There are always surprises! Your claim is the sudden and accidental covered loss you experience. Covered loss means your insurance policy applies. Examination of your policy and the circumstances of your loss is essential to determine if a loss is covered.
You are surprised by the storm, the fire, the theft. You may be even more surprised by how the loss is treated by your policy. The application of your policy to your loss requires reading your entire policy.
Someone will always need to read your policy. It has to be the policy that was in place at the time the loss occurred. That means your declaration page, which summarizes your policy and amounts of coverage, your policy itself with all its conditions, and any supplements to your policy that are listed on your declaration page.
I have asked 30-year veterans if they know what is in the policies. They answer, “I have to read it each time. There are too many policies and too many conditions.” You can’t keep them all straight. It’s better to read the one the customer purchased and know what actually applies to that particular claim.
So you need your policy. If it was lost in the flood or fire, ask your agent for a complete policy as soon as you can. Again, that means the declaration page, the policy itself, and the supplements and addendum named on the declaration page. It may also include notices required by the state insurance department regarding changes in the insurance code.
Read it yourself. It will be difficult, because things covered in one part may be denied in another. Dollar limits may apply to certain items or categories of items. When your public adjuster arrives to inspect your loss, ask him to explain your policy to you and how he will handle your loss.
He or she will look at your property. It is more than an examination of your damage. They are also looking at the value of your property compared to the amount of coverage you purchased. If anything seems out of line, it will be reported back to the underwriting department. Too much or too little insurance, or circumstances not being what was initially reported, can mean your policy could be rated, dropped, non-renewed, or even your claim denied. That usually doesn’t happen. Most of this is routine.
Then comes the loss or damage inspection. The adjuster looks at the damaged home, contents, or both. You will be interviewed for information and observations. Always answer accurately. He or she will have to make a common-sense determination of the cause of the loss. Some causes are not covered by the policy. This means that not all damage is covered damage. No one can settle a loss without knowing the policy.
What should you furnish the adjuster to help with the loss inspection and the settlement process? Here’s what every adjuster wishes you had – an inventory of the damaged items, bids or quotes on the repairs, and photos taken immediately after the damage if you had to clean up or remove items before the adjuster was able to get to your loss site.
He will always have to verify costs – either by doing his own estimate or by having another contractor whom he knows provide an additional estimate. He will verify costs of damaged contents as well. He will take his own photos and measurements. His file should be a common-sense documentation of your loss that speaks for itself, so that anyone picking up the file of your loss later has no problem understanding what happened, why it was covered, and seeing the justification for the amount that was paid.
It’s usually a simple process for a trained adjuster. Complications can occur.
If it’s a total loss – fire or flood or tornado – there may be few remains to inspect. Your policy, your purchase receipts, your photo albums showing what was in each room – they could all be gone. You may be trying to reconstruct your home and contents from memory.
Your adjuster may have trouble inspecting your property due to unsafe conditions in the structure itself, or roads may be closed due to flooding or downed power lines. You and he or she may be unable to connect due to phone problems and mail delivery problems.
Your file may be repeatedly assigned to different adjusters due to the catastrophic nature of the loss and the sheer volume of claims. You may not be able to keep track of who is handling your claim.
Each different adjuster may handle your claim differently, due to unique training and experience. It is not an automated process. Adjusters have some flexibility in their decisions within their company’s guidelines. Something started by one adjuster may be handled differently by another. This can be good or bad for your claim experience.