The pressure to resolve claims begins with property damage long before repair work is complete. Damage from water will have spread throughout the building. Tenants may be calling about lost business. Operations may come to an impasse as all parties seek answers to two questions immediately: “What happened here?” And “What does the claim support?” That is when claim assessments become more than just paperwork. A solid, well-conducted assessment sets the tempo for; provides clarity to; and helps establish the legitimacy of the recovery process.
Independent adjusting professionals are typically called in at this point not to speculate on damage or potential loss, but to carefully assess damage, compare the reported loss to policy provisions and help drive the claim towards a resolution based upon factual evidence versus time constraints.
Damage Review Requires More Than A Walkthrough
Claim Assessment Starts With Scope
Independent claim assessment typically begins with a clear definition of the loss. As obvious as that sounds, property damage often results in a difference between the original complaint and the actual extent of the damages. For example, the Facility Manager reports damage to the roof due to a storm; however, it can be determined through an independent investigation that the claim includes additional damages such as interior water intrusion into walls, ceilings or floors; damaged insulation; damaged finishes; operational disruption; and potential mitigation work already begun.
Early Documentation Shapes The Entire Claim
Independent Insurance Adjusters do not view site visits as an inspection tour. They will gather evidence to document the damage and support claim handling in the future. This evidence should include visual evidence of damage, statements from those who observed the damage, timelines of what happened before, during and after the loss occurred, how the damage was first discovered and any actions that were taken afterwards.
Site Inspections Focus On Verifiable Facts
Once at the site of loss, the claims adjuster takes note of the actual condition of the property versus their assumptions based upon earlier written communications. The documentation of the conditions of the property would include; photographs taken during an initial walk-through for reference purposes to record damaged components of a property (i.e. walls, ceilings), measurements of damaged items, notes regarding possible causes of damage and identification of both direct and indirect impact(s) resulting from the loss in a given area/building system within a property.
In multi-tenant buildings and/or commercial properties, documenting damages can become a more involved process due to the possibility that damages may occur in common areas of the building (or multiple floors), tenant space, service areas and building systems. A structured approach will assist in identifying potential damages that may not appear immediately visible. Property losses frequently do not appear equally throughout all areas of a property.
For example; stains caused by water migration into a structure may be seen above where the water originated. Damage to an exterior component could create secondary damage to interior elements that has yet to develop. Potential equipment failure may not be apparent unless operational procedures are evaluated.
Cause Analysis Matters To Coverage
A large portion of claim evaluation is identifying probable causes for damages. This is true, as coverage determinations typically rely heavily upon distinctions made by causes. While wind driven rains, plumbing leaks, long term leakage, impacts from weather, vandalism, fires or mechanical failures can create similarities in the types of damages created, they have drastically different claims implications. It is therefore expected that independent adjusters will review the facts about the loss closely enough to provide a reasonable explanation of the type of loss and the mechanism by which it occurred.
It doesn’t mean that each and every adjuster is also a forensic engineer. In certain complex technical matters, additional assistance may need to come from outside experts. However, there should be no question that the adjuster has a significant role to play in recognizing when the causative factors appear clear-cut, where ambiguity exists due to environmental conditions and/or other factors, and when additional technical input is required prior to evaluating the claim with a high degree of confidence.
Statements Help Clarify The Timeline
The extent of claim evaluation also relies upon the creation of the timeline. The majority of property claims do not rely solely on visual evidence; instead, an insurance adjuster will typically take statements from the owner(s), manager(s), maintenance personnel, tenants, contractors, etc. in order to determine when the problem developed, how long it had been noticed prior to the claim being made, what changes occurred after the problem became apparent, and whether there were any emergency measures put into place. In addition to helping establish a sequence of loss (i.e., establishing cause-and-effect), this information can significantly influence both the scope of work and the determination of coverage.
This is particularly true where the condition of property may have altered since the time of the incident causing damage to the property. Water damage may continue to deteriorate for days. Emergency repairs may be made by temporary repair vendors that can alter the initial condition of the area. Cleanup vendors may remove damaged items prior to the arrival of the adjuster. Thus, clear and concise documentation of these events provides a timeline that supports more logical and timely decision making during subsequent phases of the claim processing.
Mitigation Efforts Are Reviewed Carefully
The first step after property damage is to mitigate the damage. Mitigation is the process by which all measures are taken to protect a property from potential damage. This may include water extraction, board-ups, tarping, debris removal, use of drying equipment, and any other temporary measure to stabilize a damaged property.
Because of the nature of most claims (i.e., they occur when there is an interruption in business) and/or the fact that many insureds have an ongoing obligation to pay mortgage payments on their properties, these activities can be initiated very quickly. Independent adjusters scrutinize this type of activity as well as the costs associated with such activities. Not only does independent review determine if a property has been properly mitigated, but also whether such mitigation occurred in a timely manner and if such mitigation was reasonably necessary to prevent additional losses due to the incident which precipitated the loss.
Strong Assessments Support Better Recovery
Independent insurance adjusters perform their role as independent assessors of claims for damage to property, when they build the claim based upon documented fact, physical inspection of the site, verification of timelines involved with respect to the damages and an evaluation of measures taken (mitigation) prior to the repair. In addition, an adjustment professional inspects, records, analyzes, and establishes a causal link between the actual loss and the terms/conditions of the policy which define how the claim will be treated. Although much of this work occurs out-of-sight from public view, it significantly affects both the clarity with which each step in the claim process is executed and the confidence with which all parties make claims-related decisions.
Conclusion
The benefits for Property Managers, Facility Teams, and Building Owners can be described simply as being able to get through a claim more efficiently. When an assessment is performed in a structured way from the very beginning it will assist in moving your claim along. This can be achieved by creating clear documentation of the loss; performing a thorough cause analysis that is believable; clearly defining and reviewing the scope of work; and communicating on a regular basis to avoid confusion which can occur during this period of time when both can have costs associated with them. Independent Adjusters will help facilitate this process, as they take a damaged property and transform it into a claim file that can then be reviewed, analyzed and defended by using a consistent format.
