How to file a claim so it gets paid

Claims are decided on documentation and policy language. The people handling them are processing a large volume of files against defined criteria.

Understanding that changes how you approach it.

Immediately after a loss

Address safety first, and then protect the property from further damage.

Most policies impose a duty to mitigate — to take reasonable steps to prevent additional loss. Tarping a roof, shutting off water, boarding a window.

Reasonable mitigation costs are generally reimbursable, so keep receipts. Failing to mitigate can reduce or void coverage for the additional damage.

Do not throw anything away until the adjuster has inspected or authorized disposal. Damaged property is evidence.

Where disposal is necessary for health reasons, photograph everything extensively first.

Photograph and video everything, before any cleanup. Wide shots and close shots. More than seems necessary.

This is the single most valuable thing you can do, and it takes fifteen minutes.

Report promptly. Policies require prompt notice, and delay can prejudice a claim.

The first call

Report the facts: what happened, when, where, and the extent of damage as you understand it.

Do not speculate about cause. If you do not know why the pipe burst, say you do not know. Speculation gets recorded and can be used to characterize the loss as excluded.

Do not guess at values. Say you are compiling an inventory.

Do not admit fault on liability claims. Report facts and let the investigation determine responsibility.

Get the claim number, the adjuster's name and direct contact, and the next steps with timelines.

The documentation that decides claims

An inventory, for property claims. Item, description, age, original cost, and replacement cost with a current source.

This is tedious and it is what the settlement is built from. An incomplete inventory produces an incomplete settlement.

Receipts, photographs and manuals all help. Anything showing what you owned before the loss.

Repair estimates, preferably more than one, from licensed contractors, itemized.

Your own record of the claim. Every call: date, time, name, what was said, reference number. Every document sent and received.

This record is what protects you if the claim goes wrong.

Written communication where possible. Follow up phone conversations with an email summarizing what was agreed. Unconfirmed verbal agreements have limited value.

Dealing with the adjuster

The adjuster is not your adversary and is not your advocate. They are applying policy language to facts.

What works: being organized, being responsive, providing what is requested promptly, and being factual.

Be present at the inspection. Walk through with them. Point out damage they may not see — attic, crawlspace, behind furniture, inside cabinets.

Ask what documentation would support the claim, and provide it.

Ask for the estimate they prepare, in writing, itemized. Review it line by line against your own estimates and identify anything missing or underpriced.

Disagreement is normal and it is resolved by evidence rather than by argument.

Reading the settlement offer

Check the settlement basis — replacement cost or actual cash value.

Check the deductible applied, and whether it is a flat amount or a percentage. Percentage deductibles for wind, hail and hurricane are common and much larger than people expect.

Check whether depreciation was withheld as recoverable, and what is required to recover it.

Check for omitted items. Adjuster estimates frequently miss things — code upgrades, matching of undamaged materials, debris removal, additional living expenses.

Additional living expenses coverage deserves specific mention. If your home is uninhabitable, most policies cover reasonable additional costs of living elsewhere. Keep every receipt.

If you disagree

Respond in writing, specifically, with evidence. "Your estimate omits the code-required electrical upgrade; here is the contractor's documentation and the municipal requirement."

Request a re-inspection where new damage is found.

Most policies contain an appraisal provision, allowing each party to appoint an appraiser with an umpire to resolve disputes about the amount of loss. This is for valuation disputes, not coverage disputes.

Public adjusters work for the policyholder for a percentage of the settlement. They can be genuinely valuable on large complex claims and are unnecessary on small ones. Check licensing and the fee percentage.

And your state department of insurance accepts complaints, which insurers must respond to formally.

The general principle

Claims are paid on what you can document, within what the policy covers.

The time to prepare is before the loss: an inventory with photographs, a copy of the policy you have actually read, and a clear idea of what is covered.

Almost nobody does this, and the people who have done it have dramatically easier claims.

General information about insurance claims, not insurance or legal advice. Policy provisions, claim procedures and appraisal rights vary. Consult your policy documents and your state insurance department.