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How To Deal With A Claims Adjuster When You Disagree On Price or Scope

by Erik Folgate

A reader sent this question to us about a water damage claim she is dealing with that occurred in her home. I was a claims adjuster for three years, and I definitely know that adjusters and insurance companies love to pay the least amount possible for a claim, and they try to get away with as much as possible, hoping that the homeowner won’t push back or question their decisions. It’s the job of the insurance company and the claims adjuster to “indemnify” you, which means they have the responsibility to put you and your home back to its original condition. Here is the question from the reader:

My water heater busted and flooded my kitchen, living room, and den. I had a restoration company come out and remove the water and dry the area. The water only got 1 to 2 inches in the kitchen, but my cabinet warped a little due to the water. The insurance company only wants to repair the side of one cabinet and paint the bottom cabinet. They only want to replace carpet in the den and living room. I cannot match up my carpet with the correct carpet. The adjuster told me to get estimates, so I got several estimates. Later I contacted him and he stated that they were not the correct estimates and he could not understand them. Then he told me to call this Service Master and they gave me an estimate for $3,500. They stated that the cabinets did not need to be replaced however, I have had several contractors tell me that they do need to be replaced. My adjuster sent me a check for $2,500 and I got an estimate for $9,700. I was thinking about hiring an attorney or a public adjuster. Please help me. This is my first home, and I am a single 25 year old female. I think my adjuster is trying to take advantage of me.

This is a common situation, but it can easily be settled without the use of an attorney or a public adjuster. If you hire an attorney or a public adjuster, they will take anywhere from 20 to 40% of the claim settlement. Of course, they’ll guarantee that they get you so much money that it’ll pay for their commission, but they cannot really guarantee that, and it’s not ethical in the first place.

The insurance company sent you money, which is a great thing. This means that they agree with you that the claim is covered under the policy. So, the only difference you have is on price and scope. You disagree on how much the claim is worth, and you disagree with how and what should be replaced and repaired (scope of the loss). Scope and price can be negotiated with the claims adjuster, but you must put time and effort into it, and you must be persistent while maintaining a professional demeanor. As long as the claims adjuster didn’t get you to sign a release of liability form, then the check you received means nothing. All it means is that $3,500 is the “undisputed amount”, meaning that you and the adjuster both agree that the claim is worth AT LEAST $3,500. You can deposit that check without it being an admission of liability. But never sign anything saying that you agree that the $3,500 is the final settlement.

As far as the cabinets, you’ll probably need to concede thiis point. Cabinets can easily be repaired without requiring them to be fully replaced. Any good cabinet repairman can put your cabinets back to their original condition. Regarding the carpet, this is the area where you can negotiate with them. If the carpet runs continuous from the living room and den to other parts of the house without a break in the carpet, then the insurance company owes to replace all of the continuous areas. They cannot expect you to accept a “patch job” on carpet. Tell them that this isn’t indemnifying you. That word will get their attention that you know what you’re talking about.

The point is that you can negotiate the claim yoursef and continue to get competing bids. If they continue to be stubborn, then threaten to file a complaint with the state financial department. They will then give you the option of going to an “appraisal” which is a dispute of price and scope with a neutral mediator. This mediator often sides with the policy holder as long as you have legitimate reasons for your dispute.

I hope that answers your question! Anyone else want to weigh in on this?


Erik and his wife, Lindzee, live in Orlando, Florida with a baby boy on the way. Erik works as an account manager for a marketing company, and considers counseling friends, family and the readers of Money Crashers his personal ministry to others. Erik became passionate about personal finance and helping others make wise financial decisions after racking up over $20k in credit card and student loan debt within the first two years of college. Another one of Erik's projects is the site, Stuff We Google.

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Comments

  • http://www.FabulouslyBroke.com FB @ FabulouslyBroke.com

    Wow, good to know for future reference, if I ever have a problem.

    My brother just had his basement flood.. and the claims adjusters actually didn’t put up a fight this time.

    They did the last time, and he did something similar to what you are outlining above.

  • http://www.financialsamurai.com Financial Samurai

    Thanks for your thoughts. I’m just waiting for my own water heater to bust and flood my basement. That’s the downside to buying a historical house.

    Sounds like the best thing to do is have an open dialogue and just negotiate calmly.

  • http://www.moneycrashers.com Erik

    Yes, stay calm and negotiate calmly with the adjuster. You can avoid getting a third party involved, you just need to be stern, know your policy, and make rational demands.

  • Perfectiming!

    Erik your post is on perfect timing!

    My Brooklyn, New York home just experienced a (4-5 inche high) water flooding from a pipe burst (boilder) in my basement (800sq). The adjuster is extremely rude, inpatient & totally far from customer freindly. But i have maintained my professinalism and cool through out the process. Of course items that have been in my (fairly used) basement have no receipts or old checks i can prove purchase price. But the way he is sticking me for repair cost make me really think twice on how much he has appraised things. Even my wedding dress (23 yrs old) was in the basement and all he gave me for the repair of the water damaged dress was $120!

