It's happened. Your life now includes working through a home or business insurance claim to recover from water, fire or mold damage. As cleaning and restoration professionals we can help you be ready to work through this process. In this blog I cover some details about working one step in this process; working with your Insurance Adjuster. Search our for other helpful advice about restoration services in general, or specifics about working with contractors and insurance agents.
Keep in mind that you are the customer of both the insurance company and the restoration contractor. You pay the insurance policy for coverage. You pay the restoration contractor for services. The insurance company reimburses you. While the insurance adjuster works closely with the restoration contractor, at no point is there an financial obligation between the insurance company and the contractor.
The Insurance Claims Adjuster administers application of your policy specific to your specific situation, based on your policy, once you open a claim by contacting your insurance agent. You will be presented with two estimates that look similar. One comes from the adjuster. The other comes from the restoration contractor. "Estimate" has a very specific meaning in the restoration world. The estimate is an early determination from two perspectives, adjuster and contractor, of the investment you will need to make to return your home to pre-loss condition. I cover the details of that topic in the blog "Understanding Your Estimate."
The adjuster is either a direct employee of your insurance company or an employee of a Third Party Administrator, hired by your insurance company to work through claims process. The adjuster's job involves an interesting balancing act. They have to maximize profits for the insurance company and at the same time keep you happy so that you maintain your policy with the same insurance consultant (agent) and the same carrier. If they have found a good restoration contractor, the adjuster also wants to protect that relationship. Professional restorers that act with skill and integrity are hard to come by. It's a tough job. Because of this it is important that you are equipped to shape the conversation with the adjuster. Here are some questions that will help accomplish that.1. Is my claim covered?
If you don't get the answer you were expecting, get the answer in writing and contact your Insurance Consultant (Agent). Their stake in the game is huge because they want to keep you as a customer. They do have a voice in how your policy is interpreted. Insist that the adjuster or the agent show you specific policy language that supports their decision. Don't take the verbal answer as the last answer.
This question forces the adjuster to make a decision early in the process. Will he/she begin to formulate helpful questions and answers, or start stone-walling? Remember, part of their job is to protect carrier profits. If they are evasive in their answers, or their answer is 'no' ask then to show you in your policy the section they used to make that decision. "We just never cover that," is not an acceptable answer.3. Are there any exclusions in my policy which apply to this claim?
The answers to this question should be written down someplace you are able to quickly reference later on. This is an inoculation against the smoke & mirrors objections like "we don't pay for X." Your response is, "Mr. Adjuster, I just received a bill from my contractor that includes "X" as a line item. Your email indicates you do not reimburse home owners for "X." Can you show me in my policy where that exclusion exists? And why didn't you mention it when I asked about exclusions before?"4. Will your company pay all the necessary costs I incur to put my home back the way it was?
This is another way to get the adjuster to speak specifically about inclusions and exclusions. Once again, many people are paid to protect the profits of the carrier. Their job, literally, is to minimize pay out on claims. There are only two ways they can do this when working a claim. Either get the home owner to back off on what they expect or get the restoration contractor to back off on doing what they know is right for the home owner.5. Can I choose the contractor to perform the needed repairs to my home?
The only legal and acceptable answer is an unqualified "Yes." The home or business owner gets to choose the contractor. However, if you call your claims line or your agent at the time of loss, you are likely to end up with a "Preferred Contractor." Think about the word "preferred." The contractor standing at your door, unless you picked them, is "preferred" by the carrier, not you. Preferred contractors often enter into agreements that limit their restoration activities or limits the price they can charge in exchange for a larger volume of business referred to them by the carrier.
Professional restoration is a technical job requiring serious training, heavy overhead, and technical skill. It's every bit of a skilled trade. You can imagine the possible outcomes when a contractor knows they will continue to get referrals from the carrier provided they let the carrier tell them how to do their work and how much profit margin they have to give up to continue to get those referrals. In other words, preferred contractors will not by default cut corners to make money, but there is more pressure to do so when a contractor agrees to the stipulations of being "Preferred Contractor."
To be fair, most Preferred Contractor programs have guidelines of experience, competency and qualifications to be part of the program. I know restoration professionals that get a large volume of business through preferred programs that are administerd in such a way that everybody wins. The customer gets what they need. The insurance company keeps you as a customer and keeps some money. The contractor gets to do the job they know how to do best and makes a decent wage in the process. However, at best, the mixed and often conflicting motives of the parties involved complicates the process of getting to that beautiful outcome.
Independent contractors stay in business in only one way. They go after the business by developing key relationships and business-like promotion, and then doing stellar work. They have no guarnteed pipe line of business coming from any insurance company. They get the business because they have proven themselves in the community they operate. Their thrive on their professional performance and integrity.
In another blog post I talk about how to interview and select a restoration contractor.6. Is there anything you can tell me that will help to settle this claim?
This is another way to get to the adjuster to show their true intentions. They can either choose to be helpful, or start to clam up. Either way, you'll know who you're dealing with.7. When can I expect the first check (and how much will that be)?
This question sets the tone for future interactions. This lets the adjuster know that the client is serious about settlement and that the goal is for prompt payment. If the carrier is slow to reimburse the customer, and the contractor has terms they intend to enforce, the customer is stuck in the middle. They become the bank. Make sure your carrier, influenced by the adjuster and the agent, doesn't put you in that position.8. What if that check is not enough to complete repairs.
This question lets the adjuster know that the client is thinking ahead with an intention to complete the needed repairs. If you release the carrier from further payment without being fully restored and seeing the final bill from the contractor, their is no going back short of serious legal action against an insurance giant.9. Are you authorized to settle my claim?
The client should ask this of every person they come into contact with on the carrier side. They should continue to ask until they actually talk to someone who IS authorized to settle their claim. Field adjusters, those who actually visit your home or business, often have limits beyond which they have to submit the claim up line to their supervisor. In fact, who is authorized to settle your claim is often determined by the dollar value of your claim. The higher the dollar value, the higher up the food chain it has to go to get approval.
In any insurance claim situation, the center of gravity is the insured customer. The carrier, the adjuster, the agent and the restoration contractors all circle around the customer. It's critical that the customer understands and exercises their influence in the process of being fully restored to pre-loss condition and getting reimbursed as fully as possible based on the insurance policy in place at the time of the loss.
Eric Nei, Owner/CEO