The 10 Claim Commandments

OBVIOUSLY, in a blog like this, it’s impossible for me to teach you everything I’ve learned in the nearly thirty years of handling claims. So my first, and, I think, best advice to you would always have to be pretty simple: consult a professional.

Having said that, I realize that there are people who will refuse to hire someone else to do something they feel they can do by themselves. So for now my goal is give you enough information to help you improve your current, next, or even your previous claim.

And yes, you read right. I said it is possible improve your previous claim. Believe it or not, you really can challenge a claim that the insurance company considers “closed.” It all depends on things like how long ago the claim was, and under what circumstances it was settled or closed. I talk to people all the time who tell me they “never knew claims can be re-opened,” or “never knew that claims can be renegotiated.”

It’s in the insurance industry’s financial interests, of course, for policyholders to believe that, once they cash a check, they can’t come back to fix an error. It really is a shame how many people think this way. Mistakes happen, and your claim can be reopened and renegotiated. Here are some of the basics on how this happens.

Many insurance adjustment errors, especially on catastrophe claims, stem from the adjuster overlooking or misquoting damages. Usually, this happens for one of three reasons: adjusters don’t spend enough time to identify all the damages; they are unfamiliar with the damaged item; or their estimating software incorporates a bad price.

Other mistakes happen when adjusters either misinterpret the policy or misinterpret the facts on the ground. Either circumstance can result in the denial of a claim that should actually be covered -- or in a payment that is lower than it should be.

If you decide to handle a claim yourself, or reopen one that you think deserves a second look, please consider yourself bound by the following ten “commandments” -- all of which a qualified public adjuster would scrupulously observe.

Commandment #1: Do not try to pull one over on your insurance company!

Be thorough, but be honest. Few things turn insurance adjusters on like the prospect of catching policyholders who are engaged in fraud. Most companies have entire departments devoted to rooting out fraud, and you can be sure that the insurance company’s fraud representatives will be among the best-trained people in the company. (Too bad the adjuster who comes out to inspect your home probably isn’t trained this well.). The fraud representatives have seen and heard it all, and they eat would-be cheats alive. Remember that insurance fraud is a crime. Don't even try it.

Commandment #2: Take notes.

Image courtesy of ifanboy.com

Buy a notebook. Buy a pen. Put them to use. Take your time and go around the property, noting everything you see to be damaged. Everything. Besides the obvious stuff like missing roofs and two-foot flood lines, you are looking for scratches, scuffs, scrapes, cracks, bangs, dents, tears, stains, discolorations, swelling, unevenness – I mean everything. Look high and low, inside and out. Write it all down.

You should also keep a detailed log of all conversations that take place with your insurance company, adjusters, contractors, and other players in this drama. Keep track of everything: Your own time cleaning up, time you spend making emergency and temporary repairs, and every penny you spend that has anything at all to do with the claim. I can’t stress enough the importance of being thorough and detailed.

Commandment #3: Get pictures.

Photograph it all. Video it all. When I say “all,” I mean everything. You may need these images somewhere down the line. Warning: Your adjuster may want a copy of these records. Be sure to keep copies for yourself in case the adjuster happens to lose the images you provide.

Commandment #4: Show the adjuster all the damage.

This sounds easy enough, but in order to do it, you must know exactly what to show them. Again, you’re better off working with a professional who has done this a couple of

hundred times. If you choose not to do that … well, be sure to give the adjuster a copy of your own exhaustive list of damage to the property, and keep a copy for yourself. Lead the adjuster around the property and be sure he or she notes each and every item on your list. If that means the visit takes two hours -- or ten hours -- so be it. Be more thorough than the insurance company’s adjuster wants to be. I tend to find that if an adjuster is inspecting a property for 30 minutes, I will probably be there for two hours. If the adjuster is there for two hours, I will probably be there for four to six hours. Am I just slow on the uptake? I like to think not. I am thorough, though, and I am careful. I don’t want to miss any damage. The adjuster wants to move on to the next claim. I want to make sure you get everything you’re entitled to. Two different agendas! Ask directly about the adjuster’s experience level. You wouldn’t want to be operated on by someone with little experience, and the same goes for the insurance adjustment of your largest financial asset, your home or business. Note that an ethical, experienced adjuster making any kind of effort should be able to point out a thing or two to you that wasn’t on your list.

