Confused about insurance claims or public adjusters? Our readers send us plenty of questions about our industry! Keep reading to discover the answers to some of our most frequently asked questions.
- What is a Public Adjuster?
- What do Public Adjusters Do?
- What is a Loss Adjuster, Private Adjuster, or Private Claims Adjuster?
- What should I look for in a Public Adjuster?
- What is an Independent Adjuster?
- How much do Public Adjusters charge?
- How does a Public Adjuster get paid?
- Do I need a Public Adjuster?
- When should I hire a Public Adjuster?
- Will my loss be settled faster with the services of a Public Adjuster?
- How does ClaimsMate get paid?
- Do I have to pay upfront?
- Do I need to pay a sales tax?
- Do I need to pay if ClaimsMate is unsuccessful in getting me more money?
- What happens now?
- What is ClaimsMate’s workflow?
- What is a Bad Faith Claim?
- Can I sue my insurance company for bad faith?
- What are some examples of bad faith?
- What are unfair claims settlement practices?
- How do I file a bad faith insurance claim?
- Can I claim for smoke damage?
- Is smoke damage covered by insurance?
- What is smoke damage and what does it look like?
- Is rain damage covered by homeowners insurance?
- Does homeowners insurance cover window leaks?
- Does flood insurance cover rain damage?
- Do I need flood insurance coverage?
- What is the definition of wind driven rain?
- What is wind or windstorm insurance?
- Does homeowners insurance cover wind damage?
- Do I need wind and hail damage insurance?
- How do I tell if my roof has hail damage?
- Will insurance cover hail damage to my roof?
- What is a contract of adhesion or adhesive contract?
- What is ambiguous language?
- What is a coinsurance clause and how does it work?
- What is a doctrine of waiver?
- What is a doctrine of estoppel?
- What are the duties after a loss policy conditions?
- What are proof of loss conditions?
Insurance Claims Adjusters
What is a Public Adjuster?
A public adjuster is a state-licensed insurance professional specializing in managing every aspect of an insurance claim on behalf of the policyholder. Unlike your insurance company’s adjuster, who works for the insurance company, a public adjuster represents you and your interests. Public adjusters are individually-licensed and work as independent contractors. 46 states in America have specific licensing requirements for public adjusters. In order to call yourself a licensed public adjuster in most states, you need to meet strict requirements. Alabama, Alaska, Arkansas, South Dakota, and Wisconsin do not have regulatory schemes for public adjusters.
What do Public Adjusters Do?
Generally speaking, a public adjuster manages every aspect of your claim from beginning to end. They investigate, inspect, appraise, and adjust the insurance claim. Unlike your insurance company’s adjuster, however, a public adjuster works for you. The goal is to maximize the amount of compensation you receive from your insurance company. A public adjuster will ensure your claim is handled efficiently and achieves a fair outcome. The public adjuster will also negotiate with the insurance company on your behalf.
What is a Loss Adjuster, Private Adjuster, or Private Claims Adjuster?
A loss adjuster, private adjuster, private claims adjuster, public loss adjuster, private loss adjuster, and public insurance adjuster are all different terms for a public adjuster. These professionals work on behalf of you, the policyholder and represent your best interests.
What should I look for in a Public Adjuster?
You should look for the same qualities you would look for in any other professional, which includes experience and proven performance. Your Public Adjuster must be licensed and bonded. Your chosen Public Adjuster should also utilize its own staff of adjusters, appraisers and other professionals to assist him or her in maximizing the benefits you are entitled to receive after a claim. The Public Adjuster you choose should be aware of your needs and responsive to your concerns.
What is an Independent Adjuster?
An independent adjuster works for the insurance company. Typically, the insurance company will hire an independent adjuster on a contractual basis – say, to handle a complex claim. They’re not salaried employees of the insurance company. Don’t be fooled by the name: independent adjusters aren’t truly independent. Technically, they represent both the policyholder and the insurance company. However, these adjusters are paid by the insurance company, and their goal is to represent the insurance company’s bottom line. Independent adjusters may also receive a percentage of the claim – similar to a public adjuster.
How much do Public Adjusters charge?
Most public adjusters work on a contingency basis. Typically, public adjusters charge a fee of 5% to 15% of the final settlement offer. More experienced adjusters will command higher fees. Some public adjusters charge over 20%. Some states restrict public adjuster fees. Public adjusters in Florida, for example, are forbidden from charging more than 20% in a situation that has not been declared a public disaster and no more than 10% in a situation that has been declared a disaster.
