When you have an insurance claim, whether it’s an auto claim or property loss, there is a good chance you may end up having to deal with a few different people.  Complex claims such as a house fire could easily involve half a dozen people or more and it’s easy for an insured (you) to get confused as to whose doing what and who’s working for who.  So here’s a handy dandy little list to help sort out some of the people you may end up working with on a claim.  **Keep in mind that many of these people are looking out for you, some not so much, others are basically only looking to screw anyone they can to make a buck.  That being the case, in reality there are truly good people in each category but on the flip side there are also truly bad apples in each category.  So don’t take these descriptions as universal fact, but know that the vast majority of the time these descriptions are going to be accurate.

Your assigned insurance company adjuster.  This person is NOT out to screw you.  Let’s say you are insured with State Farm, Travelers, etc. and you have a claim.  They assign it to an adjuster (like me).  This person is probably paid a salary (sometimes hourly such as in California but that’s a different blog for another day) but really doesn’t have any interest in the true outcome of your claim other than paying you the right amount at the right time.  Adjusting is an art, and calculating the “right amount” at the “right time” is the key here, but for the most part, your friendly company adjuster isn’t out to screw you, they actually want to close your claim as quickly as possible as we are never actually caught up.

Company employed auto damage appraiser.  This person is NOT out to screw you.  This is someone who loves cars and basically looks at vehicle damage all day and every day and writes repair estimates.  Like the company adjuster, they just want to close your claim quickly to move on to the next one.  Auto damage appraisers can be looking at a dozen cars a day sometimes so they have little reason to screw you with a low estimate… it just means they have to do more work down the road.

Independent Auto Appraiser.  This person is NOT out to screw you.  Not every company is State Farm and has people everywhere so some companies hire independent auto appraisers to inspect damage and write estimates.  This person really doesn’t care one way or another, they just want to inspect your damage, write the repair estimate and then send the invoice for their time/expense to the carrier so they can get paid.

The average Enterprise Rent-A-Car representative.  This person is NOT out to screw you.  More than likely this person just recently graduated college (they have a long history of hiring recent college grads) and really just wants to do a good job so they don’t get complaints and find a better job.

The average bodily injury attorney.  This person IS trying to screw you, the insurance company, and anyone else with deep pockets.  The higher the settlement, the more this person makes.  Sure there are some great injury attorneys and there are times when you absolutely should have legal representation if you have been injured.  But if your case is only worth $4,000, and you’re not satisfied with this so you hire the Law Offices of Dewey, Cheetham & Howe and they settle for $5,000… after six months… yea that sounds better since it’s more than $4,000.  But it’s not so great when you get a check for $3,300 because they charged you 33% of the settlement.  These folks aren’t called “Ambulance Chasers” because they like seeing the flashing lights.

Cause & Origin Fire Investigator.  This person absolutely is NOT trying to screw you, or the insurance company.  Almost always a retired fire fighter, these guys (there probably is a woman C&O out there, but I’ve never come across one) really just want to find the cause of the fire.  Then they can help with identifying an at-fault party such as an appliance manufacturer or perhaps the arsonist if intentionally set.  These guys loyalty only rests with the truth.  Sometimes the truth costs insurance companies money, sometimes it helps save us money.  Their integrity is what matters in the end with these guys.

Independent Adjuster.  This person is NOT screwing you, but may be screwing the insurance company.  These people are hired by insurance carriers if they don’t have a field adjuster in your area.  They will inspect your home’s damage, take photos, write up an estimate of repairs, and forward everything to the company adjuster (me) for review.  If anything they will often over-estimate damages because there is less chance that the file will be reopened but also because often the contracts with these adjusters is based on the loss amount.  A $49,000 fire loss may result in a $1,000 invoice to the carrier for their time, but a $50,000 estimate could be worth $1,200 if there is a tier based fee schedule in place.  However in the vast majority of cases, they just want to be accurate and fast so they get paid faster for their time.  Plus they know that lousy independent adjusters don’t get called back for future claims.

Engineer.  This person is NOT screwing you or anyone else.  Insurance companies often need to hire engineers to help determine cause of loss, extent of structural damage, repair options, etc.  We don’t hire fly by night shady engineers, we usually hire well known and established engineering firms who charge a lot because if we end up denying a claim, we need to make sure that our engineer won’t get blown up in court during cross examination so we try to only hire top-shelf firms.  Like the C&O Fire Investigator, this person is more loyal to the truth and wants to keep their integrity intact.

