When a property damage claim is filed against an insurance policy, the policyholder and the insurer are immediately at odds. The policyholder has just moved from the revenue side of the ledger to the expense side. Even if the claims process is conducted in a cordial manner, the policyholder is entitled to the maximum possible benefits due under the policy. Given that insurance contracts have many ways to either deny, delay or diminish coverage, an insurer may look at such provisions to provide a lower payout as it affects their pecuniary bottom line. Such claims negotiations require a delicate balance between the policyholder and insurer to ensure an equitable resolution of the potential dispute on the horizon.
If you suffer a property loss and find yourself at the mercy of an insurance company to recover what is due to you over the resolution of a property damage claim, get professional help and utilize the following three tips to advocate for what you are entitled to under the policy terms.
1. Hire a Professional Public Adjuster
In order to obtain the fairest assessment of the property damage, a policyholder should contemplate hiring their own professional Public Adjuster who are professional loss advocates that are licensed by the Department of Insurance to exclusively serve and advocate for policyholders. A Public Adjuster’s duty is to best advocate a client’s interests and to negotiate the claim on their behalf with their approval. This is similar to the insurance company’s adjuster who purely represents the carrier’s financial interests and reduced payout. It’s a matter of leveling the playing field so the conflict of interest that one insurance adjuster who represents both the insurer and insured is removed. Having a seasoned Public Adjuster involved early removes that conflict so the Public Adjuster becomes the client’s face and voice to prepare, present and negotiate the claim with the goal of legitimately maximizing the indemnities owed by the insurer.
An insurance adjuster is someone who assesses claims and negotiates settlements on behalf of the insurance company. They represent the insurer and owe them certain duties while balancing the loopholes of the insurance contract to apply coverage decisions, exclusions, limitations, conditions, and denials to achieve their best interest. An insurance company adjuster will generally undertake all steps to do whatever is legally allowed to reduce your potential payout. Indeed, while an insurance adjuster may be very nice and polite, he/she has a job to do which is to protect the insurer’s pecuniary interests.
Retaining a qualified Public Adjuster ensures you have a professional on your side and who always acts in your best interests according to the broadest possible interpretations of the policy. A seasoned Public Adjuster will objectively comprehensively review the policy, assess the damage, and then negotiate for the highest allowed payout. Unlike an insurance adjuster, who cannot serve the best interests of two masters (i.e., the insurer and insured), a Public Adjusters only exclusively advocate for the policyholder.
2. Analyze the Policy and Document Everything Related to Your Claim
The first step in any negotiation entails knowing the rules of the game. An insurance policy is not just a piece of paper with numbers that are governed by the empirical data of damages. There are numerous loopholes to defeat coverage or reduce the claim payout. Insurance is one of the old areas of jurisprudence. There are numerous regulations, statutes, and case law that govern an insurer’s obligations and an insured’s duties under the special relationship created by the insurance contract. Arming yourself with that knowledge, which is typically better known by professionals in the insurance field, is critical to resolving any dispute. Just as one would hire a professional tax accountant to prepare the best possible tax return or retain an attorney to advocate the strongest legal position, consider having professional help that knows the ins and outs of an insurance policy, the rules of the process, and the custom and practice of each insurer and their strategies to adjust your claim lower.
Notwithstanding, the burden of proof of the claim is initially on the policyholder to support their claims and arguments with defensible evidence. In order to do this well, one should document everything related to your property damage claim including, but not limited to, comprehensively developed building estimates that provide detailed scope and unit pricing, detailed inventory of your contents, stock, or personal property damage, and any forensically developed accounting schedules to measure business interruption, extra expenses or (in the case of a homeowner) additional living expenses. Immediately after an incident, take photos and videos of the damage that your property sustained. Make these as detailed as possible and take more than you think is necessary. You never know what angle or detail an insurance company might want to see, and it is best to capture numerous views of the damaged area (close up and distanced).
