The Experience Gap: Part 2

daniel33876
Aug 19
6 min read

The Value of Experience on Both Sides of the Claim

Most policyholders experience an insurance claim from only one perspective. They report the loss, meet the people assigned by the insurance company, provide information and documentation, and eventually receive estimates, correspondence, and decisions concerning their claim. What they rarely see is how the information gathered at their property is evaluated after the inspection is over or how much importance the claim file itself can have as the process continues.

Before becoming a Public Adjuster, I spent years working within that process as both a Staff Adjuster directly for insurance carriers and as an Independent Adjuster handling claims on their behalf. I inspected property losses, prepared estimates, documented claim files, communicated with policyholders, evaluated damage, responded to management questions, and supported my conclusions as claims moved through the carrier's internal review process.

Today, I represent the policyholder, but the experience gained on the other side of the claims process continues to influence how I approach every loss. It taught me that identifying damage is only one part of developing a claim. The information also has to be documented, explained, and supported well enough that someone who never visited the property can understand not only what was found, but why it matters.

What Happens After the Inspection Matters

An adjuster can spend hours inspecting a property and leave with a clear understanding of the damage, yet many of the people who may later influence the claim will never see those conditions firsthand. They will rely instead on photographs, measurements, estimates, reports, claim notes, correspondence, and whatever other documentation has been preserved in the file.

That distinction becomes increasingly important as the size and complexity of a claim increases. A supervisor reviewing the file was probably not present for the inspection. An engineer may be asked to evaluate only a specific issue. A manager considering a significant financial decision may know the property entirely through the information provided by others. If the claim later involves additional experts, appraisers, attorneys, or regulators, documents created during the earliest stages of the loss may be scrutinized months or even years after the conditions at the property have changed.

This is why good claim documentation involves much more than taking photographs and preparing an estimate. The documentation has to preserve enough information to explain the loss to people who were not there when the damage was originally observed.

The property cannot speak for itself once the inspection is over. The claim file has to do that.

Carrier Side Experience Changes How You Build a Claim

Working for insurance companies taught me to look at an estimate as more than the dollar amount at the bottom of the page. The measurements, photographs, observed damage, proposed repair methodology, construction requirements, and supporting documentation all need to work together. When they do not, the questions usually begin long before anyone starts debating the final number.

If an estimate includes an operation that is not supported by the documentation, someone may question why it is necessary. If the photographs do not clearly demonstrate the conditions being described, the conclusion may be challenged. If the proposed repair methodology does not account for how the building is actually constructed, additional explanation may be required. When an expert report reaches a conclusion that is inconsistent with other evidence in the file, understanding the basis for that conclusion becomes just as important as reading the conclusion itself.

Having been responsible for answering those types of questions on behalf of insurance carriers changed the way I approach them today. When I develop a claim for a policyholder, I do not want the insurance company to be the first party to discover a weakness in our documentation or identify a question we should have addressed ourselves.

That does not mean every potential disagreement can be eliminated, particularly on a large or complicated loss. It means the positions we present should be based on evidence that can be explained and defended when challenged.

Experience Allows You to Think Beyond the Current Adjuster

One of the most valuable lessons I carried from the carrier side is the importance of thinking beyond the person currently handling the file. Significant claims rarely remain confined to a single adjuster or a single inspection, and information that seems obvious to the people standing at the property can lose its meaning when it is separated from that context.

For that reason, when I inspect a loss today, I am also considering what information may be needed later to demonstrate the conditions we are documenting. When I review an estimate, I evaluate whether the proposed work makes sense from a construction standpoint and whether the supporting information explains why those operations are required. When an engineer or consultant becomes involved, I look beyond the conclusion and evaluate the observations, assumptions, methodology, and evidence used to reach it. When communicating about a significant issue, I remain conscious that the correspondence may eventually be read by someone who knows nothing about the conversations or inspections that preceded it.

This is not insider knowledge or a secret formula for handling insurance claims. It is perspective developed from having actually performed the work from the carrier's side and understanding what happens to information after it enters the claims process.

That perspective becomes particularly important when a claim begins moving beyond the people who originally investigated it.

Understanding the Other Side Does Not Mean Agreeing With It

Experience working for insurance carriers also taught me that not every disagreement means someone has acted improperly. Complex property losses can produce legitimate differences concerning causation, the extent of damage, repair methodology, valuation, policy provisions, and expert findings. Understanding how those conclusions are developed makes it easier to identify the difference between an issue that may simply require additional information and one that deserves a more substantial challenge.

It also makes it easier to recognize when the investigation itself may not have gone far enough. An estimate that does not appear consistent with the documented conditions deserves closer review. An expert conclusion that does not reconcile with observable evidence should be examined rather than accepted solely because it appears in a report. When important information appears to be missing from the carrier's evaluation, the appropriate response is to identify what is missing and develop the evidence necessary to address it.

Understanding how the carrier approaches a claim does not require accepting its position. It provides a better foundation for determining when that position is reasonable, when additional information may resolve the issue, and when the facts support challenging it.

The Experience Remains. The Responsibility Changed.

When I became a Public Adjuster, the most important change was not what I knew about insurance claims. It was whom I represented.

My responsibility today is exclusively to the policyholder, and the experience gained while working for insurance companies now allows me to evaluate a claim from both perspectives before presenting our client's position. I can consider what questions I would have asked when reviewing the same information for a carrier, where I would have expected additional documentation, which conclusions might receive additional scrutiny, and what could become difficult to explain if the claim progresses beyond the current adjuster.

At Pivotal Public Adjusters LLC, that perspective is particularly important because our focus is on claims where the consequences of incomplete documentation or poorly supported decisions can become significant. The objective is not to create a dispute where one does not exist. It is to develop the policyholder's claim thoroughly enough that the facts, documentation, and conclusions can withstand the level of scrutiny that accompanies a substantial property loss.

Part 1 of The Experience Gap examined why a Public Adjuster license establishes the authority to practice but cannot demonstrate the experience behind it. Part 2 adds another dimension to that discussion. Experience is not valuable simply because someone has spent years working in the insurance industry. Its value comes from understanding how those years change the decisions being made today.

Having worked claims from the insurance company side of the table taught me how carriers evaluate the information presented to them. As a Public Adjuster, I now use that experience to make sure the policyholder's side of the claim is prepared with the same understanding of the process.

The insurance company understands how its claims process works. The person representing you should understand it too.

Coming Next

In Part 3 of The Experience Gap, we'll examine what happens when a property loss is initially treated as an ordinary claim but develops into something much larger. We will look at how early claim information can affect reserves and assignments, what happens when a loss exceeds an adjuster's experience or authority, why claims may be transferred repeatedly, and how large loss teams, multiple coverage adjusters, management review, and outside experts can dramatically change the claims process.

That is where the experience gap becomes much harder for a policyholder to ignore.