What is a Public Adjuster?
A formal request to an insurance company asking for a payment based on the terms of the insurance policy is considered a claim. Insurance claims are reviewed by the company for their validity and then paid out to the insured or requesting party (on behalf of the insured) once approved.
An insurance claim is the actual application for benefits provided by an insurance company. Policy holders must first file a claim before any money can be disbursed to you, the Insured, other contracted service. The insurance company may or may not approve the claim, based on its own assessment of the circumstances.
Individuals who take out insurance policies must maintain regular payments called premiums to the insurers. Most of the time, these premiums are used to settle another person's claim or to build up the available assets of the insurance company. Occasionally, however, an accident will happen that causes real financial damage, such as a hurricane, a flood, a tornado, a burst pipe or a fire. At this point, the insured policy holder has the right to file an insurance claim in order to receive money from the insurance company.
In general, the insurance claim is opened by calling the insurance company’s toll free number or by filling out a form on line. Many times, a recognized authority - like a public adjuster or an attorney - can file the necessary forms directly with the insurance company. The policy holder may not want to file if the damage is minor as any acts that are not weather related or an “Act of God” related can increase your premiums or give cause for canceling your policy all together.
After a claim is filed, the insurance company may send out an adjuster to assess the damages. This person's job is to objectively evaluate the damage and prepare a repair estimate for the insurance company. This is to prevent possible fraud by making sure that the damages are related to the peril and for contractors who may inflate their bills for additional compensation. Insurance companies tend to accept the adjustor's evaluation as the final word, but it is important to remember that this adjuster works for the insurance company, not you. Items are often overlooked or underpriced, so it is important that you have a public adjuster that works for you to review this.
Some insurance claims may not be recognized by the insurance company for any number of reasons. If a claimant's premiums have not been paid in full, the policy itself may not be active. Also, some items might not be covered under your policy or have “endorsements” that have excluded it from your policy. Another reason that a claim may be rejected is a failure to fall under covered conditions. Most insurance policies spell out specific areas which qualify for benefits, and if the accident or damage claim was caused by carelessness or an unavoidable "Act of God," the insurance company has the right to withhold payments. A claim is the only way to officially apply for benefits under an insurance policy, but until the insurance company has assessed the situation, it will remain only a claim, not a pay-out. It is important to have a trained person review your policy if you are denied. Insurance companies regularly deny claims that should have been approved.