Who are the people involved in your property insurance claim?

You may hear titles for a lot of people referenced in connection with your homeowners insurance claim in Florida. Who are they?

VIP Adjusting obviously recommends that you hire an experienced public adjuster to assist you in pursuing your claim for damage to your home so that the process can be explained to you all along, but in the event you haven't done that, it's important to know who all of the people associated with your insurance claim are. 

As complicated as the insurance claim process can be, it can easily become confusing who is who, and what each person can (and cannot) do for you.

Desk Adjuster

We'll start with perhaps the most important person, the "desk adjuster." The insurance company's desk adjuster is the individual assigned to review your insurance claim in-house, including all the photographs, documents, measurements, estimates (both from the independent adjuster and your public adjuster or general contractor). This person usually has not been to the property and works in an office, exclusively reviewing claims. 

The desk adjuster might also be referred to as the "inside adjuster" because they're the person at the insurance company who reviews the claim and makes a recommendation on whether to extend coverage for a claim, and how much to pay.

The desk adjuster often is in charge of editing (read: reducing) the estimate prepared by the independent adjuster according to internal adjusting standards.

The person assigned as the desk adjuster usually also has final authority to settle your claim in-full, subject to internal standards, of course. Sometimes separate authority is needed for claims over certain amounts.

Field Adjuster

The field adjuster is the individual who actually comes to your home and inspects the damages. This person may or may not be a direct employee of the insurance company, and their motives may not always be known. 

The field adjuster is in charge of taking photographs, measurements, and preparing an estimate. As previously mentioned, the field adjuster's estimate may not be the amount of the payment, because it is subject to review and modification by the desk adjuster.

Field adjusters may say things at the property that bind the insurance company. Statements that they're accepting coverage or will pay for certain items are binding on the insurance company, as these individuals have what's referred to as "apparent authority" even if the insurance company tries to claim they have no authority. This is another reason having a public adjuster present at these inspections can be in your favor, and this may become a very contentious subject if the claim requires a lawsuit at a later date.

Independent Adjuster

An independent adjuster is a field adjuster, but they usually aren't a direct employee of the insurance company. Independent adjusters have a certain license in Florida that allows them to work for insurance companies adjusting claims. They may work for themselves, or they may work for a third party adjusting company. They may only handle claims for one insurance company, or may work for several insurance companies. 

Since the independent adjuster's financial interests aren't always known, it's not always possible to know how happy they want to keep your insurance company if they appreciate their paycheck. Yet another reason to have an experienced public adjuster in your corner looking out for your best interests and protecting the value of your claim.

Claim Examiner

Claim examiner is another name for the desk adjuster. 

Ready for us to blow your mind though? Sometimes the people involved in your claim can have multiple roles and these words can be used interchangeably. Sometimes, the desk adjuster/claim examiner can be one in the same as the independent adjuster/field adjuster. 

Third Party Administrator (TPA)

A third party administrator as it pertains to a homeowners insurance company in Florida is an outsourced claims handling operation. Some insurance companies don't have their own in-house claims departments. Certain Underwriters at Lloyd's of London is one such insurance company (technically, Lloyd's isn't an insurance company but a collection of underwriters, but that's another story). Since Lloyd's doesn't have their own claims department, you would report your claim to your agent, who would follow some procedure internal to whichever underwriter holds your insurance policy, and that underwriter would outsource the roles of the claim examiner/desk adjuster and independent adjuster/field adjuster to a third party claim company.

Other times, third party administrators are used by insurance companies who do have in-house claims staff, but who either have more claims than they can handle (like in the aftermath of a hurricane or other natural disaster), or may use a TPA when reviewing a dispute to try to reasonably resolve the claim.

Claim Representative

This is a catch-all term and can refer to any one of the terms so far above. This term is often used by insurance companies who like to send out unsigned letters, usually insignificant, like acknowledging a claim, or acknowledging receipt of a communication related to a claim. Other insurance companies use this term as a cowardly way to send out boilerplate document requests, or to make a letter impossible to respond to.

Customer Service Representative

This is another catch-all term and could be used like Claim Representative above, but is more often just a call center employee who can give you basic information about your claim but has no authority to discuss the merits of your claim. 

These people are sometimes used to placate homeowners who call a lot to prevent them from wasting the time of people who actually move the claims forward, and other times these people are used to frustrate claimants and prevent them from speaking to the people who are handling the claim. 

"Manager"

Sometimes insurance companies will use the term "manager" to make it seem like they are set up like other customer service industries. 99% of the time that is not the case. 

You aren't calling AT&T or Comcast when you call your insurance company. You can't ask to speak to "the manager" when you don't like your payment or don't approve of the decisions, behavior, or professionalism of the desk adjuster/claims examiner, but this person usually doesn't have any authority to overrule the desk adjuster or claims examiner because that's the person in charge of your claim. If you speak to a "manager" you're just being strung along.

We put "manager" in quotation marks because there actually are managers but they're usually behind-the-curtain type folks whose approval is required for claims over certain values. You'll never speak to this person.

Litigation Manager

A litigation manager for an insurance company is the person assigned by the insurance company to represent them as their face if you have to sue to overturn a denied homeowners insurance claim or to challenge a dispute in scope or pricing for a claim. This person is usually very experienced in litigation and often knows what they're doing. Sometimes this person is even an attorney.

You might meet this person if you attend the deposition of the insurance company's corporate representative in connection with litigation, or if you attend a mediation or trial.

