How to Determine if a Claim Has Been Underpaid: A Guide for Public Adjusters in San Antonio

February 11, 2025 9:13 am Published by However, the policyholder in San Antonio will expect from his insurance a settlement of any property damage or loss incurred fully compensating his loss for costs of repairs and replacements. What happens, in reality, however, is most claims are shortchanged, a situation that might require a diligent approach to reveal these discrepancies. As a public adjuster, your ability in finding and confronting underpayments of claims can determine a lot with regard to client benefits. Find out if it has been shortchanged.

1. Know the Terms of the Insurance Policy and Coverage

Review the insurance policy to check in great detail if a claim has been underpaid. Be sure to look at details such as:
  • Policy Limits: Confirm the maximum sum amounts for each coverage type. Deductibles/Exclusions/Endorsements: Also confirm which ones are included or excluded. Deductibility: Check if the appropriate deductible has been applied.
  • Replacement Cost vs. Actual Cash Value (ACV): Establish whether the policy pays for the replacement cost of damaged items or the depreciated value.
Knowing what is in the policy will give you a baseline against which you can measure how well the settlement meets your needs.

2. Examine the Insurance Company’s Estimate

Examine the insurance company’s estimate. Check that it reflects the extent and cost of the damages accurately. The following are some key things you should do:
  • Inspection of the Property: Compare the actual damages with those provided in the insurer’s report from an inspection of the property.
  • Itemized Estimates: Confirm if the list of repairs or replacements is itemized and covered.
  • Market Price: The insurer’s estimate must be equal to prevailing market price regarding labor, material, and San Antonio services.
  • Overlooked Damage: Find damages the insurer might have missed, such as hidden structural damage or secondary damage like mold growth.

3. Independent Assessment

Make your own detailed estimate and compare it to the insurer’s assessment. Industry-standard platforms to estimate repair costs include Xactimate or Symbility. When building your assessment:
  • Include All Damage: Document every repair or replacement needed, including minor or cosmetic damages.
  • Accurate Measurements: Use double-checking measurements for floor coverings, roofing, and walls to avoid errors.
  • Photographic Evidence: Take clear pictures of all the damages and add them to the report to confirm your findings.

4. Comparison of Estimates

After you receive both the independent estimate and that of the insurer, compare both. Identify where the two may differ in:
  • Quantities: Check if the insurer has undermeasured the materials or labor.
  • Pricing: Check for outdated or below-market pricing by the insurer.
  • Scope of Work: Ensure all necessary repairs or replacements are included.
Highlighting these differences can help pinpoint areas where the claim may have been underpaid.

5. Evaluate Depreciation and Deductibles

Insurance companies often apply depreciation to reduce the payout, especially under ACV policies. Review how depreciation was calculated:
  • Accuracy: Ensure the depreciation percentage aligns with the item’s age and condition.
  • Replacement Cost Policies: Verify that withheld depreciation will be reimbursed once repairs are completed.
  • Deductibles: Verify the proper deductible was applied to the final settlement.

6. Review Additional Living Expenses (ALE)

If the insured was forced to leave their property due to property damage, review the ALE section of the claim. Check:
  • Reasonable Expenses: Confirm that expenses for temporary living, food, and other essentials are properly covered.
  • Policy Limits: Determine if ALE payments meet the policy’s maximum limits.
  • Receipts: Ensure the policyholder submitted all the receipts.

7. Analyze Third-Party Reports

The majority of insurance firms hire third-party adjusters, engineers, or contractors to appraise damages. Analyze third-party reports for:
  • Bias: Check whether their findings support the insurer more than the policyholder.
  • Inconsistencies: Find if there is any disparity between what they report and what really occurred.
  • Mistakes: Look for miscalculations or underestimations of damages that can affect the final settlement amount.

8. Experts on a Need Basis

For more complex claims, involve experts like structural engineers, contractors, or remediation specialists in mold remediation to provide more insight. Their professional opinion will strengthen your case when disputing underpayment.

9. Represent the Policyholder

When you establish that the policyholder was underpaid, here is how you can represent your client:
  • File a Rebuttal: Prepare a comprehensive report that explains discrepancies and explains why the settlement should be higher.
  • Negotiate: Correspond with the insurance company to get to a mutually agreed settlement.
  • Appraisal or Mediation: In case the negotiation does not materialize, appraisal clause from the policy may be invoked, or mediation could be resorted to.
  • Litigation Support: When litigation seems unavoidable, provide the attorney with necessary evidence and documents.

10. Educate the Policyholder

Finally, help your client understand the claims process and their rights. This transparency builds trust and ensures they’re informed about the steps you’re taking to secure a fair settlement.

Conclusion

To determine if a claim has been underpaid depends on comprehensive detail, acquaintance with insurance policies, and advocacy skills. This role as a public adjuster in San Antonio is very important in making sure that policyholders receive the right amount of compensation. Determining and solving underpayments will make you relevant to your clients, and this can be achieved through following these steps. Read more:

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This post was written by Trishala Tiwari

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