Working with Insurance Claims Reference

Why this matters

Storm damage, water damage, fires, and other claims-driven work create a different service workflow than ordinary repair. The customer is dealing with their insurer; the contractor coordinates between the two. The trade who understands the process gets paid faster + delivers cleaner service for stressed customers. This is the field card.

The basic claim flow

1. Loss event: damage happens (storm, leak, fire, etc.)
2. Customer reports to insurer: opens a claim with a claim number
3. Adjuster assigned: insurance company sends adjuster to assess
4. Estimate: adjuster's scope of damage + dollar value
5. Customer chooses contractor: usually free to pick within state law constraints
6. Contractor's estimate: detailed scope + dollar value
7. Negotiation / supplements: contractor + adjuster reconcile differences
8. Work: contractor performs
9. Payment: insurance pays per terms (usually direct to contractor OR via customer)

Different damage types follow this rhythm with variations.

Common claim categories

Water damage: most-common residential claim. Burst pipe, supply line leak, appliance failure, storm intrusion.

Fire damage: structural + smoke + soot remediation. Often coordinated with restoration company.

Storm / wind damage: roof + siding + window damage.

Hail damage: roof + cars + outdoor equipment. Hail-prone regions have hail-specialty contractors.

Lightning damage: HVAC equipment, electrical panel, electronics; whole-house often.

Pipe burst (frozen): cold-climate winter event.

Sewer backup: often excluded by basic policy; specific endorsement needed.

Mold remediation: complex coverage (sometimes excluded; sometimes covered).

Each category has typical adjuster + contractor patterns + pricing references (Xactimate is industry standard for adjuster estimates).

The Xactimate factor

Most insurance adjusters use Xactimate (or competitors like Symbility) to generate estimates. Contractors who use Xactimate themselves match the adjuster's pricing structure + reduce negotiation friction. Some contractors price separately + work to reconcile.

Knowing how Xactimate works:

• Line-item by trade (drywall sq ft, paint sq ft, etc.)
• Regional pricing database updated monthly
• Specific codes for each operation
• Output: detailed scope document

For high-volume insurance work (restoration companies, roofing in storm season), Xactimate proficiency is essential.

Documentation discipline

Insurance work demands thorough documentation:

• Pre-work photos: damage as found, multiple angles, dated
• Material specifications: what's being replaced, with what
• Customer-side documentation: signed authorization, signed scope, signed completion
• Daily progress photos on multi-day jobs
• Receipts for any materials (especially for billable supplements)
• Final invoice matching the scope

Skipped documentation = denied supplements + disputes later.

Insurance vs cash work - different priorities

Cash customer: cheapest fix usually wins. Customer's money; they decide trade-offs.

Insurance customer: insurance pays for "like kind + quality"; restoration to pre-loss condition. Cheaper fix may not be the right answer - the customer is entitled to the equivalent of what they had.

This is the key mental shift: don't try to "save money" for an insurance customer. Restore to the appropriate standard + bill accordingly.

Supplements (additional billing during job)

Discoveries during work that weren't in the original estimate become supplements:

• Hidden damage uncovered during demo (mold behind wall, rotted subfloor)
• Code upgrades required (new install must meet current code; old install was grandfathered)
• Material substitutions when original isn't available

Each supplement requires:

• Photos
• Detailed description
• Justification (often code citation)
• Customer signature acknowledging
• Adjuster review + approval

Supplemented work paid after approval; contractor takes on the risk if supplement is denied.

Deductibles

Customer pays the deductible to insurance OR contractor. Common deductibles range from low for water claims to higher for wind/hail in storm-prone areas.

Contractor MUST collect the deductible - illegal to waive in most states (insurance fraud). Customer may negotiate the timing but the deductible is theirs to pay.

"I want it like new"

Customers sometimes ask for upgrades during a claim - "while we're here, can you put in a nicer floor?" Insurance pays for restoration to pre-loss condition. Upgrades:

• Customer pays the difference between insurance scope + upgrade
• Document the choice clearly to avoid post-job disputes
• Separate invoice / line items for insurance-covered + customer-paid portions

Don't bundle upgrades into the insurance billing. Fraud risk.

Public adjusters

Independent of the insurance company; advocate for the customer. Customer hires + pays a percentage of the settlement. Common in larger losses where the insurance company's adjuster + customer disagree significantly.

Don't recommend public adjusters reflexively (they take 10 - 30% of settlement); they're appropriate when adjuster's scope is clearly under what's needed.

Common customer pain points

Adjuster's scope is too low: contractor + customer document additional damage, request supplement.

Insurance delays: adjuster slow, claim department slow, contractor waiting for approval. Customer frustrated. Communicate frequently.

Cash settlement vs repair: some policies pay customer who then chooses to repair OR not. If customer takes cash + spends elsewhere, your work isn't happening. Lock in customer commitment before scheduling.

Mortgage company involved: large insurance checks may require mortgage company endorsement. Adds days to the payment cycle.

Multiple-trade claim: roofer + drywall + paint + flooring all involved. Lead contractor coordinates OR each works independently. Communicate which.

Don't do this

• Storm-chasing fraud: door-to-door storm sales by out-of-state contractors during disasters; often poor work + scam. Customer should choose locally established + insured contractors.
• "Free roof from insurance": misleading pitch; customer still pays deductible + needs damage to be insurance-covered.
• Waiving deductibles: illegal.
• Inflating scope: insurance fraud; contractor + customer can both face charges.
• Working without permit when permit required: insurance can deny claim later.

Communication with the adjuster

References

• Xactimate / Symbility estimate standards
• IICRC standards (water damage, fire, mold)
• State insurance + contractor regulations
• NACHI / RCI roofing inspection standards
• Restoration Industry Association (RIA) certifications
• Manuall internal: Customer Documentation Discipline, Mold Remediation Basics