Appraiser

An appraiser is an individual, usually required to have some sort of competency, to represent an insured or insurer in the appraisal process to resolve a dispute over the amount of a homeowners insurance claim. An appraiser advocates for the party who assigned them, either homeowner or insurance company, but also works to try to reach an agreeable resolution for the claim. 

Umpire

An umpire is a third-party neutral in the appraisal process. This person is unbiased and if the insurance company and homeowner's appraisers can't reach a resolution on their own, he or she would be available to break the tie by either deciding in one of the two appraisers favor, or somewhere in between. An umpire is a bit like an arbitrator. 

If you’ve found yourself handling your own claim with a rotating cast of characters and feel like you’ve been given the run around, call VIP Adjusting today to speak to one of our public adjusters for a free claim review and consultation.

Resolving Insurance Claims through Appraisal

If your insurance claim is at a stalemate, the appraisal process might be right for you.

You’ve already completed most of the important steps for your insurance claim. Maybe your pipes have leaked and caused damage, or you’ve had a roof leak. The insurance company has inspected, accepted coverage and issued an initial payment. 

You, or your public adjuster have let the insurance company know that the payment was insufficient to fully repair your damages. Maybe you’ve even received a supplemental payment, but at this point, your insurance company doesn’t want to pay you anything else. 

How can you resolve your claim?

What is “Appraisal” when it comes to insurance?

Many people have heard the term appraisal when it comes to buying a house and getting a mortgage. If you’re purchasing a property, an inspector may be required to determine a fair market value of the property to make sure you have enough equity to qualify for the loan. 

When it comes to an insurance claim, appraisal means something else, entirely. Appraisal is a remedy contained in some (but not all!) insurance policies to resolve insurance disputes. It is a conditional provision, in this case meaning it is an optional method of alternative (to a lawsuit) dispute resolution, but if either party demands it, it becomes mandatory.

Appraisal is a bit like arbitration. The result is binding, and absent exception circumstances, is incredibly difficult to overturn. That’s why it’s best to let a professional public adjuster like VIP Adjusting assist you in evaluating your claim and letting you know your options.

Once appraisal is invoked, the insured and insurance company each select an appraiser in accordance with the terms of the insurance policy (this language actually varies from company to company and can restrict who may be chosen for a number of reasons). Once the appraisers are chosen, they select a third party neutral umpire in case the appraisers can’t resolve the claim between themselves. The two appraisers and the umpire are what’s known as the appraisal “panel.”

Agreement by any two of the three members of the appraisal panel set the value, and may also decide and determine the cause of loss for purposes of insurance coverage.

These are a lot of factors. Again, this is all the more reason not to go it alone and make sure you have a public adjuster with experience advising you throughout.

When is appraisal the proper remedy for you?

First of all, in order for this remedy to be the right remedy for you, your policy must contain an appraisal provision. Some insurance companies have appraisal and others don’t. A public adjuster can review your policy with you (or for you), because they can be difficult to read and the provision may be in more than one location.

Next is the most important part of whether to proceed to appraisal; the valuation. What is the dispute? Which rooms? Which damages? What value? What is actually going to be required to do the repairs? Are there significant questions about the proper manner and method of repair to your damage? These are all things to discuss with your public adjuster. 

Only you can make this decision with the help of your public adjuster, and the decision should only be an informed one, because it is binding and very difficult to challenge if the payment is insufficient. 

Another consideration to make is if your insurance company uses a relatively small group of appraisers that are known to your adjuster. This may make it easier to place a probability on the outcome. The most important part of this decision is that you be made whole. Does your public adjuster have the connections in the industry to be able to evaluate this choice properly?

When is appraisal possibly the wrong decision?

If you know, for one reason or another, that you absolutely need “at least $X” to get the repairs completed to make you whole after a loss, and if you come in anywhere under that, appraisal likely is not the appropriate remedy for you. Appraisal is binding. You may not be able to afford to leave the final result up to an appraisal panel.

You also don’t get to have any input into the outcome of the appraisal. Prior to appraisal, you can evaluate the merits of a stalemate by discussing with your public adjuster. You can have your public adjuster try to negotiate a settlement on your behalf and you can decide to take or leave any offer from your insurance company. You can file a lawsuit and, short of trial, can accept or reject any offer made.

In appraisal, however, the panel is supposed to be free from influence from the insured and insurer. This doesn’t always happen, but there’s case law and codes of ethics that govern this process, much like an arbitration. An entire book has been written on the topic, The Law and Procedure of Insurance Appraisal that VIP Adjusting’s public adjusters have read cover to cover and fought for both during appraisal, and in courts around the state of Florida. 

Another time appraisal may not be the right choice is if you know the insurance companies appraisers are particularly difficult and will also make selecting an umpire problematic. This is yet another discussion you can and should have with your public adjuster. 

Your claim is too important to make uninformed decisions

Your insurance company is supposed to make you whole after you’ve suffered damage. With appraisal being binding, it may be the most risky decision you make during the entire process. If you can’t afford the risk of falling short on your claim, appraisal might not be right for you. Making an informed decision with your public adjuster is the best way to protect your assets. 

All of VIP Adjusting’s public adjusters have been certified appraisers at various points by The Windstorm Insurance Network .

Justin Petrie, Esq. is a Florida attorney for over ten years, and licensed public adjuster. In that time he has handled thousands of insurance claims through the insurance claim process, In appraisal, in litigation, at mediation, to trial, and on appeal.

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