The Haze of Late-Phase Delays (Part 1)

By Mark Goldwich

Congratulations on making it through the early and mid-phase delays of your insurance claim. The problem is there is yet another round to go in the “delay game.” This is the one that takes place after the insurance company’s estimator has completed the initial estimate.

The good news is that, unless your claim is denied (a prospect we’ll cover in a future blog) you are probably going to be talking about specifics that are actually related to your claim from this point forward. There’s a relief.  The bad news is that you’re probably going to be talking about the specifics for much longer than you had in mind. And you may not like what you hear.

Once there’s an actual estimate, what’s likely to slow the process down?

It’s possible (and even likely) that essential items have been left out of the estimate the adjuster comes up with. Sometimes the estimate is so low that, if you accepted it, you would not even be able to afford to start the work necessary to complete repairs. This may be the result of an honest oversight on the part of an overworked estimator; it may be because the estimator is not quite diligent enough when it comes to identifying valid claims. In either case, you may well end up looking at an estimate that is inadequate to your needs. And that will definitely slow things down.

In all likelihood, the insurance adjuster will say that there is a logical explanation for the difference between what you expected to get and what the insurance company is offering. The adjuster may say, for instance, that the shortfall is there because the cost of the repair work is within your deductible, or because the adjuster took depreciation into account on items that call for replacement cost, or because the insurance company has decided not to pay your contractor’s overhead until it is incurred, or even because they believe a contractor would be charging too much to do the work. All of those sound like good excuses. And they all may be distractions from the real problem. Personally, I’d be looking closely at the estimate for items that the adjuster “accidentally” left off.

What happens if I can’t get the adjuster to raise the amount?

You have two options. Option one: You can walk away from the process and take what the insurance company gives you (Important note: If you simply authorize the work you think is needed done and then submit your bills to the insurance company, the odds are very good that the insurance company will consider your action to be tantamount to walking away from the process, which means that you are very unlikely to get your repairs paid for). Option two: You can continue to pursue the claim.

Hiring an attorney, or a public adjuster like me, would fall under continuing to pursue the claim. Unless you are positive the insurance company made a mistake and overpaid the claim in error, I always strongly recommend pursing the claim aggressively. You might, for instance, work with someone like me, who might advise you to demand a re-inspection.

If I demand a re-inspection does that mean the whole process starts all over again?

Not quite, but it can certainly create additional delays. However, at this stage of the game, your choices are pretty simple:

1. Accept what they are offering to pay you;
2. or accept additional delays in order to pursue the additional monies you are entitled to.

What if no re-inspection is needed – won’t the adjuster just write me a check?

Not unless the amount of additional money you are asking for is very small. (And if the insurance company does that, the odds are not good that you’ll be getting a check big enough to actually repair the damage you have suffered.)

Consider the fact that many insurance companies have entire teams set up to handle “supplemental” claims. These are claims that are made because the initial payment was disputed as being too low. There’s a reason so many adjusters are working on supplemental teams. Insurance companies dispute a lot of stuff. The adjusters on these teams are trained to resolve these claims over the phone if possible. Would it surprise you to learn that a phone-handled claim costs less than a field-handled claim?

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What will the adjuster do?

The adjuster will give the claim file material to a supervisor or file examiner (someone who sits in an office and reviews files), and the file examiner will then have to review the claim. Of course, it could be weeks before the file examiner even sees your claim.

The examiner will either approve it or kick it back down to the field adjuster (probably not the original adjuster, of course.) Which of these two is more likely? It’s hard to say, because every case is different. But keep in mind that these offices are flagrantly understaffed. Some of the people who work there are often shockingly inexperienced. I personally know of cases where the claim examiner had literally never inspected a claim in the field before. And yet this is the person who is directing, and rejecting, estimates written by seasoned adjusters!

By the way, the examiner might be handling the estimates for five adjusters, or might be responsible for as many as twenty. You have no way of knowing. One thing’s for certain: The claim examiner inevitably has a huge stack of estimates to review, a stack that gets bigger and bigger with each passing day. So that’s yet another built-in mechanism for delay.

I wish I could say the late-phase delays are over once the examiner gets an estimate from the field adjuster, but stay tuned and we’ll finish with the late-phase delays next time.

Mark Goldwich is president of Gold Star Adjusters, a group of public insurance adjusters dedicated to helping citizens get the maximum settlement for any insurance claim.