THE SHORT ANSWER
Start with the letter. Find the reason the insurer gives and the policy language it cites. Ask for the adjuster’s full estimate, compare it with a contractor’s repair estimate, and send evidence for each difference in writing. If that fails, you can look at your policy’s appraisal clause, file a complaint with your state insurance department, or get help from a public adjuster or attorney.
Read the decision closely
A denial or payment letter should explain what the insurer decided and why. Mark the reason and any policy section it quotes. Then read that section of your policy yourself.
Separate two kinds of disagreement. A coverage dispute asks whether the policy covers the loss at all. A scope or price dispute accepts coverage but disagrees on what the repairs cost. They are handled differently.
Compare the estimate line by line
Ask the insurer for the adjuster’s complete estimate if you do not have it. Put it beside a detailed repair estimate from a contractor and look for the differences.
- Areas of damage missing from the estimate
- Quantities that do not match your measurements
- Materials that do not match what is on the house
- Steps such as tear-off, disposal, or permits that were left out
Send the evidence in writing
For each difference, send the photo, measurement, or quote that supports it. Ask the insurer to re-inspect if the adjuster missed areas of damage. Keep everything in writing, with dates and copies.
This is the same work a contractor does in an insurance supplement: point to the line that should change and show why.
Know the other paths
Many property policies include an appraisal clause. It is generally used when you and the insurer agree the loss is covered but disagree on the amount. Each side chooses an appraiser, and an umpire settles what they cannot agree on. The wording varies, so read your policy first.
If you believe the insurer handled the claim unfairly, you can file a complaint with your state insurance department. The NAIC notes that the department can investigate at no charge and require the insurer to correct problems it finds.
Watch the deadlines
Policies and state laws set time limits, including how long you have to bring a lawsuit over a claim. Find the deadline in your policy, often in a section on legal action against the insurer, and do not let it pass while you negotiate.
For a large or complicated dispute, a public adjuster or an attorney can help. A public adjuster works on the claim itself. An attorney is the one to call for legal advice or a lawsuit.
Public adjusting
For homeowners and property owners with an insurance claim. We document the damage, prepare the estimate, and present the claim for you.
See Hiraya’s public adjusting