So… You’ve recently had a catastrophe in your home.
Maybe it was a water pipe that had burst from a cold weather snap, or a heavy rain storm that cause a sump pump failure. Perhaps a small fire broke out, or maybe even the dishwasher or the refrigerator sprung a leak so tiny that you went weeks without noticing the damage that was taking place. What’s a homeowner to do? Well for starts, (if you haven’t already) you call your Insurance Provider and file a claim. After all, this is why we pay for insurance right? To transfer the financial risk and burden of such an awful event to your Insurer. That’s the entire point of having a policy in the first place. After you talk to a representative from your Insurance Provider and inform them you’d like to file a claim, they will ask you a few questions about what happened, when it happened, where it happened, and they might even ask if you know why it happened. After going through the requisite “20 questions”, they issue you a Claim # and tell you that you’ll soon be hearing from an Insurance Adjuster who will be overseeing the claim, and will be in contact with you to schedule a time and date to inspect the damages.
At this point, most home owners anxiously wait near their phones, and frantically check their inboxes in hopes that their assigned Adjuster will reach out immediately with good news. After all, you’re under the impression that they’re on call to help “like a good neighbor”, or perhaps you’re assuming that “you’re in good hands”. These are literally the phrases they use to market their policies in nation-wide advertisements, so how could it not be true? So, you wait, and you wait, and then finally the phone rings, it’s your adjuster! He / She seems nice enough, but even more of a relief, they aren’t at all surprised by the catastrophe that took place in your home. They’re saying all the right things, telling you that they will take great care of you, and that they understand just what you’re going through. They’re asking all the right questions, and you’re now starting to get the impression that they know what their doing, that they’ve done this before, and that you should just follow their lead.
At this point, even though no one from your Insurance Provider has stepped foot in your home, or seen the damages to your property - you’ve gotten a bit of good news so far. The fact that they’re calling you to set the appointment for a walk-through means that you potentially have coverage for the damage(s) in question, because if you didn’t, the phone call would’ve been a sterile and brief dismissal of your claim. Something along the lines of “we're so sorry to inform you but your policy excludes coverage for (insert catastrophe here)”. At which point the phone conversation would end, leaving most homeowners shocked and confused, frantically printing and reading through the fine print in their policy only to find themselves dismayed at just how little they actually DO cover.
You see, before your assigned Adjuster calls you to set an appointment, they will immediately look for a way to deny coverage. Even if their denial is solely based on your verbal description of the cause or source of the damages. Now, lets take a moment to let that sink in; allow me to re-iterate. If you, as a homeowner, happen to misdiagnose the source of the damages that took place in your home, your insurance company will assume you are correct in your description, and use it to their advantage in denying your claim before it even starts! This is the first of MANY ATTEMPTS your adjuster will make to avoid paying for the damages to your property.
Now, lets imagine for a moment that you’ve filed a claim over the phone, the adjuster has reached out and set an appointment, inspected the property and confirmed that you do in fact have coverage for the damage(s) in question. You must be in the clear at this point, right? WRONG. You see, you have to keep one thing in mind during the entire rest of the claims process: The adjuster’s primary job, task and focus is to mitigate the financial burden to the insurance company. That’s right, they are thoroughly trained, tasked, and given incentive to either deny your claim for the most frivolous of technicalities, or whittle your claim down at every stop and corner in order to make the bare minimum repairs for the absolute cheapest cost to themselves. Now, the motivation for this type of conduct is simple and obvious. They are a business, and as a business they operate in the interest of generating a profit. If the roles between the homeowner and the Insurance company were reversed, the methods would likely be very much the same. In an ideal world, an Insurance Company would be there to serve and protect it’s policy holders without question. But as you can imagine, that would make for a horrible business model in regards to generating a profit. Your adjuster is a human being with a job, and and a boss and responsibilities just like everyone else, and while that doesn’t make them your enemy, they certainly aren’t your friend.