How does a Public Adjuster get paid?
Public adjusters have different fee structures. Some public adjusters charge a flat rate to handle your claim. Others charge an hourly rate. Most public adjusters work on a contingency basis, which means they don’t get paid until you accept your insurance company’s final offer, at which point they collect a pre-arranged percentage of the settlement amount. Your public adjuster will clearly explain their fee structure upfront.
Do I need a Public Adjuster?
If you’ve experienced a disaster at your property, then you may be considering hiring a public adjuster. Public adjusters are licensed, experienced insurance professionals. They can help you avoid making mistakes on your insurance claim. They keep your insurance company honest. They can raise your final insurance settlement by up to 70% – all in exchange for a fee of 5% to 15%. It’s up to you to decide if you need a public adjuster. In larger claims situations, however, hiring a public adjuster can quickly pay for itself.
When should I hire a Public Adjuster?
As a general rule, you should consider hiring a public adjuster if you have an insurance dispute totaling over $10,000. If you believe your home has sustained $15,000 worth of damage after a hailstorm, for example, and your insurance company offers you a check for $5,000, then you may wish to hire a public adjuster. You should also consider hiring a public adjuster if you want to expedite the claims process, maximize your compensation, or ensure fair treatment from your insurance company. Some people hire a public adjuster simply to take a load off their back during a stressful time. During the days or weeks following a disaster, dealing with an insurance claim may be the last thing you want to do.
Will my loss be settled faster with the services of a Public Adjuster?
An experienced Public Adjuster knows exactly what to provide to the insurance company to expedite the settlement of your claim. Having our professional Public Adjusters handle your loss can save a great deal of your time and result in a faster presentation of your claim. With your cooperation, we will quickly have your claim filed and the settlement process underway.
Working With ClaimsMate Public Adjusters
- We Handle Your Claim From Start to Finish
10% of the gross settlement when you retain our services from the beginning of the claim until the end of the claim.
- We Handle Your Claim Once You Have Already Been Denied or Underpaid
25% of the net settlement of new money secured for you when you file your claim and work the process until they have underpaid you or denied you. This is a more difficult process for us as you have already made statements and had an initial inspection by your insurance company’s adjuster. We must go back at this point and find out what has been said and done up to this point. Again, if we recover no new monies for you at this point, then you owe us nothing. If we are successful in winning a large award for you (which often happens), we revert back to the 10% of the total amount of the claim. Please request an explanation if this is confusing.
Do I have to pay upfront?
No. We are not paid until money is collected from the insurance company. In fact, we use our own resources and time documenting and resolving the claim before we are compensated.
We are not paid until you receive your insurance settlement.
No Settlement = No Charge
No Recovery = No Fee
What happens now?
I would first like to thank you for the opportunity to work with you on your insurance claim to make sure you get every penny you deserve. This process will take approximately 6-8 weeks to complete. So please be patient and remember…
1. DO NOT SPEAK TO ANYONE FROM YOUR INSURANCE COMPANY WITHOUT US PRESENT OTHER THAN TO VERIFY THAT WE ARE REPRESENTING YOU AND TO GIVE THEM OUR CONTACT INFORMATION AND REQUEST THAT THEY CALL US.
2. DO NOT ALLOW THEM TO SCHEDULE AN APPOINTMENT/INSPECT PROPERTY WITHOUT CALLING US FIRST. NO ONE SHOULD BE THERE WITHOUT US PRESENT.
What is ClaimsMate’s workflow?
First we meet with you and pre qualify your business or home, your insurance and your claim.
If we believe that you have a valid claim and you request our assistance, we will collect:
A copy of your policy with endorsements, a declarations page, any past estimates or correspondence if your claim has been underpaid/denied.
We will attempt to collect this information from your insurance company if you don’t have it.
We will then:
- Do a complete inspection of your property with photos for all peril related damages. Please note that if the damage is from different perils, there will be multiple deductibles.
- Let you know if you need to get any repair estimates for specialty items such as AC units, swimming pools, electrical items, plumbing items and assist you in finding someone to provide that estimate.
- Open your claim for you, if it hasn’t been opened already, by phone, fax and email and provide our contact information to your insurance company and request that they correspond through us to limit possible traps that they often set for you in recorded conversations.
- Review your policy for negative policy wording that might hurt your claim so that we know what is/isn’t covered and how to win a negotiation of your policy coverage for full indemnification.
