Insurance giving you grief?
That’s by design.
Let’s get you armed with what you need to get what you’re entitled to.
*This information has been checked for accuracy and non-bias by licensed insurance experts and representatives from National 501c3’s specialized in insurance advocacy. We are not insurance brokers. Consult with a licensed professional about your insurance policy and specific situation.
Here are some basic rules to always follow:
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It’s your adjusters job to shrink what the company pays you. If they find evidence of fraud it lands on you to defend yourself. Also….insurance fraud charges are no joke. Keep everything 100% above board.
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Every time you speak to your adjuster, follow up with an email outlining what was said. If they say anything about payouts or dollar amounts or things they will or won’t do, send them an email recap immediately after the call. Keeping it all in one email thread can be helpful. (We recommend creating a dedicated email address for your recovery process.)
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Your insurer legally has to respond to you on certain timelines. If they’re dragging their feet or making this unnecessarily hard, you’ll want a call log and email train that you repeatedly tried to reach them. The more detailed this is, the better. Here is a template for Google Drive (best functionality), and here is a template for any spreadsheet software.
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Your adjuster is a human being who is also likely exhausted. If you’re rude to them they can do simple things like call you back last. The nicer you are, the easier an experience you’re likely to have.
1.
Know Your Policy Inside & Out
The better you know your policy, the better you can advocate for what you’re entitled to.
If you need help understanding your coverages, click here.
And if you need some help understanding your policy, try asking your insurance agent, (not your adjuster), to walk you through it.
If you’re still having trouble, Tugboat Claims has a free policy review service that might be able to help.
2.
Know Your rights
As a California insurance policyholder you actually have a lot of rights. Click here to get familiar with what they are.
The more you can reference your legal entitlements, the less likely you are to get pushed around.
3.
Get organized
If you haven’t already set up a dedicated email for your fire recovery dealings, and folders for all the stuff you have to collect, check back in a few days for a full guide with easy links to download free templates.
• Keep a detailed log of dates, times, names, and summaries of every interaction with your insurer. If you’d like a template for this, there’s one in the folders linked above, or for Google Drive here or in Excel here.
Tip
“Ask your adjuster for two printed copies of your policy mailed to you, since you don’t have access to a printer right now. If it’s on your phone you might miss details.”
— Annie Barbour, Tubbs Fire Survivor
“Be sure to ask for your full insurance policy, including Declarations, Endorsements, and Amendments.
— Andrew King, Eaton Fire Survivor
4.
Get everything in writing
• Politely insist that all decisions, denials, or settlement offers to be provided in writing.
• Politely assert that the insurer cite specific sections of your policy when denying coverage or reducing payments.
• Politely but firmly refuse to make important agreements verbally.
• If your insurer doesn’t respond in writing, email or write them with a concise summary of what you understand from your conversation and request they respond to add to/correct it.
• Insurers must acknowledge your claim within 15 calendar days.
• Insurers must accept or deny your claim within 40 calendar days after receiving all requested information.
• Payment must be made promptly once your claim is accepted.
• If deadlines are missed, request immediate written explanations and feel free to ask for a supervisor.
Relevant Law:
California Fair Claims Settlement Practices Regulations (CCR Title 10, Chapter 5, Subchapter 7.5)
5.
KNow and enforce timelines
6.
Challenge lowball estimates
Insurers often use a program called Xactimate to come up with estimates. They will almost always come in with a low estimate, so it’s your job to bring in an estimate that reflects real life pricing. You may have to pay to get a “Scope Of Loss” from a contractor. This may cost money, but could result in a large difference in your insurance payout.
• Get independent estimates from licensed contractors.
• Submit competing estimates for review.
7.
escalate within the insurance company
• If you are getting nowhere with your assigned adjuster, request a supervisor review.
• Every adjuster has different levels of authority based on their tenure, so recognize when you need to climb the ladder.
Escalation shows you are serious and often unlocks additional authority to settle claims.
Your adjuster is not qualified to determine if your property was damaged by soot, ash or contaminants. That takes a professional.
• Politely insist on professional testing (Certified Industrial Hygienist reports).
• Do not accept visual inspections or verbal assurances without documentation.
• You are entitled to receive the hygienist report at the same time as the insurance company.
• If your insurance company is refusing to remediate your home, some are having success getting their own testing done and using the results to get their insurance company to take action.
8.
Demand a Fair investigation
9.
use the appraisal process
• If you and your insurer disagree about the amount of the loss (not whether it is covered), you can invoke the Appraisal Clause in your policy.
• Each side hires an independent appraiser, and the two appraisers select a neutral umpire.
• The appraisal decision settles only the value of the loss, not your policy limits or coverage terms.
• If delays, low offers, or mistreatment continue, file a formal complaint with the California Department of Insurance.
• Filing a complaint triggers regulatory oversight and forces the insurer to explain their conduct.
*The more folks who are having a problem with an insurance company file complaints, the more likely they are to get forward movement.
Where to File:
• California Department of Insurance Complaint Portal
• Phone: 1-800-927-4357
10.
file a complaint
Tip
“Our insurance company was completely delinquent in paying out our coverages until my partner finally threatened to file a complaint with the Department of Insurance. Our adjuster then said, “I couldn’t tell you to do that, but now that you have, I can pull more levers. My employers really hate DoI complaints.’ We had a check FeExed out 48 hours later.”
— Anonymous, Eaton Fire Survivor
If you have tried all of the above and are still hitting a wall, consider consulting some professionals.
• Public Adjusters: Licensed advocates who can prepare, document, and negotiate your claim. For details on public adjusters, click here.
• Insurance Attorneys: Legal specialists who can file bad faith lawsuits if your insurer delays, denies, or underpays improperly. For information on bad faith claims, click here.
Note that public adjusters and attorneys both take a portion of the payout they get for you, and bringing in an attorney will change the nature of the negotiation so choose that direction with awareness.
11.
know when to bring in help
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