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

A cash settlement is the carrier paying the customer rather than managing the repair. The money sits in the customer's account and every decision after that is theirs, including whether you get paid.

Understand the two-check structure. On a replacement-cost policy the carrier typically issues the actual cash value first, which is the replacement cost less depreciation less the deductible. The remaining depreciation is recoverable, released only after the work is actually completed and documented with a final invoice. Customers routinely see that first check, compare it to your estimate, and conclude you are overcharging. Walk them through it once, early, on paper. The estimate total is not the first check.

Watch for the mortgage company. On larger losses the lender is a named payee and the check cannot be cashed without their endorsement. Many lenders then release funds in draws tied to inspections. This adds weeks, sometimes more, and it is the single most common reason a fully approved job stalls at the funding step. Ask at the first meeting whether the mortgage holder is on the check, and build the payment schedule around it.

Do not price to the check. The customer will ask you to "just do it for what insurance paid." If the carrier's scope is short, the answer is a supplement with documentation, not a quiet reduction in what you install. Silently cutting scope to match a number leaves the customer with an incomplete repair they believe is complete, and leaves you owning the failure.

Never absorb or waive the deductible. "We'll cover your deductible" is a felony in many states and is insurance fraud generally, and it is a common recruiting pitch among storm chasers. So is inflating an invoice so the customer nets the deductible back. Say no clearly, in writing if pressed, and put it in your terms so the customer knows the deductible is theirs before work starts.

Get a contract and a payment schedule before you order material. Cash settlement means the funds are already with the customer, and once the crisis feeling passes, some customers decide the money would be better spent elsewhere. Signed scope, deposit at contract, progress payments tied to milestones, final on completion. Do not float a settlement-funded job on your own working capital.

Understand the customer's right not to repair. A customer can take the actual cash value, forgo the recoverable depreciation, and keep the money. That is their decision to make with their carrier. Your job is to document what you recommended and what they declined, decline any request to certify work you did not perform, and move on without pressuring them.

Know your state's rules on assignment. Assignment of benefits, where the customer assigns claim proceeds directly to the contractor, is heavily restricted or regulated in some states after abuse in catastrophe markets, and the form language is often prescribed. If you use an assignment, use one drafted for your state, and never use it as a way to work around a customer who has not really agreed to the scope.

Document at every step. Photos before, during, and after, a final invoice matching the approved scope, and a completion certificate signed by the customer. That package is what releases the depreciation holdback, and without it the last portion of the money never comes.

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