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 post I cover one step in this process; working with your Insurance Adjuster.
While we will focus on one piece of the puzzle, the Insurance Adjuster, here are how a few of the puzzle pieces fit together. You are the customer of both the insurance company and the restoration contractor. You pay the insurance carrier for coverage defined by your policy. You have a loss occur in your home or business. The insurance adjuster represents your carrier in determining loss pay-out. You sign a legally binding “Work Authorization” with a restoration professional to restore your structure to “pre-loss condition” based on their own estimate of cost. The insurance company reimburses you. You pay the contractor according to the terms specified in the Work Authorization. (Notice both the Adjuster and the Contractor provide an estimate.)
The Insurance Claims Adjuster administers application of your policy specific to your situation. Once you open a claim by contacting your insurance agent the Restoration Professional and Insurance Adjuster will both visit your home or business. (On very small claims, or at times when a large volume of claims are being processed, the adjuster may choose to not visit your home or business, agreeing to work with whomever you choose to work with in the restoration process.) You will then 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 work and investment needed to return your home to pre-loss condition. I cover the details of that topic in the blog “Understanding Your Estimate.”
Now, there is an exception to everything, right? If the carrier is working with a capture contractor, you may get an estimate only from the adjuster because the captured contractor gets all or most of their work from the carrier. In essence, the adjuster, representing the carrier tells the captured contractor how to do their job. The language you will here is “Preferred or Program Contractor,” but unless the contractor standing at your door was selected by you through a careful interview process, that contractor is “preferred” only by the carrier. There is a reason for this. Now would be a good time to read my blog post “Picking Your Restoration Contractor.”
The adjuster is either a direct employee of your insurance company, an independent adjuster, 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 keep you happy so that you maintain your policy with the same insurance agent and carrier. Also, if they have found a good restoration contractor, the adjuster wants to protect that relationship because professional restorers that act with skill and integrity are hard to come by. All this adds up to a tough job for the adjuster. Because of this it is important that you are equipped to shape the conversation with the adjuster. Now that you see a few of the puzzle pieces, here are some questions that will help accomplish that, but first let me introduce you to the magic question. “Would you mind showing me that in my policy?”
1. Is my claim covered?
Anything they reference that they can or can not do is legally guided by the insurance policy you paid for. Use the magic question.
2. What if my loss exceeds my policy limits? This question forces the adjuster to make a decision early in the process. Will he/she offer helpful answers, or start stone-walling? Remember, part of their job is to protect carrier profits. They do this two ways; protect the policy and retain the customer. If they are evasive in their answers, or their answer is ‘no’ use the magic question. “We just never cover that,” is not an acceptable answer.
3. Are there any exclusions in my policy which apply to this claim?
It is best to ask this question in an email, or take notes in the conversation, ask the adjuster to review and sign your notes. This question inoculates against vague answers such as “We just don’t pay for X. If you hear such a vague response, 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 that line item.” Then add the magic question.
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. Remember, the adjuster’s job is to protect carrier profits while keeping you happy. 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. Now you have to decide if you will work with a Captured Contractor or an Independent Contractor. The claims line, your adjuster, and your agent may try to steer you toward a Captured Contractor. Or, you can choose who you actually prefer based on a careful interview process you went through before your loss happened. No matter what anyone says or how you are pressured, you get to choose the contractor. What is a Captured Contractor, and Independent Contractor and how do I choose a contractor? Now would be a good time to read my blog post, “Picking Your Restoration Contractor.”
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. Make sure your carrier, influenced by the adjuster, doesn’t put you in that position of a contractor pressing you for payment while the carrier drags their feet in closing the claim by making payment to you so you can pay the contractor.
8. What if that check is not enough to complete repairs.
This question lets the adjuster know that you are thinking ahead with an intention to complete ALL needed and policy-specified repairs. If you release the carrier from further payment without being fully restored, their is no going back without you taking 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. You may have to push for direct access to this person, and it will be worth the effort to do so. That person may supervise multiple field adjusters and one of their goals is to keep their phone from ringing direct from insured clients. If you have their direct line, settling your claim gets a higher priority.
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 with the adjuster 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.
Until your next mess….
Eric Nei the Cleaning Guy