    Your experience and expertise is exactly what i need right now. PLEASE!

    Also, reading my policy and knowing what i should be entitled to has been more than what a 62yr old workingc (nurse), widowed woman can handle.
    please help i truly feel i am being taken for granted in my situation.

  • Erik Folgate

    I am really sorry that you have to go through this, and that your adjuster is not being professional. You have done everything right up to this point. Regarding your personal items, you should not need to provide receipts or proof of purchase for items that he can PHOTOGRAPH and document himself to research replacement cost value. Now, every state is different, and every standard homeowner’s insurance policy is different. In Florida, most standard forms include Replacement Cost Coverage which means that your personal items should be replaced at today’s current replacement value of something of like-kind and quality.

    Also, do you have children that could help you with the claims process? If you have a child that you trust will be more forceful and be able to negotiate with the adjuster better, you can type up a letter and sign it stating that you would like someone else to represent you for the claim. You MUST be proactive with the claim or they will try to get away with the bare minimum that they feel they owe. Don’t ever sign a release of liabiity form. As long as you never sign a form like that, you always have the right and ability to dispute the price and scope of a loss.

  • Alex Jones

    Reputable public adjusters
    like Adjusters International only charge about 10$ of the claim settlement.

  • Alex Jones

    Sorry about that. I meant 10% not 10$.

  • Bart

    I have a friend who has been living overseas for some time. Since then I have been watching his house and locating teneants and such. Recently several pipes broke due to a failure of the boiler while the tenants were out of town.

    When the tenants arrived they contacted me about flooding in the house. I immediately went over shut down the main. Took photos of everything to include the temperature of the house.The following day I spent from 8am to 8pm working with the plumber fixing pipes cutting holes in the wall etc. While doing so I documented each day. I also contacted a water mitigation company soon after the plumbers stopped the leaks and I was able to restore heat in the home. After stopping any further damage I then interviewed and got quotes to repair the damage (walls carpet etc). I was also in contact with the adjuster from day 2 (took time to get a hold of him). I submitted invoices for the different companies brought in to do repairs, I also submitted an invoice for the work I did cordinating and assisting in repairs of the house. I figured I lost 3 days of work to put all this together, do repairs along side the plumbers to include repairing the HRV etc.
    Any reason the adjuster shouldn’t accept my invoice? Just wanted an opinion since in my mind all the work I put in likely saved the insurance company by wuickly preventing further damage and there was no need for the company to hire a third party adjuster. What your thoughts. Should I get renumerated for my efforts?

  • Bruce

    Greetings,

    I have had a similar experience with regards to some minor flooding in my kitchen due to the ice maker supply line leaking. One of the things that the adjuster wrote up that needed replacement was a 24″ base cabinet adjacent to the fridge that was damaged, beyond repair. The issue is that I have Thermofoil cabinetry and the new Thermofoil base cabinet doesn’t match, even though it’s ‘white’, to the rest of the older cabinets. There is a very obvious coloration difference and it’s impossible to find a Thermofoil color in a new cabinet that will match the older ones because unfortunately Thermofoil is known to yellow over time. The cabinet frames are fine, but I don’t know if I should press the adjuster to settle for replacing the cabinet doors so it all matches right. If they were wood or painted cabinets, it would be easy to match, but this Thermofoil product is not conducive to being replaced and having it match existing older Thermofoil.

  • http://www.fastclaim.net nancy dominguez

    anyone who is having a dispute should hire an experienced and ethical public adjuster to review the claim. there are alot of good reasons not to represent yourself in a contract dispute – number one – it’s personal and you can’t help getting emotional about your own home.

    number two..and experienced PA is going to write an appropriate estimate that will take all of your damages and available coverage into consideration. They will also know how to steer you through the dispute resolution process. If you had to go to court.. you’d take an attorney.. if you had a health issue, you’d see a doctor. If you have an insurance claim you should counsel with a good PA..

    But don’t take my word for it… Florida’s Office of Program Policy and Government Analysis (kind of like the CBO) found that people who hired public adjusters generally received 547 higher settlements on regular claims – on catastrophic claims – a good PA can net you over 700% more.

    here’s the report http://www.oppaga.state.fl.us/MonitorDocs/Reports/pdf/1006rpt.pdf

  • A M Dadabbo

    Hi Erik,
    I have an insurance claim I have a question about. My roof recently started leaking and there is damage to the soffit over one section of my kitchen cabinets. Contractor (who works with insurance companies often) had a cabinet company come out to get an estimate on replacement of all kitchen cabinets to submit along with estimate for entire claim. The insurance company is agreeing to replace the section of cabinets that are under the damaged soffit only. (My cabinets are original 1959 home) Is this standard practice? Not sure they will be able to accurrately match what is currently there since they are over 50 years old!!

  • David Ramsey

    I have recently had water damage in my kitchen and half of the lower cabinets, about 12 ft, had to be removed. The kitchen is 5 years old, and the claims adjuster is saying the industry standard is not to match or replace the upper cabinets, only the lower. Seems odd to me, so I ask, is this normal??

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