Commandment #5: Remind the adjuster that not all homes are built with the same materials.

Image provided by motherearthnews.com

Insurance adjusters use computerized estimating programs that are designed to generate rough estimates (or, as I prefer to call them, “guesses”) about the average amounts of damage in average homes. These software programs tend to be fairly accurate in evaluating average homes and average losses – and tend to be less accurate on very small losses, very large losses, very low quality homes, or very high quality homes. The more familiar you are with your home and the quality of its construction, the better off you will be.

Commandment #6: Review the adjuster’s completed estimate in detail, until you understand each and every line.

This is where you will find mistakes – unfortunately, though, these documents can be extremely tough to read. Room sizes may be off, damages you pointed out may have

been omitted, or prices cited may be too low, either because the quality of the item being replaced is not correct, or because the prices being charged are higher than they were when the software for the estimating program was written. (This is a very common problem after a catastrophe).

Commandment #7: Have a licensed general contractor review the insurance company estimate and provide an independent estimate.

If this is impossible, at least see if they will indicate specific concerns they may have about the insurance estimate. This can be tough to do after a catastrophe, as contractors can be hard to come by. You may choose to get individual estimates

from the roofer, carpenter, electrician, plumber, painter, A/C man, flooring specialist, or other professional. I would not suggest that you get estimates from the “cheapest guys

in town.” If you get more than one estimate for a particular repair, count on the insurance company paying on the lowest figure associated with whatever you provide them.

Commandment #8: If the insurance company refuses to pay for an item, demand that they explain (in writing) why.

The company should not only do this, but also show you exactly where in the policy it says that what you are claiming damages for is not covered. This point is very important. Never simply accept that something is not covered because the insurance company says it’s not covered. The company has an obligation to make you understand why it is not covered. It is the company’s job to prove to you that something is not covered.

Commandment #9: Be persistent. Don't give up.

From redshoepr.com

This may be the most difficult commandment of all for you to follow, but it is absolutely essential. I am convinced that, as a group, U.S. policyholders walk away from millions of dollars in valid claims each year simply because they are sick and tired of dealing with the claims process. Hang in there. If it is appropriate to do so, write complaint letters to the company (making sure to cover the local, regional, and home office levels), as well as your state’s regulatory agency, Attorney General, or Governor; your municipality’s Mayor, Councilman, or Selectman; or anyone else in authority who may listen. Take advantage of any measures your policy or State has for reconciling these matters. (These are sometimes called Alternative Dispute Resolution methods.) When writing, be brief and to the point (I’ve seen people scribble page after page of ramblings that are impossible to make sense of. Even if they are right, these letters will never be taken seriously.) Keep after them. Be relentless. Try to stay calm.

Commandment #10: Seek professional assistance when needed.

Depending on the loss, this could mean a contractor, an engineer, a mold specialist, an accountant, an attorney – or, of course, you might decide that you need a good public adjuster after all. Again – a public adjuster will not charge you anything up front, but will, instead, charge a commission on what we are able to collect for you above and beyond what the insurance company is offering. It may feel strange, having to consult with someone to make sure that your insurance company pays you what you’re actually owed. But if they always did what they were supposed to, we would be out of work.

Think of us as your insurance against problems with the insurance company. No, it’s not “right” that you should need insurance like that, because you have probably been paying a large amount of money to the insurance company every month or quarter, and you’ve probably been doing that for years. But this is the way it is. At least now you know about it, and you also know what you can do about it.

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.