Frequently Asked Questions about How Claim Representation Works

FAQs About How Claim Representation Works

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A claim denial is generally referred to as a coverage issue. Your claim has been denied because the insurance company says you have no coverage. There can be many reasons a claim is denied for lack of coverage. The important thing is to always request the basis for the denial to be sent to you in writing. Once you have a letter, let us take a look at it and allow us to visit with you at the loss site. Many claim denials have been overturned as it is not unusual for insurance companies to make decisions’ on faulty facts or lack of all the facts. If we cannot help you we will tell you and give you our suggestions on a course of action that may include appealing a denial to a senior manager in the claims department. You would be surprised at how effective it has been in the past to have a well detailed appeal letter sent to a home office official pointing out the errors in the claim investigation. If all else fails, we can recommended several competent lawyers that specialize in first party property insurance law. 

This is probably the most frequently asked question we receive. My answer has been that if you want a quick fast settlement, you do not want to hire us. Our experience has been that if you settle quickly without doing a thorough job, you most likely are leaving significant money on the table. Insurance companies know that the quicker they can settle a claim, the less it will cost them.  Taking the time to do the right job in adjusting a loss will benefit you in the end because you have thoroughly investigated, documented, presented, and negotiated a settlement that enables you to get all you are entitled to, based on your loss and the coverage you have purchased. Hiring Tutwiler and Associates will not delay your claim it will ensure your claim is paid in full. 

You can always have your claim reviewed and re-evaluated. The exception to this might be if the statue of limitation has run or if you have signed a full release. It is not unusual for policyholders’ to ask for a review as there can be many complex issues involved in a property loss adjustment process. Gives us a call we will be glad to review your claim and give you our best and honest opinion.

In most cases experts are not needed. But there are cases where experts such as structural engineers, roofing specialist, mold experts etc., are needed to substantiate your claim. In those cases we try and work first with the insurance company to agree on an expert who is fair and honest about what needs to be done to resolves any issues. There are always situations where there are differences that cannot be agreed upon. In some losses such as building claims, the insured will be required to have an expert submit plans and specifications in order to rebuild or repair. Since these cost and experts were used in the initial construction we can often include them in a claim as part of the cost to repair. The cost of an expert for a cause of loss opinion or to prove a claimed amount or item unless covered in the policy will have to paid out of pocket. Generally these costs have been minor versus the results.  We always consult with our clients on experts and it is the client’s right to pick and choose an expert in cases that requires this additional step.   

Fees in the public adjusting profession are typically regulated by the State Insurance regulators. These regulations usually set a cap on fees but the actual fees can always be negotiated. Remember you always get what you pay for. The lowest bidder is a low bidder for a reason. Expect to pay a fair fee for the task at hand.

With Tutwiler & Associates, there is no upfront cost to utilizing our services. You pay nothing until we receive payment of your claim from the Insurance Company if we are working for you on a contingency basis. Our fees are generally 5 to 20% of the insurance claim recovery amount. The amount of our fee varies by the size of your loss, the complexity of your claim, and time estimated to manage the claim as each claim is uniquely different.

Because of our firms long history and reputation, we have at times been asked to serve as an expert in court cases and in those cases we work on an hourly basis. We have also been hired as consultants in pre-loss planning and preparation matters which is also billed on a hourly basis.