Is Your Valuable Premium Paying For Valuable Claim Adjustment?

Virtually every insurance company I have deposed or talked with (whether corporate representative, adjuster, or some other representative) has properly agreed with the following, non-exhaustive list of non-delegable claim handling standards (many of which are codified in states such as Florida, see, e.g., Fla. Stat. § 626.9541 and Fla. Admin. Code § 69B-220.201): (1) Insurers must adjust claims at their own expense; (2) The claims department is not the department through which insurers should strive to augment corporate profit (i.e., departments such as marketing, actuarial, and underwriting are where the money should be made);

 (3) Insurers must adopt and implement standards for the proper (prompt, thorough, fair, and et cetera) adjustment of claims;

(4) Adjusters must assist claimants during the adjustment process; (5) Adjusters must give claimants the benefit of the doubt when considering information gathered during claim adjustment; (6) Adjusters must not ignore evidence supportive of claim approval, must objectively report facts, and must disclose all available coverages and contractual rights to claimants; (7) Adjusters must not use biased consultants to assist with claim adjustment and/or delegate claim payment decisions to such consultants.

In the property insurance context, insurance company adjusters commonly hire contractors and/or engineers to assess claimed damage, and so do insureds and public adjusters. That is fine, if such consultants are but a piece of the adjustment equation. What is not fine is the insurance company’s adjustment of claims based solely on the findings of insurer-hired contractors and/or engineers. Why? This unwise use of gatekeeping experts directly violates or trivializes the industry standards listed above, (i.e., devalues the adjustment services one is supposed to receive in exchange for valuable premium paid), which, among other things, often turns coverage-rich policies into cheapo repair contracts and results in low or zero payout on legitimate claims.

Lest your claim adjustment hinge solely on the findings of insurer-hired consultants, you must stay on top of your game. For example, point out all reasonably applicable coverages (not just the coverages implicated by the damage the insurer-hired consultant is directed to or chooses to inspect), demonstrate that the insurer-hired consultant’s findings are anomalous (use your own reputable consultants), and keep a detailed written record of communications with adjusters along these lines (or along any other lines for that matter).