- Request an inspection or re-inspection date with your insurance company’s adjuster and meet them at the property to point out damages and argue policy coverages for you. We will be prepared with industry specific tools and data to back up our position and your claim. THIS INSPECTION COULD TAKE UP TO TWO WEEKS TO HAPPEN AS WE ARE SUBJECT TO THEIR ADJUSTER’S SCHEDULE.
- Once we receive the approval or denial, we will negotiate with your insurance company to properly indemnify your claim…meaning we will fight for every last dollar for you!
- After we think that they have covered all damages, we will explain to you what was/wasn’t covered, why and for how much. We will turn in any additional estimates to back up our estimate amount. We will always ask if you approve of the settlement before accepting any final offers for you and will not close the claim until you give us permission to.
- We will work with your insurance company to get new proceeds distributed to you in a timely fashion.
- We will also assist you in finding qualified contractors that have successfully worked with our clients in your area and provide references if needed for them.
- We will discuss other options with you and your insurance company if the claim is denied or underpaid and how to remedy those.
Bad Faith & Unfair Claims Settlement
What is a Bad Faith Claim?
“Bad faith” is a legal term describing an insurance company committing dishonest practices against a client. Under United States law, insurance companies have an obligation to practice in good faith to their clients. The so-called “implied covenant of good faith and fair dealing” is a crucial part of every insurance contract signed in the United States. When an insurance company violates this covenant, they’re said to be acting in bad faith.
Can I sue my insurance company for bad faith?
Yes, you can sue your company for bad faith. If you believe your insurance company is acting in bad faith, then you may wish to sue your insurance company. Clients across the United States have successfully sued insurance companies for bad faith. When suing for bad faith, you may be able to recover an amount larger than the face value of your policy – especially if your insurance company’s conduct was particularly egregious.
- Deny your claim without reason
- Make a ridiculously low offer in response to your claim
- Fail to conduct a prompt and complete investigation of your claim
- Offer less money than your claim is worth
- Refuse to pay a valid claim
- Make threatening statements
- “Drag their feet” while processing your claim, or take too long to process your claim
“Bad faith” is defined as “intentional deception or dishonesty” or “an intentional failure to meet an obligation.” There are plenty of different ways an insurance company can operate in bad faith. These are just a few examples.
What are unfair claims settlement practices?
Most states have adopted some version of the Unfair Claims Settlement Act. This act regulates the behavior of insurance companies to ensure they act fairly towards clients. Generally, a state’s Unfair Claims Settlement Act prevents insurance companies from altering insurance documents, lying to clients, acting in bad faith, and performing other problematic actions. If an insurance company is found to be violating the terms of the act, then the insurance company is said to be engaging in unfair claims settlement practices.
How do I file a bad faith insurance claim?
Insurance companies have an obligation to treat policyholders in good faith. When an insurance company fails to meet that obligation, the company is said to be acting in bad faith. If you believe your insurance company is acting in bad faith, then take the following steps:
Step 1) Review your insurance contract. Most bad faith insurance claims involve a violation of the insurance contract. Get a copy of your insurance contract and ensure you understand exactly what is covered and what is not covered. If your insurance company is refusing to cover something that should be covered according to your policy, then you might have a case for a bad faith insurance claim.
Step 2) Keep logs on your claim. You will need to prove the validity of your claim. Get all documents, photos, receipts, estimates, and other evidence. Document disputed calls and correspondence with your insurance company.
Step 3) Document your denial of claim. If your claim is denied, request to speak with a supervisor at the insurance company. If the denial is not reversed, then contact your state’s insurance regulatory agency. Document all correspondence with your insurance company discussing the denial of claim.
Step 4) Make a final demand. Send a written demand letter detailing your claim to your insurance company. The insurance company has 15 to 60 days (depending on state law) to respond to the claim. Tell the insurance company you intend to pursue a claim for bad faith if your claim is denied.
Step 5) File a complaint with your state’s Department of Insurance. Each state has its own Department of Insurance. Contact this department to file a complaint. Typically, this department will attempt to resolve the dispute through mediation.
Step 6) Consider hiring a public adjuster. A public adjuster may be able to successfully resolve your insurance dispute before it becomes a bad faith lawsuit.
Step 7) Initiate a bad faith lawsuit. Contact an insurance attorney if none of the other steps have worked. An insurance attorney will work with you to complete the bad faith lawsuit.
Smoke Damage Claims
Can I claim for smoke damage?
