Serving Communities Across Nassau & Suffolk Counties on Long Island, NY

People Involved in an insurance claim

People Involved in an insurance claim

insurance claimUnderstanding and remembering all the people who may be involved in your claim can be daunting and exhausting to remember. The larger the job, the more participants, that’s a given. Another factor is the type of emergency it is and what was affected (structure, contents, ability to live at the home, etc.). We will list the potential participants and what their area of involvement is on your typical homeowner’s insurance claim.


Insurance Agent

An insurance agent is a person who likely assisted you in securing the insurance policy that you currently have. They are often affiliated with one or more carriers but are not involved in the insurance claim, other than to help you start the claim & be an advocate for you to help work through any difficulties in the process. Some agents do not get involved in the claim at all, they will direct you to the “claims department” for all your answers & assistance from preferred vendors of the insurance carrier who will do the work. While others will value having their own list of local preferred vendors that tend to be much more service-oriented. This second type of agent knows very well that making sure the claim is handled well could mean the difference between having a long term renewal with this affected insured or losing them as a repeat customer due to a mishandled cleanup & repair by a vendor they know nothing about and no influence over.

Insurance Field Adjuster(s)

An insurance Field adjuster is someone who investigates the actual site to gather information. They take pictures and measurements of the affected finishes and interact with you and whomever the contractors that are working on your claim. They do the actual estimates and or critique the estimates given by your contractors. These estimates for cleanup, repairs & content damage are done using an industry-standard pricing database. Once the estimate of damages is completed they are passed off to the desk adjuster for final approval & payout.

In some cases, like large loss jobs, there may be additional field adjusters for each portion of your claim (mitigation, repairs, contents). The best practice is to gather all the adjuster’s business cards & keep track of which aspect they are assigned to find out their individual process.

Insurance Desk Adjuster

This is the main insurance carrier adjuster that will make the decisions on your claim. Occasionally, this desk adjuster will do the field adjusting as well. They mostly rely on the field adjusters’ visit notes & pictures and/or the equivalent from your restoration contractor. If the claim is dragging along or you have a money question, seek this individual out for a direct answer or intervention.

Emergency Mitigation Company, a.k.a. Restoration Company

An Emergency Mitigation Service Company is a uniquely licensed, insured & specifically trained entity that not only performs the emergency mitigation service (a.k.a. EMS, or cleanup) but also can assist in starting & processing an insurance claim for an insured. They are more often the 1st on scene and are the ones that are relied on to do a quick intervention to minimize the damages & keep the loss to the carrier at a minimum.

  • Applying industry standard cleanup

    These companies apply the industry standards for cleanup & mitigation developed and approved by the insurance carriers. Once a claim is started, these companies will seek approvals from the carrier’s claims department on an agreed scope of work based on the existing condition & will apply the industry-standard cleanup services. Often, the only requirement is pictures of proof as a justification for the scope of work, knowing this, the experienced restoration company can move rapidly on your cleanup.

    Invoicing out at the agreed industry rate

    The most unique aspect of their work is that they don’t estimate, they perform the work and document the quantities after the fact & invoice out at the agreed industry rate. The carriers are totally fine with this arrangement as they realize that taking estimates and waiting for those estimates to be evaluated and approved create delays and those delays will likely cause additional damages necessitating higher claims payout costs.

    Restoration work starts immediately

    These restoration companies typically perform all the cleanup work “on credit” and await payment from the carrier. They will ask the insured to sign a service authorization that has language in the agreement that directs the carrier to pay the restoration contractor directly for services rendered. This agreement coupled with the ability to invoice out the services rendered at the agreed rate enables the restoration company to begin work immediately with confidence that an acceptable payment will be received.

Restoration Repair Contractor

Sometimes, this company will be the same as the mitigation company and can handle other parts of your claim like contents cleaning & offsite storage.

You don’t necessarily even need a repair contractor as you can do the work yourself. There are however several advantages to working with one in terms of settling your claim & receiving the correct repair payout much quicker than when they aren’t involved in the process. Having a restoration contractor who also is experienced in the industry standards and is willing to do a competitive estimate on your behalf will not only be valuable in terms of net dollars for your repair; but will dramatically speed up the process of settling your claim with the carriers’ adjusters.