As you go through the claims-filing process, continue to keep written records of everything. Communicate with your insurer via email, as that leaves a written record, and take copious notes when talking to your insurance adjuster by telephone. Document the conversation factually as to what was stated by each party. If you purchase new items, undertake repair work as a result of the damage, make sure you try to provide proper and adequate notice to the carrier first, try and obtain prior approval, and maintain itemized and written receipts or documentation. These will prove what you have incurred out-of-pocket as a result of the incident. You will need to articulate to the insurer why you believe these costs are compensable under the policy. In turn, if your insurer will rely on loopholes in the policy to deny, delay or diminish the amounts due and must do so with factual, contractual and legal specificity and basis.
3. Use Effective Negotiation Tools
A seasoned professional will rarely treat the negotiation as a dispute or fight. Effective negotiation of any righteous claim entails understanding the other side’s position by listening and effectively countering their positions with supportable data articulated in a manner that convinces them that you have a better position. Indeed, effective negotiation tactics entail not just getting what you want but also helping the insurer understand why you are entitled to what is being claimed. In order to achieve that objective, one should listen to the issues raised by the insurer and find common ground to obtain the end result. Not everything is price driven as sometimes the period of restoration, the scope of work, booking of revenues as an extra expense, or other claims issue is the hold-up.
The timing of the communication for resolution is also critical as the insurer sometimes needs to go through the claims process before they are ready to resolve claims. Figure out what you believe is rightfully owed to you and then frame your negotiation strategies accordingly so you get what you believe is owed. If you give in on a point, make sure you get something in return for it otherwise your negotiation position will be weakened. Effective listening, timing, the framework of issues, finding common ground, and getting when giving will result in positive outcomes. However, the most effective tool is knowing when to walk out. A great negotiator will take the emotion out of the equation and when he/she is not getting what they are entitled to and will be willing to walk away. Calmly work the process to your best objective as it is not about winning or losing. It’s about getting a fair resolution.
SunPoint Public Adjusters, Inc. Advocates Only for the Insured’s Benefit.
SunPoint Public Adjusters, Inc. (“SunPoint”) is the “Gold Standard” of the Public Adjusting industry. We comprehensively review and evaluate your policy, immediately deploy a team of experts to assess and quantify your damages, and customize a strategy around your personal recovery to promptly and properly maximize the resolution of your claim. Our in-house and other veteran experts are experienced in quantifying and negotiating building, personal property, inventory, or other additional coverages. We work solely on your behalf to favorably resolve your claim. Our experts ensure your insurance company does not delay, diminish, or deny benefits that are rightfully owed to you. Industry experts agree that having a public adjuster like SunPoint on your side early in the process expedites and maximizes your recovery.
Our team of experts have been advocating on behalf of policyholders for decades. We have handled, managed and successfully navigated claims ranging from homeowner losses; corporate losses in the hundreds of millions of dollars; disaster losses involving government entities and entire municipalities; agricultural and recall losses, and virtually any type of disaster claim that could be imagined. Our team of Public Adjusters, building cost consultants, inventory specialists, forensic accountants, equipment consultants, and many other experts make up a group unmatched in our industry. It is easy to be big. But it takes dedication every day to be the best – we have that dedication. Our goal is aligned with yours. To obtain a free assessment of your specific circumstances and recovery please contact us to strategize your optimal means of recovery.
Masood is one of the Principals of SunPoint Public Adjusters Inc., which is one of the premier public insurance adjusting, valuation, and loss consulting organizations in the United States. His experience as a Public Adjuster, Attorney, Assistant General Counsel, and Executive Vice President for various companies provides him the tremendous insight to advocate on behalf of commercial professionals and homeowners who have suffered catastrophic losses and need a professional and dedicated expert on their side to level the playing field. Since 1992, Masood has helped numerous individuals and businesses recover from disasters such as firestorms, hurricanes, tsunamis, tornadoes, earthquakes and other catastrophes throughout the United States, Asia, and the Caribbean. For a consult, please call him at 415.271.2612 or by email at firstname.lastname@example.org.