An insurance claims adjuster is an employee of your insurance company who will physically visit your home to estimate the repair and replacement costs of your hurricane damage.
This blog entry provides information about the role of insurance claims adjusters, the different kinds of insurance claims adjusters, and how to deal with them in the aftermath of a hurricane or similar catastrophic event. Q&As include:
What is the general role of an insurance claims adjuster?
Should you accept what an insurance claims adjuster tells you?
What is a public adjuster?
What is an independent insurance claims adjuster?
How much time do insurance adjusters have to respond?
Do public insurance adjusters need to be bonded?
What should you do if you disagree with an insurance claims adjuster?
What are the most common complaints about insurance adjusters?
What hurricane damage does a typical homeowner policy cover?
What does an insurance adjuster mean by “depreciation?”
What if you are asked for “proof of loss?”
What can you do about a denied hurricane insurance claim?
How much does it cost to dispute a denied hurricane insurance claim?
1. What is the general role of an insurance claims adjuster?
Insurance claims adjusters are hired by insurance companies to physically visit your home after a hurricane or similar event to estimate the repair and replacement costs of the storm damage.
After making such an assessment, a claims adjuster creates a report to be evaluated by a claims examiner—also an employee of the insurance company—who ensures that all guidelines have been followed: both legal and corporate.
If approved, the insurance adjuster negotiates with you to settle the claim.
2. Should you accept what an insurance claims adjuster tells you?
The answer to this question hinges on who is paying the insurance claims adjuster.
The one whom the insurance company sends to your home will be their employee and thereby incented to offer you the smallest settlement possible. When interpreting the ambiguous language and opaque legalese commonly found in insurance contracts, he or she will have a bias that is in direct conflict with your interests.
In sum, a claims adjuster employed by your insurance company is definitely not on your side, which is why your hurricane lawyer might retain the services of a public adjuster to help you with your claim. (see 3)
3. What is a public adjuster?
Similar in concept to a certified public accountant (CPA), a public adjuster is a professional licensed (usually by the state) as a lawful fiduciary entrusted to represent your rights during a homeowner insurance claim. However, he or she cannot help you with the legal aspects of your claim—you need a hurricane lawyer for that.
Working in conjunction with your hurricane attorney, a public adjuster can bring specific knowledge and expertise to the claim process about hurricane damage replacement and repair costs: concerns that an insurance company employee would be inclined to minimize (or conveniently ignore) in deference to his or her employer.
State licensing requirements for public adjusters typically include previous experience in insurance adjustment. (e.g., 2,000 hours in California) and—in many states—passing a competence exam (e.g. New Jersey, North Carolina, and California). But they are not lawyers, nor are they trained in the law, and so they cannot provide legal assistance to you.
4. What is an independent insurance claims adjuster?
These are adjusters who work for an independent firm that is contracted by an insurance company to help it process claims more efficiently when there is high demand, limited staff, and/or need for specialized expertise (see source).
So effectively, an independent insurance claims adjuster is an indirect employee of your insurance company, and thereby similarly predisposed to interpreting nebulous language and vague legalese to the company’s benefit, not yours.
So, do not be complacent just because the adjuster shows up in a car that has a different name and logo on it than those of your insurance company. He or she is not on your side; and you need someone who is: a hurricane attorney with real-world experience at fending off insurance company delays and tactics.
5. How much time do insurance adjusters have to respond?
The span of time within which insurance claim adjusters must respond to your initial contact regarding a claim varies with the particular insurance company, in which state you reside, and the nature of your overall situation.
As informed by the National Association of Insurance Commissioners, most states have enacted fair claim practice laws that ostensibly ensure your insurance claims will be handled in a timely and fair manner.
Typically, an insurance company must at least acknowledge and begin investigating your claim within 30 days. But the various state laws do not actually dictate how long your insurance company has to respond.
In some states, a response is supposed to be forthcoming within two weeks. Other states allow several months.
Galindo Law has its main offices in California, Texas, and Colorado.
In California, state law stipulates that insurance companies must respond to your homeowner insurance claim within 15 calendar days and pay it within 30. In Texas, the company must respond within 15 days and pay within five. In Colorado, within 30 days and pay within 30-to-45 days (see source).
As you might guess, a disaster of major proportions—such as a hurricane, tornado, or massive flooding—will seriously impact more than one home. Thereby, it can delay the arrival of an insurance claim adjuster to your home.
6. Do public insurance claim adjusters need to be bonded?
In most states, a public insurance adjuster must obtain a surety bond, which provides a financial guarantee that he or she will obey the law and conduct business ethically.
A surety bond is essentially a contract among three parties: the state’s insurance authority (or “obligee”), the public insurance claim adjuster (or “principal”), and—in this case—you. If in response to your complaint, the insurance authority determines that a public insurance adjuster has acted unethically or illegally, it will require the public adjuster to pay damages to you. If he or she cannot or will not pay, you can file a claim against the public adjuster's bond, and the adjuster will be liable for paying the surety back.
7. What should you do if you disagree with an insurance claims adjuster?
Before arguing with any claims adjuster that your insurance company sends to your home or property, you need to read up on exactly what your insurance policy is supposed to cover: info that is listed in the legal paperwork you received when you purchased the policy.