Some home insurance policies clearly deny claims for smoke damage. Other home insurance policies are more ambiguous. Typically, however, a home insurance policy will cover damage caused by flames, smoke, ash, or soot. Many experts recommend hiring a public adjuster to deal with smoke damage insurance claims, particularly if the claim involves a disputed amount more than $10,000. Insurance companies are notorious for dragging their feet on smoke damage claims, and some may refuse coverage even though smoke damage should be covered by your policy.
Is smoke damage covered by insurance?
Most homeowner’s and commercial insurance policies include smoke damage as a covered peril. Your insurance company will typically cover the cost of remediating and cleaning smoke and ash damage in your home. Disputes may arise, however, when trying to clean or replace smoke-damaged items in your home. If your insurance company is pushing back against your smoke damage insurance claim, then you may want to contact a public adjuster.
What is smoke damage and what does it look like?
Fire and smoke can have devastating effects on your property. Even if you are able to put out the fire, smoke might have permanent effects on your furniture and possessions. Common signs of smoke damage include:
- Toxic gases, vapors, and particles
- Interior damage
- Electrical damage
Smoke damage can permeate throughout your home. After a fire, you might have permanent discoloration of your walls, furniture, and possessions. You might have unpleasant odors throughout your home. Toxic odors and particles might linger in every fabric in your home. Fortunately, most home insurance policies cover smoke damage.
Water Damage Claims
Is rain damage covered by homeowners insurance?
Rain damage is typically covered by homeowner’s insurance. However, not all rain damage will be covered by a typical policy. Generally, if the rain damage is caused by improper home maintenance and other issues, then it may not be covered by homeowner’s insurance. If your roof hasn’t been replaced in 25 years, for example, then you may not be able to file a claim when your roof leaks during the next rainstorm because there are holes in your shingles. Nevertheless, most home insurance policies cover rain damage.
Does homeowners insurance cover window leaks?
Homeowner’s insurance typically covers window leaks, assuming your windows have been properly maintained. If the leak is sudden and accidental, then a home insurance policy will typically cover the leak. However, if you ignore an ongoing leak over a long period of time, then your insurance company might challenge your claim.
Does flood insurance cover rain damage?
Flood damage occurs when water touches the ground before it enters your home. If rain is washing off the street into your home, for example, then it’s considered flood damage and will likely be covered by flood insurance. typically, flood insurance only covers flood damage – it does not cover water damage. You will need to process water damage claims under your ordinary home insurance policy.
Do I need flood insurance coverage?
Like most insurance questions, this one is entirely up to your desired level of risk and the amount of insurance you’re willing to pay for. Generally, anyone who lives in a flood-prone zone will want to buy flood insurance. If your insurance company does not provide flood insurance (which they don’t in certain flood-prone regions), then consider buying flood insurance through FEMA’s National Flood Insurance Program (NFIP), which covers 21,000 flood-prone communities across America that would otherwise not qualify for insurance.
What is the definition of wind driven rain?
Wind-driven rain is one of those terms you rarely hear about until you buy home insurance. To insurance companies, however, the term wind-driven rain is important. Wind-driven rain is rain that is driven into your home by the wind. Let’s say a storm damages your home. Normal storm damage – including damage caused by the wind and rain of the storm – is covered by your home insurance policy. However, if the storm broke a window in your home and wind was driven into your home through that broken window, then that may be considered wind-driven rain. Some homeowners also have a claim denied for wind-driven rain caused by improper roof maintenance. Your roof might be improperly maintained. When a storm hits your home, rain is driven into your home through the roof by the wind. This may not be covered by home insurance.
Wind Storm & Hail Damage Claims
What is wind or windstorm insurance?
Wind insurance or windstorm insurance is a special type of property insurance that covers damages caused by high winds, including hurricane-force winds, tornadoes, hail, and other weather events. Wind insurance will cover damage to your home, detached structures, sheds, and swimming pools, as well as the personal belongings inside your home. Typically, you only need to purchase windstorm insurance if you live in a wind-prone area of the country.
Does homeowners insurance cover wind damage?
Windstorm insurance is typically included on a homeowner’s insurance policy. However, if you live in a certain wind-prone area of the country, then insurance companies might require you to buy an extra wind insurance policy. Check with your insurance company to ensure wind damage is covered under your insurance contract. If not, you may want to purchase additional coverage.
Do I need wind and hail damage insurance?
