On July 20, 2022, Wheeler, DiUlio & Barnabei hosted the seventh installment of the 12-part webinar series, The Perfect Claim. The goal of this series is to discuss the entire claims process from start to finish so attendees can learn how to resolve claims more efficiently.

In Presenting the Claim, Partner Anthony DiUlio discussed how to present the claim to the insurance company. As part of his discussion, he explained how to present the claim in a way that maximizes the chances of it being covered and provides the best results for the client.

Goals of the First Joint Inspection

There are three main goals to keep in mind when approaching your first joint inspection with the adjuster:

  • Set expectations
  • Limit work for the carrier
  • Provide proof

Set Expectations

Setting expectations proves that you, the insured, understand and have reasonably determined the value of the damage. In addition, setting expectations can determine how easy or difficult it will be to generate a result.

It is important to note that setting the reserve is the most important aspect of the claim. Insurance carriers do not want to change the reserve amount for recovering the loss after setting the initial amount. Utilize a negotiating technique called anchoring to make sure the carrier is setting an appropriate reserve amount upfront. This entails the insured setting an initial value of the claim in the carrier’s mind to set the tone for the carrier in gauging the value of the loss.

Limit the Work For the Carrier

Second, limit the work for the carrier. If you give the carrier everything they need without their team having to take on the heavy work, the carrier is more likely to deliver results benefitting the individual filing the claim.

Provide Proof

Thirdly, provide as much proof as possible. Having physical evidence, including photos, videos, etc., will give the carrier a reason not to deny your claim right away. The insured will also have a much better chance of receiving a positive outcome.

Documentation for Presenting the Claim

As mentioned in previous webinars, documentation matters and is crucial in presenting the claim. Carriers are looking for holes, undisclosed issues, and any other reason to deny a claim.

Having documentation accessible is critical for preventing an immediate denial of your claim. The documentation should be delivered in a manner that is easy to understand and easy to follow so the carrier can justify paying for those expenses.

Types of documentation include:

  • Estimates – Estimates, such as ones that come from sources like Xactimate, T&M, or contractors, set a base amount for the carrier to build upon.
  • Photo reports – These should show side by side visuals of the damaged areas as well as written descriptions of the damage.
  • Causation reports – This may be the most important report as they limit the amount of emphasis the carrier may place on sending their evaluators out for inspection. These can include roofing or plumbing reports.

All three documentation types make a claim harder to dispute or reject by outlining the damage in detail. In turn, this makes the carrier’s job easier.

Presenting the Claim

How an individual presents the claim to the adjuster is just as important as properly documenting the claim. A best practice in presenting the claim includes the creation of a presentation packet for consistency and ease of use. A presentation packet further establishes credibility for the claimant.

The packet should be professional and follow an organized approach with a separate folder for each claim or loss. This packet will make the rest of the process easier if done correctly.

Building Trust With Carriers

Documentation goes a long way when filing a claim. However, carriers are also more receptive to individuals they trust. Do not give carriers a reason to be skeptical of you or your claim. Trust is built with consistency and maintaining a relationship with the adjusters.

Adjusters are more likely to work with you, and less likely to fight back, if you are reasonable, can explain each part of your claim, show give and take, and give them what they ask for. Ultimately, establishing trust can also help if the insured faces backlash from the adjusters.

Changing the Adjusters Mind

Changing the adjuster’s stance when he or she has already made up their mind or disagrees with the claim is not an easy task. However, it is not impossible. Here are some do’s and don’ts for changing the adjuster’s mind:

Do:

  • Be polite, clear, and succinct
  • Cite to proof with the policy and pictures
  • Use the indisputable facts against them
  • Use questions to get them to your answer

Don’t:

  • Tell them what is right and what is wrong
  • Be rude, long-winded, or cross
  • Tell them they are wrong
  • Tell them what to think

With the above concepts in mind, you can get coverage and provide your clients with the best results. Have any questions about the claims process? Contact our team to learn more from the professionals at Wheeler, DiUlio & Barnabei.