Frequently Asked Questions

Your insurance agent serves as your advocate and advisor throughout the claims process. Understanding this role helps you leverage their support effectively.

Agent’s role in claims:

Initial reporting: Helping you report claims correctly and completely.

Coverage guidance: Explaining what coverage may apply to your situation.

Process navigation: Guiding you through the claims process.

Communication: Facilitating communication between you and the insurer.

Advocacy: Representing your interests in disputes or negotiations.

Documentation: Helping you prepare necessary documentation.

When to involve your agent:

Immediately: Contact your agent when any incident occurs that might result in a claim.

Coverage questions: When you’re unsure whether something is covered.

Problems: When you’re having difficulties with the claims process.

Disputes: When you disagree with the insurer’s position.

Complex claims: When claims involve significant amounts or complexity.

What agents can do:

Expedite handling: Push for faster claims processing.

Clarify coverage: Help interpret policy language.

Escalate issues: Take problems to higher levels within the insurance company.

Provide context: Give the insurer context about your business and situation.

Negotiate: Help negotiate claim settlements.

Agent limitations:

Not the decision-maker: Agents don’t make coverage or payment decisions.

Not adjusters: Agents don’t investigate or value claims.

Carrier relationship: Agents must maintain relationships with insurers too.

Not attorneys: For legal disputes, you may need legal counsel.

Building an effective relationship:

Communication: Keep your agent informed about your business.

Proactive contact: Reach out before issues become problems.

Documentation sharing: Provide information your agent needs.

Feedback: Let your agent know how claims are being handled.

A good agent is a valuable resource in claims situations. Use them.

The first hours after property damage are critical for safety, loss mitigation, and successful insurance claims. Taking the right steps protects people and your claim.

Immediate priorities:

Ensure safety: Evacuate if necessary. Don’t enter unsafe structures.

Call emergency services: For fires, injuries, or ongoing emergencies, call 911.

Secure the premises: Prevent unauthorized access that could cause additional loss or injury.

Shut off utilities: If safe to do so, turn off water, gas, or electricity that could cause further damage.

Prevent further damage: Take reasonable steps to mitigate ongoing damage (tarps on roofs, boarding windows).

Documentation:

Photograph everything: Take extensive photos and videos before cleanup begins.

Document conditions: Note weather, time, and circumstances surrounding the damage.

Preserve evidence: Don’t throw away damaged items until the adjuster has seen them.

Witness statements: Get contact information from anyone who saw what happened.

Written record: Write down the sequence of events while fresh in memory.

Notifications:

Insurance agent or carrier: Report the loss as soon as possible.

Landlord: If you lease the space, notify the property owner.

Utilities: Report utility-related damage to providers.

Local authorities: File police reports for theft, vandalism, or suspected arson.

Mitigation expenses:

Reasonable efforts: Policies require you to take reasonable steps to prevent further damage.

Keep receipts: Emergency repairs, temporary barriers, and mitigation costs may be reimbursable.

Document decisions: Record why you took specific mitigation actions.

Don’t over-repair: Emergency mitigation is different from permanent repairs; wait for adjuster approval for substantial work.

The steps you take immediately after damage directly affect your claim outcome.

Public adjusters are licensed professionals who represent policyholders in insurance claims. Unlike company adjusters who work for insurers, public adjusters advocate for your interests.

What public adjusters do:

Claim preparation: Document and prepare your claim for submission.

Negotiation: Negotiate with the insurance company on your behalf.

Valuation: Develop detailed valuations of your losses.

Policy interpretation: Help you understand your coverage and rights.

Advocacy: Represent your interests throughout the claims process.

When to consider a public adjuster:

Large losses: Significant claims justify professional assistance.

Complex claims: Business interruption, large property losses, or complicated situations.

Disputes: When you disagree with the insurer’s valuation or coverage determination.

Time constraints: When you can’t dedicate time to managing the claim yourself.

Denied claims: When you believe a denial was improper.

Public adjuster fees:

Percentage basis: Most charge a percentage of the claim settlement, typically 5-15%.

Fee timing: Usually paid from the claim proceeds.

Negotiable: Fees may be negotiable, especially for larger claims.

State regulation: Many states regulate public adjuster fees.

Selecting a public adjuster:

Licensing: Verify they’re licensed in your state.

Experience: Look for experience with your type of loss.

References: Check references from past clients.

Contract review: Understand the fee structure and terms before signing.

Reputation: Check reviews and any complaints with state regulators.

Alternatives to public adjusters:

Your agent: Your insurance agent can advocate on your behalf.

Attorney: For coverage disputes, an insurance attorney may be appropriate.

Self-representation: For straightforward claims, you may not need professional help.

Public adjusters can be valuable for complex claims but aren’t necessary for every situation.

Understanding policy exclusions helps you identify coverage gaps and avoid surprise claim denials. While exclusions vary by policy, certain types of losses are commonly excluded.

Common liability exclusions:

Intentional acts: Damage you cause deliberately isn’t covered.

Contractual liability: Liability assumed by contract beyond what you’d have anyway (though many policies add back coverage for common contracts).

Professional services: General liability excludes professional errors; professional liability covers these.

Pollution: Standard policies exclude pollution; separate environmental coverage is needed.

Employment practices: GL excludes employee claims; EPLI covers these.

Auto accidents: GL excludes auto liability; commercial auto covers this.

Common property exclusions:

Flood: Standard property policies exclude flood; separate flood insurance is needed.

Earthquake: Excluded in most areas; separate coverage available.

War and terrorism: Generally excluded, though some terrorism coverage is available.

Nuclear hazards: Excluded from standard policies.

Wear and tear: Gradual deterioration isn’t covered.

Equipment breakdown: Mechanical/electrical failure often excluded; equipment breakdown coverage fills this gap.

Cyber: Data losses increasingly excluded; cyber policies cover these.

Workers’ compensation exclusions:

Intoxication: Injuries caused by employee intoxication may be excluded.

Intentional self-injury: Self-inflicted injuries aren’t covered.

Violation of law: Injuries during commission of crimes may be excluded.

Non-work injuries: Injuries outside the course of employment.

Addressing exclusions:

Specialized coverage: Many exclusions can be addressed by purchasing specific coverage types.

Endorsements: Some exclusions can be removed by endorsement.

Alternative risk transfer: Self-insurance or captives may address uninsurable risks.

Risk management: Controlling excluded risks reduces exposure.

Review your policies to understand exclusions and ensure appropriate coverage for significant exposures.