What are the Steps in the Insurance Claim Process?

Insurance Claims Adjuster Training: Life of a Claim

Welcome back, reader!

Today, we will be exploring the life of a claim.

As a public adjuster, sooner or later you’ll find yourself in the situation where you need to file an insurance claim. When it comes down to it, it’s important to remember this – every claim you file is the same.

Really???

No matter how different they may be in nature, all of them are still kind of the same. To be more precise, the life of a claim is always the same, even though the content of the claim will vary depending on the case.

With that said, let us now further explore the 4 stages every insurance claim process is bound to go through. Are you ready?

Great! Let’s go!

Step 1 – File an Insurance Claim

Even though filing the claim is the first step in the life of an insurance claim process, there are some things that will go down before the claim is actually filed.

First, you – as a PA – will be contacted by a client to come in and assess whether or not there’s any damage to the property that would require an insurance claim.

Of course, since you’ve been contacted that means that the damage exists. But what’s also very important to note is that not every damage requires an insurance claim to be filed.

You may ask why.

For instance, if you’re contacted by a client that has a leak in a single room in their house, but there the leak has been occurring for a long time, or it was as a result of faulty installation, well the claim may not even be covered.

Or, if the loss occurred in a very small area, and the cost to repair won’t even surpass the policy deductible, then the claim is literally not worth filing.

Watch a brief video about whether or not you should file the insurance claim.

That’s why you need to assess the losses first and determine whether or not it is worth filing the claim.

Therefore, If there’s no extensive damage, there really is no need to file an insurance claim.

However, once you’re done with your initial assessment and you determine that there is – in fact – enough to justify the claim, you’ll need to gather all the evidence and documents – such as pictures, videos, repair estimates, expert documentation, water mitigation, etc., and file your claim.

To file the claim, you will need to contact the insurance company and let them know about the losses.

Additionally, you’ll also need to provide them with your client’s policy number, and you’ll receive the claim number in return.

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Step 2 – The Initial Insurance Claim Inspection

Once you file the claim, you can expect to hear back from the insurance company within 24 to 48 hours.

Thanks to the power of the internet, you can nowadays file the claim online as well.

So, the field adjuster will contact you within the aforementioned timespan and schedule the initial inspection of the property in question for the date that works for both of you.

During this part, the homeowner doesn’t need to be present because you – as a PA – will have all the necessary information and documentation.

So, once the insurance company adjuster comes to inspect the property, they will pretty much do the same type of inspection as you did prior to filing the claim.

But why?

This is done solely because the insurance company needs to make sure that the claim is valid.

Now, it’s also important to mention that not every insurance company has their own adjuster. Instead, some companies choose to hire field adjusters and independent adjusters.

If it’s the field adjuster or an independent adjuster you’re meeting up with, they won’t be the ones in charge of making any kind of coverage decision.

Instead, they’ll just gather the evidence and submit them to the insurance company just like you did.

However, the field adjuster or independent adjuster may feel like it is necessary to call mitigation even though you didn’t think so yourself, so they may end up doing that as well.

On the other hand, if you’re meeting up with an insurance company adjuster that just happens to work on the field, you’ll be meeting with the person you’ll be negotiating the settlement for the claim directly.

Honestly, this is always better as they’ll get the chance to see first-hand all you did when you were assembling the claim.

Needless to say, it’s always easier to negotiate with someone who’s had the opportunity to check the place out first-hand than with someone who’s making all the decisions form their cubicles, without actually having the chance to see the matter at hand.

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Step 3 – An Insurance Claim Follow-up and Reinspection

After the initial inspection, the next step you’ll need to see through is the follow-up.

On your part, you’ll need to contact the insurance company and see if everything is in order. This step will also include any kind of reinspection that may be needed or any recorded statements from the insured.

As a public adjuster, you’ll need to be present during any reinspection. Your job will also include meeting any professionals that the insurance company sends out, such as engineers, contractors, roofers, plumbers, etc.

The reason an insurance company may send out experts to assess the situation is to – again – ensure that the claim is a covered loss.

I also always recommend that you be there, as a public adjuster, if your client is making a recorded statement.

This way your client will feel far more comfortable and you’ll be there to ensure that every important detail of the case is being covered.

Step 4 – The Coverage Determination and Payment

Finally, once all the steps are covered, there comes the time for coverage determination and payment.

During this part of the process, the insurance company will decide whether the claim is going to be paid or denied.

Furthermore, the insurance company will also decide how high (or low) the payout is going to be.

Here, in some cases, you – as the PA – will also get the chance to negotiate the payout.

However, it can also happen that the insurance company decides to pay out only what they consider to be the fair amount. Needless to say, this won’t always work in your client’s favor. Learn how to deal with a difficult adjuster.

That’s when you will also need to file a dispute, an appraisal or go to mediation, depending on your state’s requirements.

In Florida, in particular, you will need to file an appraisal dispute if you’re not satisfied with the outcome.

Of course, there are plenty of other things that happen during and after this process.

As mentioned earlier, even though the life of a claim is always pretty much the same, each claim is unique in its own way. After this part of the job is taken care of, there will be plenty more things to come. But that’s a topic for another blog post.