It is your Adjuster’s responsibility to act in the in the interest of the Insurance Company, and though they might appear to be cheerful and helpful, they are tasked with positioning your claim in their favor. One method of doing this starts under the guise of being a helpful recommendation. After your walk-through your Adjuster might say to you that they have a list of “Preferred Vendors” that they are happy to recommend, who are registered with their Insurance Company and are experts at handling these types of repairs. That sounds good right? A “Preferred Vendor” being recommended to you from the person who’s been guiding you along this entire process so far? Think again. How this actually works is that the Insurance Companies seek out contractors who will work for the absolute cheapest price in exchange for the Insurance Company “drowning” the contractor with work. So, cheap pay, in exchange for lots of work. Be warned - there is no shortage of b-list contractors who are eager to take this offer, and make the Insurance Company happy. So, buyer beware - you get what you pay for, or in this instance, you get what THEY pay for. But, Remember one thing here: You are the homeowner, you are the policy holder, and this is your property. While your adjuster may recommend some of their “Preferred Vendors”, you have every right to seek out your own contractor of choice, and your Insurance Provider is not allowed to prohibit you from this, or imply otherwise. It is imperative for you to seek out a Contractor who specializes in Insurance Claims who will work FOR YOU. First and foremost, by hiring a Contractor of your choice, you’ve eliminated what is probably the biggest threat to your claim - The contractor responsible for the repairs no longer has an incentive to appease the Insurance Company because their incentive now lies in appeasing YOU. They will work directly with the Insurance Company on your behalf, to make sure that your home is brought back to Pre-Loss Condition, without compromise, or shortcuts.
Another major benefit of hiring a Contractor that specializes in Insurance Claims is that they are familiar with the methods involved in resolving them. Insurance Claims are VERY different from remodels and run-of-the-mill renovations. These Contractors know the in’s and out’s of the claims process, and they know the verbiage that can either make, or break your claim. They have experience with all the tricks Adjusters try to use to whittle down the cost of your claim, which sometimes includes simply lying. One recent example I can provide is when I heard a career “professional” Insurance Adjuster for one of the major big-box insurance companies try to tell one of my customers, who experienced a major water damage event in their home, that “there is no need to perform water mitigation in the damaged rooms / areas because it was a one-time event”… dumbfounded at what could only be interpreted as malice, or ignorance, I immediately intervened in the conversation to let our customer know that mold can fester and grow in as little as 24 hours, that this damage had been sitting for maybe weeks, and that the damaged material in question was not rated to be wet for any amount of time, ever. And, that it was unacceptable to imply in any fashion that it was OK to let water soak and fester within the walls of a home. From there it took several days of defending the necessary repair scope to the Adjuster, but we were able to get our customer approved for a professional remediation and mitigation service to properly clean out and dry the damaged areas. One can only imagine how the rest of that claim would’ve went if an unsuspecting homeowner were not to have included a professional contractor in that walk-through and had just taken the adjuster at their word. This one example alone accounted for several thousands of dollars of the final claim that the adjuster was trying to save the Insurance Company from by short-cutting the homeowner and putting the property at risk. Unfortunately, this exact type of behavior from the adjusters we encounter on a daily basis, is NORMAL. They work within a moral, ethical and legal “grey area” where claim negotiations are simply open for their interpretation, until a well informed Homeowner, Contractor, Licensed Public Adjuster, (or in the worst case an Attorney) intervenes.
Now, this isn’t to say that this is how it always goes, or that all insurance adjusters are evil and diligently sift through claims looking to take advantage of homeowners in order to satisfy the insatiable greed of their employers. After all, there are a lot of genuine adjusters that do look out for the best interest of their policy holders, and guide themselves with excellent moral and ethical compass. But it is to say, however, that there is certainly the potential for this egregious behavior or ignorance to reveal itself during the claims process, and it is my professional opinion that this happens more often than not.
With major disasters happening in peoples homes as rarely as once in a lifetime, no one can really blame a homeowner for not being scrupulous of the entire process. They have likely never experienced something like this before, and hopefully wont ever again. But with something as important as your home and the dollar values involved, it’s not only worth the consultation of a professional - it is absolutely necessary. Seek out a competent and trusted contractor, read reviews, call, ask questions! The safety and value of your home depends on it.