Table of Contents

What to Do When You Disagree With Your Insurance Adjuster: A Comprehensive Guide

Disagreements with your insurance adjuster can feel like hitting a brick wall. It’s frustrating when you believe your claim is valid, yet the adjuster’s assessment doesn’t align with your understanding of the damage or your policy coverage. Don’t despair. You have options. If you disagree with your insurance adjuster, the first step is to understand why they arrived at their decision. Request a detailed explanation, in writing, outlining the specific policy language and evidence they used to reach their conclusion. Armed with this knowledge, you can then gather your own evidence – independent appraisals, contractor estimates, expert opinions – to support your claim. Be prepared to negotiate and communicate effectively with the adjuster, presenting your counter-arguments clearly and respectfully. If negotiation fails, consider escalating the matter within the insurance company, pursuing mediation, or, as a last resort, seeking legal counsel.

Understanding the Root of the Disagreement

Often, the friction between a policyholder and an insurance adjuster stems from differing interpretations of the insurance policy itself or the extent of the damage covered. Before escalating the issue, meticulously review your insurance policy documents. Pay close attention to the definitions of key terms, the scope of coverage, and any exclusions that might apply.

Common Sources of Conflict

Coverage Disputes: Is the damage covered under your policy? Was the cause of the damage an excluded peril?
Valuation Disagreements: Is the adjuster underestimating the cost to repair or replace damaged property? Are they correctly applying depreciation?
Liability Disputes: Who is at fault in an accident? Is the adjuster unfairly assigning blame?
Pre-Existing Conditions: Is the adjuster claiming the damage existed before the policy took effect?

Once you’ve identified the source of the disagreement, you can focus your efforts on gathering evidence and building your case.

Gathering Your Evidence

The burden of proof often falls on the policyholder to demonstrate the validity of their claim and the extent of the damages. Therefore, meticulous documentation is crucial.

Types of Evidence to Collect

Photographs and Videos: Capture detailed images of the damage immediately after the incident.
Repair Estimates: Obtain multiple, independent estimates from licensed contractors. Ensure the estimates are comprehensive and itemize all necessary repairs or replacements.
Expert Opinions: Consider consulting with engineers, appraisers, or other specialists who can provide expert assessments of the damage and its cause.
Receipts and Invoices: Gather proof of ownership for damaged personal property.
Police Reports: If the damage resulted from a crime, obtain a copy of the police report.
Witness Statements: Collect statements from anyone who witnessed the incident or the damage.
Independent Appraisals: For significant property losses, consider hiring an independent appraiser to determine the fair market value of the damaged property.

Negotiating with the Insurance Adjuster

Armed with compelling evidence, you can now engage in a more informed negotiation with the insurance adjuster.

Effective Communication Strategies

Maintain a Professional Tone: Even if you’re frustrated, remain calm and respectful in your communication.
Document Everything: Keep a record of all conversations, emails, and correspondence with the adjuster.
Present Your Evidence Clearly: Organize your evidence logically and present it in a clear and concise manner.
Understand Their Perspective: Try to understand the adjuster’s perspective and the constraints they are operating under.
Be Prepared to Compromise: Negotiation often involves finding a middle ground. Be willing to compromise, but don’t settle for less than what you’re entitled to under your policy.

Escalating the Matter

If negotiations with the adjuster prove unsuccessful, you have several options for escalating the matter.

Internal Appeals Process

Most insurance companies have an internal appeals process. File a formal appeal, clearly outlining your reasons for disagreeing with the adjuster’s decision and providing supporting evidence.

Mediation

Mediation involves a neutral third party who helps facilitate communication and negotiation between you and the insurance company. Mediation can be a cost-effective and efficient way to resolve disputes without resorting to litigation.

Appraisal Clause

Many insurance policies include an appraisal clause, which provides a mechanism for resolving disputes over the value of a loss. Under the appraisal clause, you and the insurance company each select an appraiser, and the two appraisers then select an umpire. The appraisers independently assess the damage, and if they can’t agree, the umpire makes the final decision.

Legal Action

As a last resort, you can file a lawsuit against the insurance company. This should only be considered after exhausting all other options, as litigation can be time-consuming and expensive. Consult with an experienced insurance attorney to discuss your legal options. A lawyer can review your policy, assess the merits of your claim, and represent you in court.

Frequently Asked Questions (FAQs)

FAQ 1: What is an independent insurance adjuster, and should I hire one?

An independent insurance adjuster, also known as a public adjuster, works on behalf of the policyholder, not the insurance company. Hiring one can be beneficial, especially for complex or large claims. They can help you assess the damage, prepare your claim, and negotiate with the insurance company. However, they typically charge a percentage of your settlement, so weigh the costs and benefits carefully.

FAQ 2: How long do I have to file a claim?

The timeframe for filing a claim varies depending on your policy and state laws. Check your policy for specific deadlines. Generally, it’s best to file your claim as soon as possible after the incident.

FAQ 3: What is a “proof of loss” form, and when do I need to submit it?

A proof of loss form is a sworn statement that details the damages and the amount you’re claiming. The insurance company typically requires you to submit a proof of loss form within a specified timeframe. Complete the form accurately and thoroughly, and attach all supporting documentation.

FAQ 4: Can the insurance company cancel my policy if I file a claim?

In most cases, filing a legitimate claim will not result in policy cancellation. However, insurance companies may cancel or non-renew your policy if you file multiple claims within a short period, or if you misrepresent information on your application.

FAQ 5: What is “depreciation,” and how does it affect my claim?

Depreciation is the decrease in value of an item due to age and wear and tear. Insurance companies often deduct depreciation from the replacement cost of damaged property. You may be able to recover the depreciated amount if you have a “replacement cost” policy.

FAQ 6: What is “bad faith,” and what are my rights if the insurance company acts in bad faith?

Bad faith occurs when an insurance company unreasonably denies or delays a legitimate claim, or engages in other unfair practices. If you believe the insurance company has acted in bad faith, consult with an attorney. You may be able to recover damages beyond the amount of your claim.

FAQ 7: Should I accept the first offer from the insurance adjuster?

Generally, it’s advisable not to accept the first offer without thoroughly reviewing it and understanding the basis for the adjuster’s valuation. Compare the offer to your own estimates and documentation, and negotiate if necessary.

FAQ 8: What if the damage is worse than initially estimated?

If you discover additional damage after settling your claim, notify the insurance company immediately. You may be able to reopen your claim, provided you can demonstrate that the additional damage resulted from the same incident.

FAQ 9: What if I can’t afford to repair or replace the damaged property upfront?

Some insurance policies offer advance payments to help you cover immediate expenses. Discuss this option with your adjuster. You can also explore financing options to cover the costs of repairs.

FAQ 10: Can I use my own contractor, or do I have to use one the insurance company recommends?

You generally have the right to choose your own contractor. The insurance company cannot force you to use a specific contractor. However, they may have preferred vendors who offer guaranteed work or discounts.

FAQ 11: What if the adjuster says my policy doesn’t cover “acts of God”?

The term “acts of God” typically refers to natural disasters like floods, earthquakes, and hurricanes. Whether these events are covered depends on your specific policy. Carefully review your policy to determine what perils are covered and excluded.

FAQ 12: How do I find a qualified insurance attorney?

Look for an attorney who specializes in insurance law and has experience handling claims similar to yours. Ask for referrals from friends, family, or other attorneys. Check online reviews and verify the attorney’s credentials.

By understanding your rights, gathering evidence, and communicating effectively, you can navigate disagreements with your insurance adjuster and pursue a fair resolution to your claim.