Jun 29, 2022

When the Insurance Company is Being Difficult!

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When a home owner’s insurance (or renter’s insurance) claim is filed, an adjuster is assigned to evaluate, investigate and confirm coverage for the event that caused the claim.  In many cases insurance companies try to save money by not accepting certain expenses that should be accepted as part of the loss.  There many times when the adjuster will deny the claim for a potentially bogus reason simply telling the client they do not accept the claim for a variety of reasons.

On this last reason does that mean you are stuck with that adjuster’s decision to deny your claim? No, not necessarily.  In my experience many times an adjuster will deny a claim simply to save the company money and hope that you will accept that decision. You certainly don’t have to accept that decision if there is a valid reason.  What recourse do you have in these situations?

That is a good question.  If you feel you are not being treated fairly by the adjuster and that company here are a few things you can do.

  1. Talk to the supervisor of the adjuster assigned to you and communicate your concerns and the reasons for them about why the claim should be accepted.  This can often get results if the assigned adjuster is really not being fair about things.
  2. It can also help to have the right contractor or vendor in your court.  What I mean is that many times the insurance company will send out one of ‘their approved vendors’ to evaluate the situation and put various estimates together.  These vendors, though, have to follow the direction the adjuster gives them which can result in a conflict of interest on their part since these vendors would also be working for you if you sign a contract with them to do the insurance approved repairs or other work needed, such as in water damage claims.

So, in this case it can be good to have a contractor, an environmental company/person like a Certified Microbial Consultant (that evaluates mold and microbial growth) that can advise you properly on what should be done based on industry practice to get your home back in working order as it was before the event that damaged it.

  1. Every state has an insurance commissioner.  You can tell your adjuster and their supervisor that you will be forced to file a complaint with the State Insurance Commission because they are not handling the claim in a good way, for lack of better wording.  This can well motivate the insurance company to adjuster their view of the claim and provide proper coverage.
  2. Consider hiring a Public Adjuster.  What is this exactly? These are licensed companies/individuals that can legally represent you to the insurance company and they know the rules that have to be followed.  Their job is to maximize the amount of money on your claim.  Their fees run between 5% to 15% of the total claim.  While this can lower the overall money you can spend on repairs and such it is much better than not having any money at all or much less than what the insurance has approved for the work.  

These are viable steps to take.  I know of one client some years ago that kept badgering the insurance company adjusters on a claim that had no basis for coverage yet over several weeks/months he was able to get it covered.  He did happen to be an attorney, though. The claim was around $50k on damages.

Steve Mullins (i.e. Mold Detector)

Moisture and Mold Detection, Inc.


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