Do You Need a Public Adjuster to Help You Through the Insurance Claims Process?

When you meet with the insurance adjuster about your property claim, should you hire a public adjuster to represent you? The insurance claims process can be simple or complicated, depending on the insurance company, the damage, and the policyholder. Still it’s a good idea to have a professional to speak on your behalf. It’s especially important when the damage to your home is extensive or the coverage is complicated, or when your claim involves complex policy language.

Simple Claims

If your property damage claim is small and uncomplicated, with no coverage issues, the process can go quickly and smoothly. When the insurance property adjuster comes to your home he will do several things:

  • Inspect and photograph the damage

  • Talk about how it occurred

  • Answer your questions

  • Write an estimate

  • If there are no unresolved issues, he might issue a check

  • He’ll work with your contractor to resolve any estimate differences.

Complicated Claims

If you have a commercial loss, a catastrophic claim, coverage problems, or if the damage occurred under suspicious circumstances, things can get pretty complicated. His investigation will be more in depth and probably take a while to complete. He will conduct the same activities as above and also…

  • Make an initial judgment call on coverage

  • Try to determine if the damage occurred the way you said it did

  • Rule out fraud

  • Do whatever he has to do to protect the insurance company’s rights.

Adjuster’s pay attention to everything

An insurance adjuster asks a lot of questions. If your claim is large, complicated or questionable, he might conduct a recorded statement or ask you to write and sign a statement with your version of the facts. It’s important to think before you say anything that might jeopardize your rights.

Complications that can arise

An adjuster usually does a quick coverage review—policy period, property location, named insured—before he visits your property. But he will still be on the lookout for additional coverage concerns—increased hazards, policy violations, not enough coverage—while conducting his inspection.

If he notices any “red flags,” such as a claim made soon after the policy is purchased, no receipts or proof of ownership for expensive property, or a history of multiple claims, he may begin to wonder if there is an element of fraud. He won’t issue a check or finalize your claim unless he’s satisfied that your claim is fraud free.

What happens after the inspection?

There may be a delay while the company sorts out the facts. If you’ve made any red flag statements or the adjuster notices any potential for fraud, he could dig in for an even more comprehensive investigation. That could mean a credit check to verify your financial situation, a background check and more.

The adjuster may issue a formal reservation of rights letter to protect his company’s rights while he continues to investigate the claim. It’s also possible that his boss, his boss’s boss, or even a home office bigwig will add their two cents about what to do next. The options might include offering you a percentage of your claim instead of the full amount, or a declination of coverage.

Insurance company Claims Adjusters must follow Texas laws

The Texas Department of Insurance governs all insurance company operations within the state. The Texas “Consumer Bill of Rights for Homeowners, Dwelling, and Renters Insurance” explains an insurance company’s duties in the event of a claim. But what does that mean to you?

  • The guidelines say what an adjuster can and cannot do.

  • He must be licensed by the state.

  • He must answer your phone calls and letters in a timely manner.

  • The insurance company must pay your claim promptly or give you detailed, legitimate reasons why they can’t.

  • If they decline coverage or deny your claim, they must give an explanation.

  • The TDI has a process for consumer complaints.

Yes, you will probably get paid

Dealing with an insurance company can be exhausting, but you’ll probably get paid after you jump through all of the company’s hoops. If you prefer to get through the claims process with minimal frustration, you should consider hiring a public adjuster to intervene on your behalf.

If you have a property claim and need someone to protect your interests, contact us. We can help.

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