Insurance Claim Process | Home Repair

Insurance Claim Process When Involved in A Home Repair Issue

After 25 years of being in the insurance repair business, I forget how daunting and confusing the whole insurance claim process must be. Homeowners or better known to the insurance repair industry as policy holders, may have one or two experiences with the insurance claim process in their life time..

So when policy holders have a insurance repair claim and it is "covered" ( the term used to explain that the insurance company has accepted that they will pay what is acceptable to bring your damaged home to a pre loss condition.), the insurance claim begins.

Let's go over the steps that usually occur from the beginning to the end of the claims process.

Step 1: Reporting the claim

As you can imagine the first step is to make the phone call to your insurance company. Remember that it's the company not your agent who you should call. For faster service look for the claims phone number instead of the main phone number of the insurance company.

When you get someone on the phone be direct of exactly what the issue is without going into a full description. The person on the phone can only take your information and get a basic idea of what is going on. They may also want to know what the damage was caused by. Remember not to make suggestions on how you think the damage was caused as this may lead the claims office saying that you are not covered. If you aren't sure 100 % then just say that. Again keep it simple and get a claim number.

Depending on the insurance company they may send out a contractor or an adjuster. It's important to understand the differences between a contractor, an adjuster and an insurance agent.

The insurance adjuster is a representative of the insurance company who is responsible to make sure that your claim is settled fairly and is responsible to getting a check to you or your contractor. They make the determination if your damage is covered by the policy language.

A representative contractor is in fact a contractor that is trusted to inspect and photograph the situation . It is not there job to determine if the damage is covered. Only an adjuster can determine coverage. Usually the adjuster is in an office and can make a judgement clearly by the photo's. The representative contractor is not authorized by the insurance company to do the work. As with most states, the homeowner has the right to use the contractor of their choice.

The insurance agent is the person you bought the insurance from. Besides selling you insurance, they do not get involved in the claims process unless you feel you have been treated unfairly.

Step 2: Arranging an inspection

As you can expect, you will arrange an appointment to have the damage inspected. If the damage is days old, you may want to call a water damage restoration clean up company to dry the wet areas. You may not see any wet areas, but if it's a water leak you will have issues such as mold. It only takes 36 to 72 hours for mold to grow.

The insurance company representative will come out and take photo's and measurements. They will determine the amount of damage that is covered. If it's covered they will let you know what they are paying out for the claim. Sometimes they will need to go back to the office and use a software called Xacatamate. This software is used by most insurance adjusters and insurance repair contractors. If you choose a contractor make sure they use this software. If they don't , you will have an up hill battle with the adjuster.

Now I wish I could tell you that the adjuster will contact you about coverage and how much you will get for the claim by the next day. In fact it can take days or weeks. With the adjusters work load especially during or after a storm may cause this issue.

If you hire a professional insurance repair contractor, expect him/ her to get an estimate after inspection to the adjuster within 3 business days. You should contact your insurance repair contractor after 3 days to see if the adjuster received the estimate. Once that happens, it's out of the contractors hand and everyone must wait for the adjuster to make a decision.

Step 3: Negotiation Process

If your contractor uses Xacatamate software and he/she correctly estimates your claim, then there should be no problem. But there are times where there is a difference of opinion between your contractor and the insurance adjuster. An experienced insurance repair contractor knows what to ask for and how to ask for it.

For example an adjuster that I know recently explained how another contractor was upset that he didn't get paid for replacing a floor that included a subfloor. The mistake that the contractor made was to combine both the flooring and the sub flooring in the same price.

Had the contractor separated the two items and priced them as two different items , he would have been paid for the sub floor.

If you have a contractor who has little experience with insurance repair , you may end up waiting weeks for a final answer and getting your house back in order.

Step 4: You've been approved!

Ok you got the call that your claim got approved and now you call your contractor to let him know the good news. If you choose a contractor that doesn't have an Xactamate estimate you'll run into the trouble of not really knowing what exactly you paid for.

With an insurance repair contractor who uses Xacatamate , you will get a break down ( or you should get a break down ) of the work being performed. Use it as a check list of what needs to be done.

Step 5: Completion of Satisfaction

In many cases with projects less than $ 50,000, an experienced and well established insurance repair contractor, will not ask for a deposit to do the work. They know that once the project is finished and you have signed a completion of satisfaction form they will get a check from the insurance company. They may also get paid by what is called a third party check.

In this process, the insurance company sends you the check, but it needs your signature and the contractors signature as well. This process not only protects you the homeowner or policy holder, but also the contractor. In other words it prevents anyone form  "running away" with the money.

The insurance claims process is not as scary as many insureds ( homeowners or policy holders ) believe it can be. Insurance adjusters are also not mean people who's ultimate objective is to save the insurance company money. Just remember this fact. Understand the claims process and understand the rules of the process and your claims experience should be fine.

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