Hail damage is covered under most home insurance policies. Wind damage, meanwhile, is covered under most home insurance policies – except for homeowners who live in states with heavy winds. If you live in a wind-prone region, then wind insurance may be worth it for maximum protection. Hail damage, however, does not typically cost extra.
- Granules missing from your asphalt or other material
Whatever your roofing material may be, get on the roof (safely) and check for dents, cracks, and other physical damage. Pay particularly close attention to the ridge cap of the roof. The ridge caps often absorb the most damage. Carefully check the whole shingle, including the edges, for signs of damage. Binoculars can be a useful too for spot checking your roof from the ground.
Consider hiring a professional to assess roof damage after a hailstorm. Some damage may be difficult to spot.
Will insurance cover hail damage to my roof?
Damage to a roof caused by hail or wind damage is typically covered under most home and business insurance policies. Even in hail-prone states, it’s rare for an insurance policy to not cover hail damage to your roof. However, depending on your state and insurance policy, coverage can be applied in different ways.
Insurance Policy Contracts
What is a contract of adhesion or adhesive contract?
A contract of adhesion is a contract drafted by one party in a position of power, leaving the other party – the weaker party – to “take it or leave it”. An insurance contract is a type of adhesion contract. The insurance company and the insurance agent have the power to draft the contract. The potential policyholder, similarly, has the power to refuse the contract. The policyholder cannot counter the offer or create a new contract: the policyholder can either “take it or leave it”.
What is ambiguous language?
Insurance companies will sometimes get caught using ambiguous language in an insurance contract. Ambiguous language might be used in an attempt to limit an insurance company’s liability. The wording in your insurance contract might be considered ambiguous if it can be interpreted in two or more different ways. Generally, insurance companies are discouraged from using ambiguous language on insurance contracts. In cases of ambiguous language, a judge or arbitrator will typically side with the policyholder.
What is a coinsurance clause and how does it work?
A coinsurance clause is a property insurance provision that penalizes the insured’s loss recovery if the limit of insurance purchased by the insured individual is not equal or greater than a specific percentage (typically around 80%) of the value of the insured property. In more straightforward terms, a coinsurance clause means you need to have insurance that covers a certain percentage value of the property. If your property is worth $500,000 and you have an 80% coinsurance clause in your home insurance contract, then you are required to have at least $400,000 of insurance coverage on your property. If you fail to meet or exceed that limit, then a relative amount may be deducted from your final settlement amount.
What is a doctrine of waiver?
A doctrine of waiver prevents an insurance company from canceling your contract when you breach an otherwise minor policy provision. The doctrine of waiver was implemented by most states to protect insured individuals. Without the doctrine of waiver, an insurance company might be available to declare your insurance contract void because you violated a minor term of the agreement.
What is a doctrine of estoppel?
Estoppel is a legal principle that prevents someone from arguing something contrary to a claim made or act performed by that person previously. Said another way, the doctrine of estoppel prevents one party from contracting its own previous actions if those actions have been reasonably relied on by another party. An insurance company that has repeatedly told an insured individual that they are covered for certain damages, for example, cannot suddenly decide that coverage does not apply. The insured individual has been led to believe that they are covered, and may have taken actions based on that presumption. The insurance company would be estopped from denying coverage for the claim.
What are the duties after a loss policy conditions?
When you buy insurance from your insurance company, you’re entering a contract. The insurance company is agreeing to cover certain damages if those damages occur in certain circumstances. You also have responsibilities as part of this agreement. These responsibilities are grouped under “duties after a loss”. Major duties after a loss policy conditions include:
- Take all reasonable steps to protect the property from further damage
- Inform the insurance company of the loss as soon as possible
- Notify the police if the loss occurred due to illegal activities (say, a break-in or arson-related fire)
- Provide information to your insurance company
- Cooperate with your insurance company
- Provide proof of loss, including a sworn statement of facts about the loss
In insurance terms, the “duties after a loss” policy conditions mean that you need to cooperate with your insurance company. Failing to cooperate with your insurance company may violate the terms of your insurance contract.
What are proof of loss conditions?
As an insurance policyholder, you are required to file a proof of loss after making an insurance claim. The proof of loss comes with certain conditions that you need to abide by. The proof of loss conditions can include:
- Describing the amount of loss claimed
- Filing the proof of loss within 30 to 60 days of the incident
- Detailing the date and time of the loss
- Submitting documents supporting the amount of loss claimed
Other proof of loss conditions may be required by your insurance company. Contact your insurance company or work with a public adjuster to ensure you’re abiding by proof of loss conditions.