10 Claim Commandments

The 10 Claim Commandments You NEED To Know

Written by: Mark Steven Goldwich, President/CEO Gold Star Adjusters, Inc.

Licensed & Bonded Public Adjuster FL License # A099530 GA License # 2670650 What You NEED To Know To Collect What You Are Owed Copyright © 2021

The 10 Claim Commandments You NEED To Know

In a post like this, it’s impossible for me to teach you everything I’ve learned in the past three decades of handling claims. So my first, and, I think, best advice to you would always have to be pretty simple: consult a professional.

Having said that, I realize that there are people who will refuse to hire someone else to do something they feel they can do by themselves. In this very short booklet, my goal is give you enough information to help you improve your current, next, or even your previous claim.
And yes, you read right. It is possible to improve your previous claim, even if the insurance company considers it “closed.” It all depends on things like how long ago the claim was, and under what circumstances it was settled or closed. I talk to people all the time who tell me they “never knew claims can be re-opened,” or “never knew that claims can be renegotiated.” It’s in the insurance industry’s financial interests, of course, for policyholders to believe that once they cash a check, they can’t come back to fix an error. It really is a shame how many people think this way. Mistakes happen, but your claim can be reopened and renegotiated. Following are some of the basics.


Many insurance adjustment errors, especially on disaster claims, usually happen for one of three reasons: adjusters don’t spend enough time to identify all the damages; they are unfamiliar with the damaged item; or their estimating software contains a bad price.

Other mistakes happen when adjusters either misinterpret the policy, or misinterpret the facts of your claim. Either circumstance can result in the denial of a claim that should actually be covered — or in a payment that is lower than it should be.

If you decide to handle a claim yourself, or reopen one that you think deserves a second look, please consider yourself bound by the following ten “commandments” — all of which a qualified public adjuster would scrupulously observe.

Commandment #1: Do not try to pull one over on your insurance company!
Be thorough, but honest. Few things turn adjusters on like the prospect of catching people who are engaged in fraud. Most companies have entire departments devoted to rooting out fraud, and you can be sure that the insurance company’s fraud adjusters will be among the best-trained in the whole company (too bad the adjuster who comes out to inspect your home probably is not trained this well.). Fraud adjusters have seen and heard it all, and they eat would-be cheats alive. Insurance fraud is a crime. Don’t even try it. And don’t ask us to try it for you … we won’t!

It seems a little unfair, doesn’t it? The insurance company can make one “mistake” after another that cost you money, and just coincidentally benefit the insurance company – coincidences that, taken together, can result in your claim being underpaid by thousands, tens of thousands, or hundreds of thousands of dollars, and nothing ever seems to happen to the insurance companies (outside of record profits, I mean). But if a policyholder can be shown to be bumping his or her claim up by a few hundred bucks, that’s not considered a coincidence. In that situation, you may rest assured that the insurance company will seek criminal charges if at all possible, even for what might seem by comparison to be fairly trivial amounts of money. What’s more, it is very likely that the company will secure a conviction — through the state, of course. A cynical person might wonder how even the playing field really is. I’ll only point out that the insurance companies have the lobbyists, who, in turn, have the ear of lawmakers and other powerful folks.

Commandment 2: Take Notes.
Buy a notebook. Buy a pen. Put them to use. Take your time and go around the property, taking detailed notes of everything you see to be damaged. Everything. Besides the obvious stuff like missing roofs and two-foot flood lines, you are looking for scratches, scuffs, scrapes, cracks, bangs, dents, nicks and cuts, tears, stains, discolorations, swelling, and unevenness – I mean everything. Look high and low, inside and out. Write it all down.
You should also keep a detailed log of each and every conversation that takes place with your insurance company, their adjusters (and yours), any contractors or other “experts” (especially if sent by the insurance company), and other players in this drama. Keep track of everything: Your own time cleaning up, the time you spend making emergency and temporary repairs, and every penny you spend that has anything at all to do with the claim. I can’t stress enough the importance of being thorough and detailed.

Commandment #3: Take pictures.

Photograph and video it all. When I say “all,” I mean everything. You may need these images in the future. Warning: Your adjuster may want a copy of these records. Be sure to keep copies for yourself in case the adjuster happens to “lose” the images you provide.

Commandment #4: Show the adjuster all the damage.