Public Adjuster.  This person is ABSOLUTELY screwing you, the insurance company, and anyone else they need to bulldoze to make a buck.   I’m sure there are some lovely people who are “PA’s” and in the end, I get that they are just doing their job.  But this really is the dark side of insurance claims.  Public Adjusters are kind of like attorneys in that they represent you after a loss, often on property claims vs. bodily injury claims.  Rates are negotiable but it’s not uncommon that they will take 10% or more from your settlement.  Have a $250,000 house fire?  Well, you’re only going to get paid $225,000 after Joe PA takes his cut.  At the end when you realize that you indirectly paid this guy $25,000 for his services, you’ll probably scratch your head and wonder if it was worth it.  Trust me, it likely wasn’t.

Your Plumber.  This is a toss up as to who this person is screwing.  Could be nobody, could be everyone.  Good honest plumbers are hard to find.  But whatever you do, NEVER take the plumber’s referral for the company that can clean up the water damage.

The emergency company recommended by the plumber.  This person is ALMOST ALWAYS screwing the insurance company, and often will have to screw you in the process.

The emergency company recommended by your insurance company.  These guys likely aren’t going to screw you because they know that the insurance company is paying.  They could very well be trying to screw the insurance company but that comes back to why adjusting is an art form.  The “legitimate” emergency companies and insurance companies are in a never ending game of cat and mouse.  They will steal our cheese if we don’t catch them, but if we do, they won’t put up too much of a fight because they still want future work.

The emergency company you found on your own.  Wild card.  Some are great and provide a legitimate service for a “reasonable” price.  Others… not so much.  When I say reasonable, you’ll see their bill for $5,000 and think it’s a rip off, and for the most part I’ll agree but I may still pay it.  Take into consideration that these people will show up to your home at 2:00 am on a Sunday morning to clean-up your basement which had a gross sewer back-up, you can see why they charge so much to begin with.

The General Contractor.  This is truly a wild card also.  I know some great contractors.  And on the flip side, you can’t spell contractor without C-O-N.

Contents Expert.  This person may be screwing you, but it’s probably not on purpose.   If your house burns down, often we hire someone (however some of the bigger carriers may have in-house people who do this) to calculate your contents loss.  This person literally may sit with you for a day and try to capture in a spreadsheet every single item in your home that you lost.  They may not have anything to go by with regards to quality or true replacement cost so sometimes we just have to take average values.  Don’t know how much your sofa cost new because it was 15 years old?  Could be $500, maybe $750, possibly even $1,000.  Just depends on what the contents adjuster comes up with given the limited available information.  Perfect example of garbage in leads to garbage out.

SIU Investigator.  Every insurance company is required to have a “Special Investigation Unit” to try to help identify insurance fraud.  These are often former police or other people with investigative backgrounds.  If they have to get involved, rest assured, they aren’t trying to screw you, they are trying to help us make sure you’re not screwing us.

The doctor your ambulance chasing attorney referred you to.  This person is likely out to screw the insurance company, Medicare, and anyone else footing an inflated bill.  If they are truly shady, you may get caught up in a shady insurance fraud ring and if this happens, you’re screwed.

The chiropractor referred by your ambulance chasing attorney.  Shadier than the doctor but without the medical degree.  Oh, and he can’t bill Medicare so he has to find deep pockets elsewhere.

Your Insurance Company.  These people are VIRTUALLY NEVER out to screw you.  You may think they are screwing you, don’t like it when a claim is denied, and feel that your policy is worthless, but your policy is a contract and we are heavily regulated to make sure that we’re living up to our promise.  Yes, sometimes mistakes can be made and in extremely rare cases we have our own bad apples, but the risk of a bad-faith lawsuit somewhat guarantees that you’re getting a fair shake from your carrier, even if you disagree.

So there’s a good run-down of the most people involved in auto and property claims.  Again, these are just generalizations and there are great people and bad apples in each category.  Feel free to let me know if you have any questions or comments or have had your own insurance loss and want some help getting it resolved quickly.

-Damon

 

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