  • The benefits of a restoration contractor

    Some restoration contractors will seek a fee for this estimating & claims settling consulting service. This should be considered as valuable if you are looking to save time & aggravation. To come to an agreed repairs payout entails meeting with your field adjuster onsite, field measuring the affected structure for application into a CAD based estimating software (Xactimate) for a super elaborate insurance estimate. They will also have many email & phone exchanges with the adjusters leading toward an agreed scope of work to bring your structure back to “pre-loss” condition with like, kind & quality items. The real value a restoration contractor provides is their understanding of the software and how to apply it to the real-life condition of doing the repair work. Another benefit of having an experienced insurance restoration contractor on your team is the fact that most adjusters (field & desk type) don’t have the necessary construction knowledge and little to no construction experience to diagnose intricate repair costs. Their lack of experience often leads to insufficient payouts with lengthy, time-consuming supplemental approvals.

    Using a general contractor

    Another repair contractor can be a typical general contractor or home improvement contractor. Though they possess the skillset & knowledge to do all the repair work needed, they do tend to fall short in terms of estimating the costs of the repairs. Most typical contractors (99 % of them) don’t possess the access to the insurance estimating database & will provide you a very vague estimate that an insurance adjuster will struggle approving. When their estimated value of repairs is more than the Xactimate database estimate generates there will likely be long delays in settling the claim which frustrates the adjusters and causes them a lot of extra work.

Vendor Program /Third Party Administrator (a.k.a. TPA)

Smaller insurance carriers and even some of the major carriers will utilize the services of a TPA as a claim’s administrator. These TPA’s supplant the carriers claims department field adjusters. They also have their own list of preferred vendors. TPA’s have very stringent requirements for response times & timely communications of project development & advancement. They also are empowered to scrutinize vendor bills prior to carrier payment processing & will consult with the carriers’ desk adjusters on scope of work approvals.

Independent Adjusters (IA) / Public Adjuster (PA)

As if all of this wasn’t confusing enough, here are a few more individuals that you may or may not have involved in your claim. The first type is an independent adjuster (a.k.a. IA). Just like their name says, they are independent, meaning, they operate in a special capacity as the carriers’ field adjuster. They are impartial and may work for many different carriers. You will often encounter IA’s during a “surge event” or catastrophe type (major storm, flood, etc.) and you might hear them referred to as “cat adjusters”. These adjusters often are storm chasers that get brought to the local region to help assist in the multitude of claims that are occurring. These same IA’s, when not involved with a cat event, may also work for restoration contractors as an estimator. The restoration contractors like to utilize their services because they know the IA’s have intimate knowledge as to what the carriers are willing to pay for & how to present the information with the least amount of pushback.

The public adjuster

The next type to discuss is the public adjuster (PA). The term PA is kind of a curse word to the insurance carrier & insurance agents. These adjusters work exclusively for the insured in a special capacity as a claim negotiator. They are licensed to take over a claim & replace the insured as the point of contact & decision-maker on the claim. The PA typically will have a lot of insurance claims adjusting experience & will battle the carrier tooth & nail for the biggest payout on all aspects of the claim. They sell their services to the insureds with the promise of a huge payout. To get this huge hypothetical payout they will most likely drag out the process battling back & forth in the hopes of wearing down the adjusters. They are not hard to find if you have a large loss fire, they will be the guys standing in the street with clipboards & fancy printed marketing folders. They often are out front while the fire department is still dousing the flames on your home. They are not for altruistic reasons like helping you in your time of need, their main motivation is getting “PAID” for their services with fees as high as 8-10% of your total insurance payout. They often have intimate relations with board up companies who are motivated through referral fees to funnel business their way. Once hired by an unwitting insured, they often bring their own “preferred” vendors in to do the work collecting even more “referral” fees from these bottom basement subcontractors. Most restoration contractors, insurance agents and adjusters have a negative experience in dealing with these PA’s. We believe that a full-service restoration contractor (mitigation & repair) that also has vast construction knowledge & intimate knowledge of the Xactimate estimating software will get the same payout that an PA. We at True Restorations charge NO COST for this estimating & consulting service assuming we perform the work for you at the agreed Xactimate values.

We hope this information has helped you understand all the different people involved in your insurance claim.  To learn more about insurance claims read our blog post, “Homeowners insurance claim payout FAQ’s“.

Kind Regards
The True Restorations Team

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