Who is the Adjuster at Your Door?

When you have damage to your home or business, your first responsibility is to “mitigate” the damage, or to stop further damage to the best of your ability. This may mean that you mop up water, cover a damaged roof with a tarp, or board up a broken window or wall. It may also mean that you call a qualified emergency service company that exists in your area.

The next step is to report the claim to your insurance company.  Your call will most likely connect you with a call center, where a representative will take the information that you provide them, and file them with your claim. The details you provide during this short phone conversation are very important both to you as well as your insurance carrier. You will likely be wondering if you have coverage, and how the rest of the claims process will work. The answers to these questions will be decided by the information and details you give the insurance company.  The details that they receive are compared to a general knowledge bank to make the first determination whether they have a liability or not.  The words you use are important! Most insurance policies are written in plain but confusing language. Words like, mold, seepage, and long term, may be words that may not be interpreted properly by your insurance carrier, as these words trigger limiting language in your policy. Your lack of knowledge to the insurance process could cost you a denial from your carrier just because you described the loss wrong.

Once the claim has been reported an adjuster will usually be assigned to come and investigate the damages. Here is where it gets tricky.     Who is the adjuster at your front door?  There are several types of adjusters that can show up to investigate your claim. Depending on your insurance company’s claims handling practices, they fall into two categories… a company adjuster, and an independent adjuster. This seems fairly simple, but it is important that you know who you are dealing with and what qualifications and authority they bring with them.

The company adjuster will usually come with proper identification and maybe even a company car or logo on their shirt.

The independent adjuster is not an employee of the insurance company, but rather an independent third party contractor. They will usually show up and identify themselves as such and produce a business card, letting you know that they are there to investigate the claim for the insurance company.

These differences are subtle, but important.

In Arizona and other states, the company adjuster does not need to have a license to perform his duties because he falls under the authority of the insurance company’s license. The independent adjuster is a different story. They must have a license issued from the Arizona department of insurance and it must be current  for them to act in the capacity of an adjuster to evaluate your claim.  The information that these two types of adjusters relay to the insurance company should be the same, but as you will later find, the way the insurance companies use this information can greatly affect your claim.

The company adjuster’s “scope of repairs” is a document that the company will use to pay for damages sustained. It is a final document that usually does not receive review beyond a cursory review after the fact.  This review is more for the benefit of the insurance company than yours, as the reviewers are looking for methodology and company policy violations, rather than searching for missed details about your claim. Many company adjusters in an effort to provide better customer service actually cut you a check on the spot and try to get you to sign release papers closing out the claim.

The independent adjuster’s “scope of repairs”, is treated differently by the insurance company.  Their “scope” is turned into the insurance company, and becomes nothing more than a recommendation for the insurance company to evaluate. The independent adjuster does not have authority to adjust the claim, or settle the claim, just to provide their recommendation for repairs.

The actual adjuster for your claim (if an independent adjuster is used) is commonly referred to as a “desk adjuster” and will only see your claim through the eyes of the independent adjuster’s scope of repairs.  The desk adjuster, armed with the independent adjuster’s scope, will apply the policy language for coverage and make payment from there. It is not uncommon for the desk adjuster to remove items from the independent adjuster’s scope for various reasons. The most common is usually coverage issues, and others are usually methodologies for reconstruction, or simply because the desk adjuster feels that the claimed amount is in excess of what would be considered “normal” for that specified peril.

Just as you would ask a surgeon about his qualifications before he performed any surgical procedure on you, it is also important for you to know who the adjuster is at your front door, what his qualifications are and what authority he has.

Why is this so important?

Recently while on an Allstate claim, an adjuster showed up driving an Allstate car, wearing an Allstate logo t-shirt and spoke about policy coverage issues with authority. It was not until well into our discussion that it was revealed that he was not an Allstate adjuster at all, but an independent third party adjuster, sent out with an Allstate logo car and shirt.  Without us probing for his qualifications and authority he would have come and gone without us knowing that we had actually not dealt with an Allstate employee at all. When he was asked for a business card all he would provide was a phone number to Allstate’s claim department. When asked where his company’s offices were located, he informed us that they were located right inside Allstate’s office. While there may not be anything illegal about this, we felt deceived and lost trust for Allstate and this adjuster.

The knowledge required to traverse the claims process and understand the coverage afforded you in your insurance contract is vast.  At the beginning of this post, I made reference to the first thing you do once you have discovered damage to your property. An informed consumer will hire a licensed “public adjuster” at the beginning of any claim to help them navigate through these treacherous waters.

The public adjuster is the only adjuster who can represent you and your claim to the insurance company.  In Arizona and most other states, public adjusters must be licensed, and in some instances carry a bond for their performance.  Public adjusters understand the claims process and can help you recover from your loss with the full value of the claim.

So when the adjuster from the insurance company shows up at your front door, whether he be a company adjuster or a third party independent adjuster, have him be met on your side of the door by someone who has dealt professionally with insurance claims before. A licensed public adjuster.

Hudson Douglas Public Adjusters is a team of licensed public adjusters who can help you through the insurance claims process. We look forward to helping you out.