Pursuant to your insurance contract and backed by volumes of New York State case law, it is the policyholder and NOT the insurance carrier who is responsible to prepare and present policyholder loss evaluations. Don’t be fooled into believing that your carrier’s decision to send their own insurance adjuster to evaluate your claim is in your best interest. From the inception of the modern insurance industry, carriers have dispatched their representatives to protect their interests by investigating, assessing and minimizing the amounts they have to pay for policyholder damages. It is a fact that in New York State your carrier is required to dispatch someone to visit your loss within required regulatory statutes in order to meet with policy holders and collect data. However, if the carrier’s representatives do not reduce their findings to writing, they are not be required to compile or send policyholders a written estimate of damages.
The initial duty of an insurance company adjuster is to establish whether or not a policyholder is entitled to any insurance coverage, which in part is based on statements made by a policyholder from the moment they file their claim.
Through the claim process, subsequent statements made by policyholders to in-house and field adjusters, fire marshals, origin and cause (O&C) investigators as well as insurance company preferred restoration vendors, can negatively affect your insurance coverage. Each insurance company adjuster has their own style of interviewing policyholders. There is no specific script and their questions may be ambiguous or suggestive, resulting in speculative answers that may be negatively interpreted and included on your claim file.
Is An Adjuster Also An Investigator
In the eyes of New York State law your carrier’s insurance adjuster is authorized to interview / question claimants in their official capacity as insurance investigators. Without representation, you alone must determine if an insurance adjusters questions are leading and or ambiguous. Public adjusters are also licensed to investigate claims and if they recognize an improper line of questions they can stop a interview and advise you to file an official complaint with the NYS-DFS or seek legal counsel. Answers to inapt questions during an interview may result in a denial of your insurance benefits.
How Long Are You Being Investigated
It is important for you to know that throughout your claim, your insurance company, its adjusters and agents will be investigating you, your family members and any witnesses or persons with knowledge of your loss, including but not be limited to neighbors, friends contractors, emergency service vendors, or anyone who’s name you mention / involve. Persons not listed on your insurance policy and those who have no property interest in your claim benefits are not required by law to answer an insurance adjusters questions. Even after establishing coverage, your carrier, its agents, adjusters and preferred vendors are looking for ways to give you less. Even after your carrier establishes your coverage, your claim or elements thereof can still be denied based on your statements and third party opinions.
Recorded Statements vs. Written Statements
Although your policy may not require you to give a recorded statement, most insurance company adjusters demand one, sometimes by deceptively invoking your insurance policies Failure to Cooperate Clause. Insurance Attorney Opinion / Insurance Carrier Industry Opinion. Don’t be fooled by this ploy. If the carrier’s adjuster cannot find the specific verbiage in the Property Section (not liability section) of your insurance policy, then you are entitled to give a written statement, which for your protection should include the adjusters written questions. In writing, you will be able to review the carrier’s written questions and take the necessary time to reduce your answers to writing and or edit them before you sign your statement with confidence. Photocopy / photograph your statement before handing it over to your carrier’s insurance adjusters / investigators and never be bullied into an audio or video recorded statement that is not required.
Regardless of what you are told, once you conduct a voice or video recorded interview, you will not be entitled to a copy of it. Once given, carriers declare it as protected work product and you are NOT entitled to it.
If you agree to conduct a written interview you will likely be told at a later time that you are not be entitled to a copy of it, so photograph your statement before you hand it over to anyone.
Insurance Company Vendor Obligations to Obtain a Work Contract & Report Information
Insurance company recommended vendors, sent to mitigate your damages, are instructed to get your signature on their contracts as well as to document and report information to your carrier, including but not limited to; the extent of your damages and possibly opine on the cause of your loss. Many claims have been denied and or seriously damaged by a vendor’s erroneous perceptions and or conjecture regarding the cause of a policyholder’s insurance loss. All vendor contracts hold policyholder’s responsible for their service invoices if the carrier refuses to pay your claims. It is best to retain the services of a vendor who will answer to you or your public adjuster.
Insurance Company Vendors Billing Practices
On occasions when challenged for their poor performance, carrier vendors argue that they take their orders from your carrier. In fact, all restoration vendor contracts require policyholders to assign insurance benefits to their firm for the work they perform and if the claim is denied the policyholder becomes responsible to pay their bill. Their prices may vary upward from what carriers usually pay for itemized services.