How to Spot When Your Insurance Adjuster Is Undermining Your Claim

Insurance adjusters play a pivotal role in the claims process, acting as the bridge between policyholders and insurance companies. While their job is to assess damage and facilitate fair settlements, their primary loyalty lies with the insurer—not the policyholder. This conflict of interest often leads to insurance claim denial, severe underpayment, or drawn-out delays that leave property owners struggling to recover.

Understanding the tactics adjusters use to minimize payouts is essential for property managers, commercial contractors, and facility managers handling large-scale claims.

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How Insurance Adjusters Undermine Claims

Insurance companies profit by collecting premiums and paying out as little as possible on claims. Adjusters are trained to achieve this goal through a variety of subtle and strategic methods, including:

1. Inconsistent Assessments

One of the most common signs of claim manipulation is inconsistent damage assessments. An adjuster may initially provide an estimate for repairs, only to later present a significantly lower figure without clear justification. This discrepancy can confuse policyholders and pressure them into accepting less than they are owed.

2. Delays in Communication

Prolonged response times are a deliberate strategy used to frustrate policyholders into giving up or accepting a lower settlement. If your adjuster repeatedly misses deadlines, requests redundant paperwork, or provides vague excuses for delays, they may be intentionally stalling your claim.

3. Vague or Misleading Explanations

Adjusters often use ambiguous policy language to justify claim denials or underpayments. Terms like “normal wear and tear” or “pre-existing conditions” are frequently misapplied to minimize payouts. If an adjuster cannot clearly explain their reasoning with direct policy references, it’s a red flag.

4. Downplaying Hidden Damage

Some damages—such as structural weakening, microbial contamination from water damage, or smoke infiltration—are not always immediately visible. Adjusters who dismiss these issues without thorough inspection may be trying to limit the scope of your claim.

5. Denying Claims Without Justification

Insurance claim denial often occurs without clear explanations. Adjusters might claim that damages aren’t covered, fail to cite specific policy exclusions, or insist that required documentation is missing when it isn’t. Studies, including one by the Office of Program Policy Analysis & Government Accountability (OPPAGA), show that policyholders who challenge these denials and seek professional assistance receive higher settlements.

Why Insurance Companies Benefit from Underpaying Claims

Insurance carriers operate with profit in mind, and the fewer claims they pay out, the higher their bottom line. Delaying, denying, or underpaying claims benefits insurance companies by:

• Reducing payout obligations and increasing profit margins.
• Forcing policyholders to settle for less due to frustration or financial pressure.
• Discouraging future claims by making the process difficult and exhausting.
• Limiting their liability in widespread disasters where multiple claims are filed simultaneously.

Because of this inherent conflict of interest, many property owners find it beneficial to work with public insurance adjusters to level the playing field.

How to Counteract Insurance Adjuster Tactics

Recognizing the warning signs of an adjuster downplaying or undermining your claim is only the first step. The next step is taking proactive measures to protect your rights and secure a fair settlement.

1. Document Everything

• Take high-resolution photos and videos of all damage immediately after the loss.
• Keep detailed records of damaged inventory, equipment, and structural elements.
• Save receipts for emergency repairs, temporary accommodations, and other loss-related expenses.

2. Keep a Communication Log

• Record all interactions with your adjuster, including emails, phone calls, and in-person meetings.
• Note dates, times, and summaries of discussions to establish a paper trail in case of disputes.

3. Understand Your Policy

• Review your policy carefully, paying close attention to exclusions, limitations, and requirements.
• Familiarize yourself with terms that adjusters may misuse to justify reduced payouts.

4. Seek Independent Evaluations

• Hire contractors, engineers, or restoration specialists to assess damage independently.
• For fire and smoke damage, consult professionals with IICRC Fire and Smoke Damage Certification.
• For water damage, seek out experts with IICRC Water Damage and Structural Drying Certification.
• Compare their assessments to the insurance adjuster’s report and challenge discrepancies.

5. Work with a Public Insurance Adjuster

Unlike insurance company adjusters, public insurance adjusters work exclusively for policyholders. They conduct independent damage assessments, negotiate with insurers, and fight against unfair denials or underpayments. The National Association of Public Insurance Adjusters (NAPIA) and the American Policyholder Association (APA) both advocate for the rights of policyholders and recognize public adjusters as key allies in securing fair settlements.

When to Escalate Your Claim

If an adjuster’s actions delay, devalue, or outright deny your claim unfairly, it may be time to escalate. Consider the following steps:

• Request a higher-level review within the insurance company, providing all documented evidence to support your claim.
• File a complaint with your state’s Department of Insurance if the insurer is engaging in bad faith tactics.
• Consult a public insurance adjuster to take over negotiations and challenge the insurer’s position effectively.
• Explore professional advocacy organizations like the APA, which works to expose unfair claims practices and protect policyholders' rights.

Insurance Adjusters Work for the Insurance Company—Not You

At the end of the day, insurance adjusters are trained to protect the financial interests of their employer, not the policyholder. The burden falls on property owners to ensure their claims are handled fairly, which can be an overwhelming and frustrating process.

If you suspect your insurance adjuster is undermining your claim, don’t navigate the process alone. Public insurance adjusters serve as powerful advocates, ensuring that your claim is valued correctly and settled fairly.

Contact Velocity Public Insurance Adjusters to learn how we can help you navigate the complex world of insurance claims with confidence.