The Haze of Late-Phase Delays (Part 2)

By Mark Goldwich

Last time we started talking about late-phase delays, and we ended with the field adjuster finally getting the claim file and estimate to the often overworked and all too often inexperienced examiner (office-based file reviewer). Remember, these examiners are usually reviewing the files of multiple field adjusters who are all trying to crank out files for payment (mainly for their own fee payment) as fast as possible. This can result in a new stack of files being delivered to the examiner daily.

If they’re so overworked, why don’t they just approve my claim?

Suppose you had this person’s job. What kind of impression would you make on your employer if you “rubber-stamped” everything that came across your desk?

It’s a little-known fact that most independents get paid more for higher claim estimates. But insurance company examiners know all about this state of affairs, and they are inclined to compensate for it. In fact, they are trained and dedicated to “correcting” adjusters who are “padding” estimates for a higher fee. There’s not only a built-in mechanism for delay; there’s a built in incentive for skepticism about the dollar figures associated with claim estimates.

How deep does that skepticism run? Consider this: I recently spoke with an independent adjuster who complained that when his estimate is adjusted down  he only gets compensated based on the amount actually paid on the claim. If the claim is later re-adjusted, and the policyholder is eventually paid exactly what the independent initially requested, the independent adjuster still does not get paid what he would have been paid if his initial estimate had been accepted!

By the way, after this happens a few times, how long do you think it’s going to take the independent adjuster to realize that he or she might as well just write the claim estimate for the (low) amount the insurance company is going to accept, and save the time and aggravation of writing the estimate for the (higher) amount that it should be written for?

What happens if the adjuster gets my claim kicked back to him or her?

There is additional delay. The adjuster now gets it back in his or her system. The adjuster has to find time to look at the file again to see what the examiner had a problem with; and then the adjuster has to try to resolve the problem, which might require another inspection. That means another trip through the adjuster’s to-do list, probably a lengthy trip. And then, of course, your claim may require additional photographs, additional documentation, and additional phone calls. It is definitely going to require additional time.

Cut to the chase. How long is it going to take for me to get a check I can actually cash a check that comes close to covering the valid claims I have?

That’s the big question, of isn’t it. Assuming that the case does not end up in litigation, you can count on six months to a year before you get your money if you’re trying to do this on your own. To be sure, some people complete the process in just a few months. There are three possible reasons for this. One: They’re not getting all they’re entitled to. Two: They’re very, very lucky. Three: They’re working with someone who knows the system quite well.

What if my claim is still disputed after a year or so?

It happens. In that case, you are probably headed to court (or should be), and can count on another two to three years before the claim is resolved by litigation. The insurance companies also know this, and they are not particularly worried about the time factor. It seems there is simply not any meaningful incentive for them to wrap the process up more quickly. In fact, just the opposite seems to be the case. The longer the delay, the more likely it is that policyholders will either walk away from their claims altogether or at least walk away with less than they have coming. It’s my experience that most people simply don’t realize how badly they’ve been underpaid, or have no idea how to dispute the claim, or are too mentally exhausted to bother anymore.

Would working with a public adjuster be likely to reduce the delays?

The answer is almost certainly “yes.” A qualified public adjuster knows how the bureaucracy works (or rather, doesn’t work). A qualified public adjuster knows what, if anything, can be done to expedite any part of the “holding pattern.” An additional benefit, of course, is that the public adjuster isn’t emotionally involved to the same degree that you are, which means he or she may simply be less shocked, burnt out, and/or furious about the delays than you are.

Again, a cynical man might wonder whether the insurance companies count on the policyholder’s losing sleep – and initiative – over the extraordinary delays associated with getting the money they are owed.

Does pursuing a claim without outside help really burn policyholders out?

 Definitely. I’ve seen it time and time again. After a certain amount of time, people have spent so much time and psychological energy on this problem they just cannot face it any more. The months go by, and people simply give up on believing that they can affect the outcome. So they take what they’re offered -- or, to be more accurate, accept that they haven’t been given what they deserve – and try to move on with their lives. That costs them money that they have coming to them. Here’s the moral of the story: You’d work with an attorney to handle serious legal problems. You should work with a public adjuster to handle serious insurance problems.

Unfortunately, delay is not the only problem you are likely to encounter when dealing with an insurance company after a hurricane, fire, flood, or other insured loss. You’ll also have to deal with denial – quite possibly the most powerful weapon in the insurance industry’s arsenal (next to time, and money – they have plenty of weapons!).

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.