AboutRestoration.com » Disputes with the insurance company
Presented by the Cleaning and Restoration Association

Disputes with the insurance company

We’ll approach this subject from the viewpoint of resolving differences rather than trying to arm someone with facts that can be used to prove your case and ultimately create a bigger rift. The old saying applies “you can win the battle and lose the war.” You might also want to read Working with Adjusters.

So you’re at the point where there is a dispute with the claims representative. You’ve already expressed your concerns and there was not a satisfactory resolution. Hopefully the claims representative did explain to you what the coverage issues were. If not, ask for an explanation. It is always best to remain calm. If you feel like you are about to become angry, excuse yourself and continue the conversation later.

What are your options?

Talk to the Claims Manager
Do not hesitate to contact the claims manager to explain your concerns about the claim if you do not agree with the explanation given by the claims representative after you have given them the opportunity to respond to your questions. You should put your concerns in writing and send them to the insurance company. Provide copies of supporting documents. Also, send a letter and copies of documents to the insurance company’s headquarters, whose address is usually found on the first or last page of the policy. Whether you are working with a company adjuster or an independent adjuster, the letter will go into a file that will be reviewed by a supervisor. When writing letters, be professional and carefully explain your reasoning for your request.

Contact the Department of Insurance

If you do not hear from the insurance company or you’re still convinced that you haven’t been given an adequate response to your concerns, and then you can contact the Department of Insurance (DOI) for further assistance. Each State is different in the way they handle consumer inquiries. One function of the DOI is to investigate inquiries and answer questions related to the handling of claims.

Consult an Attorney

If you’re still convinced that you have not been given an adequate response to your concerns, you can hire an attorney. You will need to provide him/her with a copy of your insurance policy and all other relevant documents. Get your attorney’s fee structure in writing before you give him/her your business. Once you have retained an attorney, the insurance company will no longer talk with you directly. You can remain current on the progress of your claim by insisting that you receive copies from your attorney of all correspondence involving your case. Your attorney must have your approval before committing to any settlement.