Working With Insurance Adjusters Reference

Why this matters

Insurance work is significant in many service trades - water damage restoration, roofing storm damage, fire damage, theft, vandalism. Adjusters control the customer's reimbursement; how you interact affects your customer + your business. The tech who understands adjusters works smoothly with them. This is the field card.

The players

Customer: policyholder; has the claim

Insurance company: pays claim per policy

Adjuster: investigates + values the claim

Public adjuster (sometimes): represents customer; not insurance company

Contractor (you): estimates / performs repair

Restoration company (often involved): water/fire/mold remediation

Customer pays you; insurance reimburses customer (or pays you directly via assignment).

How a claim typically works

1. Customer reports loss to insurance
2. Insurance opens claim
3. Adjuster visits property (in person OR remote)
4. Adjuster scopes damage + writes estimate
5. Customer gets quotes from contractors
6. Contractor performs work
7. Customer / contractor submits invoice
8. Insurance pays per policy (after deductible)

Some variations: assignment of benefits (AOB) - customer assigns claim payment to contractor directly.

Adjuster types

Staff adjuster:

• Employed by insurance company
• Handles routine claims
• Industry-standard pricing

Independent adjuster:

• Hired by insurance company per claim
• Often catastrophe / overflow work
• May have less local knowledge

Public adjuster:

• Hired by customer
• Advocates for customer (against insurance interests)
• Paid percentage of settlement
• Sometimes creates tension with insurance adjuster

Initial interaction

When you arrive + adjuster is present OR expected:

Be professional:

• Introduce yourself + company
• Provide license / insurance info
• Reference customer's claim number

Cooperate fully:

• Show your work
• Answer questions factually
• Don't argue scope

Document independently:

• Your photos
• Your measurements
• Your assessment

Your role

You are NOT:

• The insurance company's contractor
• Bound by adjuster's pricing
• Required to accept adjuster's scope

You ARE:

• The contractor customer hired
• An independent professional
• Documentation source

Scope of work disagreements

Adjuster's estimate may differ from yours:

Common reasons:

• Adjuster sees less damage
• Adjuster uses unit pricing (Xactimate)
• Adjuster doesn't know local labor costs
• Adjuster missed hidden damage

Response:

• Document additional damage with photos
• Provide your scope with line-item detail
• Communicate with adjuster (not customer in middle)
• Offer to meet on-site if differences significant

Pricing systems

Insurance industry uses standardized pricing software:

Xactimate (Verisk):

• Most common
• Updated regularly with regional pricing
• Line-item pricing for each task
• Customer / adjuster can verify

Symbility:

• Competitor to Xactimate
• Similar function

Simsol:

• Less common

If you submit estimates in these formats: easier integration with adjuster's process.

Supplemental claims

Often initial scope misses things:

• Hidden damage discovered during work
• Code upgrades required (insurance covers if in policy)
• Material delays + price changes
• Mistakes in initial estimate

Supplement:

• Document new finding
• Submit to adjuster
• Photo / video proof
• Receipt of pricing
• Time of discovery

Most insurance accepts supplements with documentation; some push back.

Code upgrades

Per "ordinance + law" coverage (in policy):

• Bringing existing damage up to current code
• Sometimes covered; sometimes not
• Check policy language

Examples:

• Roof requires upgraded vents
• Plumbing requires new copper supply line
• Electrical upgrade to 200A
• Insulation to current R-value

Customer may not know they have this coverage; help them check.

Customer education

Customer typically doesn't know:

• How to read their policy
• What's covered vs not
• Deductible mechanics
• Replacement cost vs actual cash value
• Coinsurance penalties
• Claim impact on premium

You can help educate within reasonable scope; ultimately their policy + carrier's interpretation.

Communication best practices

With customer:

• Their carrier's decisions are final
• "Insurance is saying " - relay factually
• Don't argue with carrier in customer's presence
• Help customer advocate if they're being mistreated

With adjuster:

• Professional
• Document-based
• Reasonable + cooperative
• Push back on incorrect findings

Documentation:

• Photo before, during, after
• Time-stamp
• Receipts for materials
• Labor records
• Communication log

Avoiding insurance fraud

Things to avoid:

• Inflating estimate ("insurance is paying anyway")
• Including unrelated work in claim
• Misrepresenting damage source
• Backdating documents
• Forging signatures

Insurance fraud = criminal. Don't.

Customer's deductible

Standard practice:

• Customer pays deductible
• Insurance pays remainder

Some contractors offer to "waive the deductible":

• Reducing your invoice to match (lying about cost)
• Charging customer for items not in invoice
• Both = fraud

Customer should pay actual deductible per policy.

When the customer's coverage is denied

Insurance can deny:

• Damage isn't covered (specific exclusion)
• Pre-existing damage
• Improper maintenance
• Customer's policy lapsed
• Material misrepresentation

If denied:

• Customer may appeal
• Customer may hire public adjuster
• Customer may litigate
• Customer pays out-of-pocket

Your work proceeds based on customer's decision.

Storm damage scenarios

Storm caused damage:

• Roof damage from hail / wind
• Tree fall through structure
• Water intrusion

Process:

• Customer files claim
• Insurance investigates
• Sometimes large catastrophe = special teams + procedures
• Customer needs reliable contractor while many others competing

In catastrophe areas:

• Out-of-state "storm chasers" often arrive
• Some legitimate; some fly-by-night
• Customer should choose established local

Restoration company collaboration

For water / fire / mold:

• Restoration company often dispatched first
• Mitigation work (drying, demo)
• Then reconstruction (you?)
• Two distinct phases; sometimes same company; sometimes different

Coordinate:

• Restoration finishes their phase
• Documents to support claim
• You take over for reconstruction

Multi-contractor claims

For large losses, multiple trades:

• Roofer + drywall + HVAC + electric + plumbing
• Insurance adjuster oversees
• General contractor (GC) often coordinates

Your scope:

• Within your trade
• Coordinated timing
• Submit your invoice separately OR through GC

Cash settlements

References

• Xactimate (Verisk) training resources
• NICR (National Insurance Crime Bureau) anti-fraud
• State insurance commissioner regulations
• IICRC restoration standards
• Manuall internal: Insurance Claim Work, Documentation Discipline