On September 7, 2022, Wheeler, DiUlio & Barnabei hosted the ninth installment of their 12-part webinar series, The Perfect Claim. The goal of this series is to discuss the entire claims process from start to finish so viewers can learn how to resolve claims more efficiently. This webinar specifically focused on how to handle problems that arise when filing a claim.

In Handling Problems During a Claim, Partner Anthony DiUlio discussed ways to navigate common mishaps during the adjusting process. He also listed policy language that is commonly missed and identified what to do when you’ve exhausted most of your options.

Common Problems During the Adjusting Process

There are many problems that may arise during the claim adjusting process. The number one issue includes delayed responses. Some of the other most common problems are:

  1. Interpreting the policy language wrong
  2. Ignoring important information
  3. Refusals for items like reinspections or sending experts to evaluate the damage

The previous list is not all-inclusive. There are plenty of other claims that may present difficulties such as the following:

  • Tenant issues
  • Vandalism or theft
  • Frozen pipe claims
  • Stucco or siding claims
  • Vacancy or under construction

Handling Adjusting Process Problems in General

When problems appear during the claim adjusting process, it is critical to remember your goals for filing the claim. In responding to such hurdles, being reasonable and avoiding accusations are crucial to supporting your position.

Both of these actions are just as important in speech as in written conversations. Although heated conversations may come about when dealing with these issues, being reasonable and placing your goals at the forefront can help reduce the risk of any other hiccups, delays, or refusals during the process.

Most importantly, remember to ask questions and use those questions to your advantage. One of the best questions to ask the carrier is, “What could I provide you with to approve the claim?” This type of question places the ball on the carrier’s side and is more likely to generate a valuable result than if asked in a defensive way. For example: “What can I give you to change your mind?”

Another way of handling problems is to involve the insurance department. However, insurance departments do not care about coverage disputes; the insurance department only cares when there is a statute violation, such as a violation of the Unfair Claims Practice Act. Playing lawyer will not help your case. But reading the policy and being able to cite the statutes will provide support for your claim.

Lastly, social media is your friend and your carrier’s enemy. Use social media reviews to your advantage. Carriers are afraid of negative reviews, so they are likely to respond to a disapproving comment in a prompt manner.

Dealing With Delays or an Ignoring Adjuster

A delay is the most common problem that occurs during claim filing for numerous reasons. One of those reasons may be that an adjuster is simply ignoring the claim. To overcome this, send follow-up emails often.

Each follow-up should state that you have not received a response yet and that you are asking for one as soon as possible. Also, cite your local Unfair Claims Practices Act. As mentioned, citing the statute sends a message that you know the rules and that you have the exact language that states those principles. This helps to establish credibility.

If the delays remain ongoing, do not be afraid to go up the ladder. Letting the claim go unresolved is worse than attempting to uncover more information from someone in command.

Next, use social media posts and reviews to your advantage. After that, get insurance departments involved. This is one of the biggest pet peeves of adjusters therefore their involvement is likely to push them forward with handling your claim.

Dealing With Refusals

Refusals on claims (such as a carrier refusing to conduct further inspections) is another common issue. To overcome refusals, be prepared to pose questions, especially, “What can I present that would help you see our position?”

If the questions-tactic does not show results, try to go up the ladder. In addition, have an expert inspect the damage anyways and provide the results in a follow-up email with the adjuster. This is another great way to present your case.

Interpretation Errors

While it is critical to have read and understand the policy to the best of your ability, insurance policies are not written to be clear. If you are unsure about what you have read in a policy, seek outside assistance, such as from the Wheeler, DiUlio & Barnabei team.

Furthermore, when following up with the adjuster:

  • Cite relevant policy language
  • Present sources and examples
  • Provide your understanding of how you interpreted the information

Again, do not practice law, but use the law to your advantage. Do not tell the adjusters or carriers they are in breach of the law but rather cite the policy and your interpretation of what is stated.

Policy Misses

Reading each policy is very important as policies are not the same and tend to be inconsistent. Also, policy forms change frequently.

As a Last Resort

When all else fails when filing a claim, there are two paths for your next steps:

  1. Appraisal
  2. Litigation

Not all cases are good for litigation, and not all cases are good for appraisal. Contact an attorney to assist you in your next steps in the claim filing process.

Have any questions about the claims process? Contact our team to learn more from the professionals at Wheeler, DiUlio & Barnabei.