What to look for
Red flags on
your claim
None of these proves wrongdoing on its own. Each one is a signal to slow down, get it in writing, and learn your rights before you agree to anything.
From the insurance company
Decisions only by phone
Coverage positions, scope changes, and denials that never arrive in writing. Follow up every call with an email that summarizes it.
What to do →A denial that doesn’t quote your policy
A denial should identify the specific policy language and facts relied on. Ask for it in writing.
What to do →Pressure to use the “preferred” vendor
Steering you to a program contractor, or implying coverage depends on it. Ask who the vendor works for.
What to do →An engineer or expert report you can’t get
If a report drives the decision, ask for a complete copy and ask whether its author inspected the property.
What to do →Rotating adjusters and restarting the file
Every new adjuster asks for the same documents again. Keep a dated log of every handoff and request.
What to do →Silence past your state’s deadlines
Most states set time limits to acknowledge, investigate, and decide claims. Track the dates.
What to do →A “final” check with a release attached
Read anything labeled “full and final” before you sign or deposit. Ask what is being released.
What to do →A request for a recorded statement before you’ve read your policy
Know what your policy actually requires before you agree to be recorded.
What to do →In the estimate
“Dry and paint” for contaminated water
Category 2 and 3 water losses carry removal requirements under the IICRC S500 standard.
What to do →Missing line items
Containment, contents manipulation, cleaning, permits, detach-and-reset, and code items are commonly left out.
What to do →No overhead and profit when a general contractor is needed
When the job reasonably requires coordinating several trades, ask why O&P was left off.
What to do →Patching that won’t match
Replacing only damaged pieces when new material can’t reasonably match the rest. Some states have matching rules.
What to do →Depreciation with no explanation
Ask how depreciation was calculated and whether it is recoverable after repairs.
What to do →Smoke damage written off as “cosmetic”
Residue and odor need assessment and cleaning to a standard, not just a coat of paint.
What to do →From a contractor
No license number or proof of insurance
Verify the license with your state board before work starts.
What to do →A contract that signs over your entire claim
Read assignment-of-benefits and direction-to-pay documents carefully; some states restrict them.
What to do →No moisture readings, photos, or drying logs
A professional water mitigation job is documented daily. Ask for the logs.
What to do →Promises to “negotiate your claim”
In many states only a licensed public adjuster or attorney may represent you in negotiating a claim.
What to do →“Mold kill” spraying instead of removal
The IICRC S520 standard centers on physically removing mold contamination, not just spraying it.
What to do →Seeing several of these?
Put your concerns in writing to the insurer, keep copies, and consider a complaint to your state Department of Insurance or a consultation with a licensed public adjuster or attorney.
How to file a complaint