It is the policyholder and NOT the insurance carrier who is responsible to prepare and present loss evaluations. Don’t be fooled into believing that your carrier’s decision to send their insurance adjuster is in your best interest. Although a carrier is required to investigate your claim, they routinely dispatch their representatives to protect their own interests. If their investigator/adjuster does not reduce their assessment to writing they are not be required to provide you with a written damage estimate. NYS Insurance Law Section 3407-A.
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.
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. Every adjuster has its own style of interviewing policyholders. There is no specific script, and leading or ambiguous questions can result in speculative answers that may negatively impact your claims.
Is An Adjuster Also An Investigator?
In the eyes of New York State insurance adjusters are authorized to question claimants in their official capacity as insurance investigators. Without representation, you alone must determine if your carrier’s insurance adjuster is asking leading or ambiguous questions. Public adjusters are also insurance investigators licensed to represent policyholders, and if they recognize an improper line of questions they can stop an interview and advise a policyholder on a proper course of action, including but not limited to filing an official complaint with the NYS-DFS or seeking the assistance of a property/casualty attorney. Answers to inapt questions during an interview can result in a denial of your insurance benefits. If you have a large loss you should always retain the services of a public adjuster.
How Long Are You Being Investigated?
Your insurance company can investigate you, your family members, and any witness or persons with knowledge of your loss, including but not be limited to neighbors, friends contractors, emergency service vendors, or anyone who names you decide to volunteer/involve. Persons not listed on your insurance policy and those who have no property interest in your insurance benefits are not required to answer an insurance adjuster’s questions. Your carrier and their preferred vendors look for ways to give you less, and elements of your claims can be denied based on your statements as well as 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 your interview as a protected work product and you are NOT entitled to it.
If you conduct a written interview you will also be told 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 you or your public adjuster.
Insurance Company Vendors Billing Practices
If you decide to use your insurance carriers preferred emergency service vendor they will follow the decisions of your carrier’s adjuster. All emergency service vendors require that policyholders assign their insurance benefits for the work they perform, however, if your claim is denied you will be responsible to pay their bill and in many cases (similar to medical insurance billing practices), you may be billed at a higher rate than what a carrier preferred vendor accepts from the insurance company. Don’t go it alone, call us today.