage Limits and Exclusions

When it comes to filing insurance claims—especially commercial claims or ones involving property damage—it’s not enough to have insurance. You need to understand what your policy actually covers, its limits, and what is excluded. At Affiliated Adjustment Group, we know that clarity around coverage can make or break a claim. Whether you hire a public adjuster or work directly with your insurance adjuster, knowing the policy details helps you get the settlement you deserve.

What Are Insurance Coverage Limits?

Insurance coverage limits are the maximum amounts an insurer will pay under a given policy. According to Progressive, your limit is the top-end dollar value the insurer agrees to for a covered loss.

There are different kinds of limits:

• For commercial property or general liability policies, there might be separate limits for building damage, contents, loss of business income, or legal liability.

• Limits can be either per incident (each claim) or aggregated over a policy term.

• Choosing higher limits usually means paying more in premiums—but may save you from out-of-pocket expenses if a loss exceeds what your insurer will pay.

What Are Exclusions?

Exclusions are events, circumstances, or damages your policy does not cover. They’re just as critical as limits because even if you’ve met your deductible and the limit is sufficient, if the loss is excluded, the insurer may deny payment altogether. Common exclusions include:

• Certain natural disasters (e.g., floods, earthquakes) require specific coverage.

• Wear and tear, mold, or maintenance issues.

• Intentional or criminal acts.

Public Adjuster vs Insurance Adjuster

When there is significant property damage or a complex commercial claim, enlisting the services of a public adjuster can be a smart move. A public adjuster advocates for you, the policyholder, helping interpret the policy’s limits and exclusions and maximizing your claim.

An insurance adjuster is the insurer’s representative: they evaluate damage, estimate cost, and decide what the insurer will pay based on the policy. To achieve a fair outcome, you may need to work with your public adjuster to challenge exclusions or push for full limit coverage when applicable, and also possess a working knowledge of the insurance adjuster’s role.

Tips for Navigating Coverage

• Read your policy carefully, especially the section on limits and exclusions.

• Get written estimates for all damages—building structure, fixtures, business interruption if commercial.

• Document everything with photos, receipts, and expert reports.

• If in doubt, consult a public adjuster—they may find coverages you weren’t aware of or challenge wrongful exclusions.

Insurance Limits and Exclusions NYC

At Affiliated Adjustment Group, we help businesses and individuals through the maze of insurance claims involving property damage, commercial losses, and all the nuances of coverage limits and exclusions. For more information or to speak with one of our experts by contacting us today.