Also, compare what is stated or inferred in any glossy sales brochures you might have been given (to sell you the policy) against what the insurance adjuster is saying now. Such materials might include language that shows the company promised more benefits than they are now willing to deliver.
After a hurricane, you might be dealing with more than one adjuster. And often enough, where one adjuster might deny coverage for a certain kind of damage, a different adjuster from the same company might allow it.
Knowing exactly what is in your insurance policy allows you to challenge any inconsistencies put forward by an insurance claim adjuster before the process proceeds any further in the wrong direction.
8. What are the most common complaints about insurance adjusters?
People will tell you: delays.
Delays (1) because the adjusters might be swamped with work after a hurricane and cannot get to you. Delays (2) because of “rotating adjusters,” one who might accept a claim where another does not. And delays (1 + 2) because you consequently have missing and/or conflicting information about what is covered and what is not (see source).
Other complaints are inadequate repair estimates and settlement offers, adding to your pain and aggravation, especially if this is an insurance company that you have been trusting for many years, paying their premiums on time and without questions.
These problems add to the psychological trauma of being a hurricane victim, making you want to “just settle and get it over with,” which is self-defeating and a major reason why you should retain a hurricane lawyer who will protect your interests over those of the insurance company.
9. What hurricane damage does a typical homeowner policy cover?
What is covered or not by your homeowner policy is listed in the paperwork you received after you purchased the policy, and you should make yourself completely familiar with it before you try to challenge an insurance company claim adjuster. (Your hurricane attorney can help you with this chore.)
Hurricanes can cause severe damage—and often do. Flying objects can brutally damage homes, vehicles, and other property. Heavy rainfall can cause flooding that destroys structures and washes away roads. Severe wind gusts can send objects airborne, smashing houses and buildings while taking down trees and branches to inflict other kinds of damage.
Severe storm surges combined with the astronomical tide can create storm tides and rip currents that devastate everything in their path. A hurricane can even spawn tornadoes, spreading the devastation beyond its principal landfalls.
Specific damages often include:
Broken windows and glass doors
Damaged or destroyed decks and sunrooms
Damaged or destroyed landscaping, trees, and shrubs
Damaged or destroyed roofs
Damaged or destroyed swimming pools, detached garages, and outbuildings
Damages from loss of utilities (e.g. gas, electric, and water)
Flooding and water damage
Foundation and structural damage to houses and buildings
Lost, damaged, or destroyed personal property
If you have suffered any of these kinds of losses—and your insurance company is denying your claims—you should seek assistance from a skilled hurricane-damage lawyer.
10. What does an insurance adjuster mean by “depreciation?”
Depreciation reflects the hard truth that the things you own decrease in value over time. So all those kitchen appliances you paid a lot of money for a decade ago are worth a lot less now, even though they were in “mint” condition the day before the hurricane.
But remember that depreciation is not an exact science.
Different claims adjusters will differ from one another about how much and which items to depreciate. So it is up to you to argue for realistic numbers, which can be difficult if you do not have precedential knowledge about the value of such losses: something with which a skilled hurricane attorney can help you.
[N.B., if you have an RCV (replacement cost value) policy instead of an ACV one (actual cash value), then the insurance company must compensate you for the difference between what they paid you for the item’s actual cash value versus what it actually cost you to get a new one. (You will need the receipts to prove it.)]
11. What if you are asked for “proof of loss?”
Be sure to retain any paperwork that will help you prove the loss (e.g. receipts, estimates, local news articles, etc.). But the best proof of loss is photography.
Take photos that exhibit the damage from various angles; and make sure you snap them before you make temporary repairs, which insurers typically insist you do ASAP to prevent further damage. (E.g. putting up tarps or nailing plywood over shattered windows).
It will strengthen your claim if you can include photos of your property that you might have taken before the hurricane so they can be compared to pictures taken after it.
Remember that an unscrupulous insurance company can indefinitely delay your hurricane damage claim by making unreasonable demands for proof of loss.
Too much insistence about “before photos” can be a bogus issue raised to delay the process and wear you down. Or the company might ask for proof‑of-losses that are not related to your insurance policy, or they might not conduct a thorough investigation before making demands for proof. More reasons to hire a skilled hurricane attorney.
12. What can you do about a denied hurricane insurance claim?
If you have filed a claim for damages and it has been denied, simply calling your insurance company and trying to change their mind going to be fruitless in most instances. Remember that an unspoken part of the job for insurance claim adjusters is saving money for their company, and they are consequently experts at getting you to say things that will weaken your claim.
At Galindo Law, we have experienced attorneys who specialize in assisting people with denied hurricane-damage claim issues. We will protect and defend the integrity of your damage claim and negotiate with insurance companies to get you the settlement you need and deserve.
13. How much does it cost to dispute a denied hurricane insurance claim?
Galindo Law does not charge any upfront or out-of-pocket fees. We are only paid a percentage of the settlement we are able to secure for you. So by working with Galindo Law, you incur zero financial risk.
Remember: You are not asking for charity. You have paid to be insured. You deserve to be adequately compensated.
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