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The Insurance Claims Estimating Process - Step 1

As a general contractor who specializes in insurance claims repairs, ARES representatives often get asked, “What is the insurance claims estimating process?” This post is intended to shed some light on what a home or business owner can expect. Please note, this is NOT insurance advice NOR does it represent how every claim is handled. ARES is part of a community of local contractors who have dedicated themselves to helping home and business owners restore their property following damage events. 

Estimating Sequence Step 1 for Insurance Claims
Insurance Claims Estimating Process

Insurance Claims Estimating Step 1

If you refer to the infographic above, Step 1 in the insurance claims estimating process (or sequence) consists of one key question and three fundamental steps. 

The Insurance Claims Coverage Question 

The question that every insured will need to ask and discuss with their insurance company (aka carrier) representatives is, “Is this damage event covered by my insurance policy?” As we discussed in a prior post regarding insurance claims,

The source of loss can be covered or excluded (not covered) by the terms in your policy. It is important to understand what you are buying, especially if you chose your policy based on the lowest price. Elements of your insurance claim may be covered, not covered (excluded), or have limits on the extent of coverage. If the damages resulting from a covered (or non-excluded) source, the cost to mitigate and repair those damages should be covered by the claim.

Insurance Claims Coverage Determination

Insurance claims coverage for a damaged home is typically determined by several factors, including:

  1. Type of Policy: The specific type of homeowners insurance policy you have can affect what is covered. There are different levels of coverage, such as basic, broad, or comprehensive policies.

  2. Cause of Damage: The cause of the damage plays a significant role in determining coverage. Certain perils, like fire, windstorms, and theft, are commonly covered, but other events, such as floods or earthquakes, may require additional coverage or separate policies.

  3. Policy Limits: Each policy has limits on the amount it will pay for covered losses. It's essential to understand these limits to ensure you have adequate coverage for your home and possessions.

  4. Deductibles: The deductible is the amount you must pay out of pocket before the insurance coverage kicks in. Higher deductibles often result in lower premiums, but it's important to choose a deductible that you can afford to pay in the event of a claim.

  5. Valuation of Property: The insurance company will assess the value of the damaged property to determine the amount of the claim. This may involve estimating the cost of repairs or replacement.

  6. Exclusions: Insurance policies also have exclusions, which are specific events or circumstances that are not covered. Reviewing these exclusions is crucial to understanding the limitations of your coverage.

To get the most accurate and current information regarding insurance claims coverage for a damaged home, it's advisable to contact your insurance provider directly and review your policy documents. Insurance policies can vary widely, and only your provider can provide specific details about your coverage and any recent changes in their policies.

Three Insurance Claims Estimating Steps

If a homeowner in South Hill has a water damage event, they could consult with a local water damage restoration contractor to provide them with a moisture assessment and a recommendation for a mitigation plan. Often it is recommended to ensure the contractor and the insurance carrier are communicating so that there are no surprises for the customer (the insured) if there is a disagreement about the scope and cost of the work. We refer to this as The Restoration Triangle (contractor, carrier, and customer) and if you are interested in more details about this process you may find a recent episode of The DYOJO Podcast to be helpful. 

  • File an Insurance Claim 

  • Confirm Coverage 

  • Clarify Any Exclusions

If a homeowner in Parkland is unsure of the source or the extent of the water damage, a local water damage restoration contractor could assist them in answering both of these questions. A water damage professional should have moisture meters, infrared cameras, and other tools to help them determine the extent of the water damage and the moisture saturation of various materials. 

As we noted above, each member of The Restoration Triangle has a key role in this process. 

  • The customer knows what occurred in their home or business which can help all parties determine the source of the loss as well as how extensive the damages are. 

  • The contractor has the knowledge and skills to identify the issues, develop a plan, and speak to the recommended steps to restore the structure. 

  • The carrier understands the policy and should help the customer understand what is and is not covered by this contract document.

Insurance Claims Estimating by Local Contractors

The estimating process often starts with filing an insurance claim and confirming coverage. Local contractors experienced in this process, such as ARES, can help inspect and document the site conditions which are valuable components for consumers and insurance carriers alike. As a home or business owner, you should understand what is and what may not be covered under your insurance policy.

If you are reading this and you have not reviewed your policy with your local insurance agent recently, now would be a good time to schedule a review with them. In the event of damage to your home or business, it is good to always ask questions to understand what you are being asked and why it is important to the process. There are some great resources for consumers via United Policyholders which we reference in a prior post on surviving an insurance claim

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