This sounds easy enough, but in order to do it, you must know what to show them. Again, you’re better off working with a professional who has done this a couple of hundred times, but if you’re going it alone, be sure to give the adjuster a copy of your own exhaustive list of damage to the property, and keep a copy for yourself. Lead the adjuster around the property and be sure he or she notes each and every item on your list. If that means the visit takes two hours — or ten hours — so be it. I find that if an adjuster is inspecting a property for 30 minutes, I will probably be there for two hours. If the adjuster is there for two hours, I will probably be there four to six hours. Am I just slow? I like to think not. I am thorough, though. And being thorough tends to mean more settlement money is collected.

I don’t want to miss any damage. The company adjuster just wants to move on to the next claim. I want you to get everything you’re entitled to. Two different agendas!

Ask about the adjuster’s experience level. You wouldn’t want to be operated on by someone with little experience – the same goes for the insurance adjustment of your largest financial asset. Note: an ethical, experienced adjuster making any kind of effort should be able to point out a thing or two to you that wasn’t even on your list.

Commandment #5: Remind the adjuster that not all homes are built with the same materials.

Insurance adjusters use computerized estimating programs that are designed to generate rough estimates (or, as I prefer to call them, “guesses”) about the average amounts of damage in average homes. These software programs tend to be fairly accurate in evaluating average homes and average losses – and tend to be less accurate on very small losses, very large losses, very low quality homes, or very high quality homes. The more familiar you are with your home and the quality of its construction, the better off you’ll be.

Commandment #6: Review the adjuster’s completed estimate in detail, until you understand each and every line.

This is where you will find mistakes –unfortunately, though, these documents can be extremely tough to read.

Commandment #8: If the insurance company refuses to pay for an item, demand that they explain (in writing) why.

The company should not only do this, but also show you exactly where in the policy it says that what you are claiming damages for is not covered. This point is very important. Never simply accept that something is not covered because the insurance company says it’s not covered. The company has an obligation to make you understand why it is not covered. It is often the company’s job to prove to you that something is not covered.

Commandment #9: Be persistent. Don’t give up.

This may be the most difficult commandment of all for you to follow, but it is absolutely essential. I am convinced that, as a group, U.S. policyholders walk away from hundreds of millions of dollars in valid claims each year simply because they are sick and tired of dealing with the claims process. Hang in there. If it is appropriate to do so, write complaint letters to the company (making sure to cover the local, regional, and home office levels), as well as your state’s regulatory agency(ies), Attorney General, or Governor; or your municipality’s Mayor, Councilman, or Selectman; or anyone else in authority who may listen. Take advantage of any measures your policy or State has for reconciling these matters. (These are sometimes called ADR, or Alternative Dispute Resolution methods.) When writing, be brief and to the point (I’ve seen people scribble page after page of ramblings that are impossible to make sense of. Even if they are right, these letters will never be taken seriously.) Keep after them. Be relentless. Try to stay calm.

Commandment #10: Get assistance from a professional when needed.

Depending on the loss, this could mean a contractor, an engineer, a mold specialist, an accountant, an attorney – or, of course, you might decide that you need a good public adjuster after all. Again – We will not charge you anything up front, but will, instead, charge a commission on what you are able to collect above and beyond what the insurance company is offering. It may feel strange, having to consult with someone to make sure that your insurance company pays you what you’re actually owed. But if they did what they were supposed to, we would be out of work.

If you buy insurance for peace of mind, why
do so many policyholders have nightmares
when they have to submit a claim?
Consider us your insurance against problems
with the insurance company.

No, it’s not “right” that you should need insurance like that, because you have probably been paying a large amount of money to the insurance company every month or every six months, and you’ve probably been doing that for years. But this is the way it is. At least now you know about it, and you also know what you can do about it.
Congratulations! Having made it this far, you are miles ahead of countless past victims of the insurance nightmare. May you stay that way. But if you ever feel you’re losing ground, feel free to give us a call.
I truly hope you enjoyed this booklet, and that you learned from it as well.
I would like to personally hear about any questions, concerns or differences of opinion you have – just contact me. The Gold Star team looks forward to assisting you.
Wishing You More!
Mark

Posted in Uncategorized | Tagged , | Comments Off on 10 Claim Commandments