Who All Is Involved In My Insurance Claim?

by | Jun 13, 2019 | Article, News | 0 comments

Who All Is Involved In My Insurance Claim?

One of the biggest issues for property owners who file an insurance claim is simply keeping track of who they are talking to. While some claims are simple, many involve over half a dozen different entities, and it’s difficult to remember who is responsible for what.

We’ve put together a brief guide listing the most common groups involved in the property damage restoration process.

Main Parties Involved

YOU (a.k.a. Homeowner, Property Owner, or Insured)
You’re what’s known as “the insured”, and you’ll likely hear that term a lot throughout the process.

Insurance Agent
Your insurance agent is the person who originally sold you your insurance policy. During your initial discussions, they’ll likely ask you about the size and age of your home, any remodels or upgrades, and other questions so they can get an accurate understanding of the value of your home and the contents inside.

When you need to file a claim, your insurance agent can help, but they are not in charge of the claim process – that would be your adjuster. However, if during your claim process you run into difficulties or things seem to be moving slowly, your agent MAY be able to make some phone calls to get things moving again.

*** PRO TIP ***
When insuring your home, make sure to insure it for MORE than the purchase price of the home. In case of a fire or other large-scale damage, it can cost significantly more to remediate and repair a home than it did to actually buy it.

Insurance Adjuster
Your insurance adjuster is essentially the representative of your insurance company that you’ll be working with during your claim. Your insurance adjuster usually performs an on-site inspection of the damages, approves the various types of work required to fix your property, and coordinates things for the insurance company.

Property Damage Restoration Company
At it’s core, a property damage restoration service is the company that performs the actual work at your home. However, they realistically do much more than this. Your restoration company will likely prepare the initial scope of work (essentially an estimate) for your insurance adjuster, and will help you navigate your way through this claim process.

While some property damage restoration companies (like Constructeam) are full service, you may need multiple companies to handle different parts of your project.

  • Mitigation Company
  • Reconstruction Company
  • Contents Company

Specialty Trades
Depending on what type of damage affected your home, other tradespeople may be involved initially who are not directly affiliated with your contractor(s). This could be a plumber, if a pipe broke in your home, or a tree removal service if a storm knocked a tree onto your property.

If you contact a contractor first, they can likely coordinate these different companies on your behalf so you don’t need to worry about it, but it’s uncommon even for full service contractors to have in-house plumbers, electricians, or tree removers. More likely, they have companies they have used and trust, or in Constructeam’s case, companies who have gone through a vendor review process to ensure they are properly licensed, insured, etc.

Additional Parties Involved

Sometimes, depending on your insurance company or the complexity of your claim, there may be other parties involved.

Third Party Administrator (TPA)
TPA’s have become much more prominent in the insurance industry over the last decade. TPA’s work with you on behalf of your insurance company to help make sure your claim process goes smoother. They vet local contractors, ensuring they are maintaining their licenses, insurance, and sticking to timelines on their projects. If you call your insurance company to report a claim, they’ll have their TPA contact you if they utilize one.

Examples of TPA’s include Alacrity, Nexxus, Sedgwick, and CodeBlue.

Mortgage Company
This one is pretty simple, though it can be very frustrating. If you have a mortgage on your home, your mortgage company technically has an interest in your home being restored after it was damaged. When your insurance company pays you, they may include your mortgage company on the check. This means you’ll have to call your mortgage company, send the check to their corporate office, then wait for them to endorse it and send it back or deposit it to send you a new check entirely.

On the mitigation side this isn’t as big of a deal, but if there is a lot of reconstruction work, the payments can be split into multiple draws, and having to send them out to the mortgage company can slow the process. It’s unfortunate, but it’s the way the industry works. Most restoration contractors are understanding of this, and will continue working on your home even if the payment is delayed in this way.

Public Adjuster
A public adjuster is an adjuster who works on your behalf instead of your insurance company’s. In theory, this sounds great. They’ll walk you through the process, they’ll prepare a scope of work, they’ll communicate with your insurance company on your behalf. The issue is that they’ll also charge you an average of 10% of your finalized scope of work to do these things, so if the final scope of work is $30,000, you’d be left with $27,000 to do $30,000 worth of work.

Most people choose to just bring in a property damage restoration company (like Constructeam), who handles the entire process for them without any additional fees. Instead, the property damage restoration company simply does the work for the amount the insurance company pays, just like an auto body shop would if you were doing work on your car.

Other Parties
Occasionally there may be other parties involved in the claim. This could be tenants, if the property is a rental, or an engineer brought in by your insurance company. However, the above list sums up the majority of people who could be involved in your claim. Hopefully it helps you keep track of everyone!

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