Claims Investigation, Evaluation and Adjustment Practices
The adjustment process
A defensible file moves through: notice of loss and first contact, coverage analysis and reservation of rights, investigation (photographs, measurements, recorded statements, weather data, engineer reports), valuation, proof of loss, payment or written denial, and continuing communication. Document every contact and confirm your authority before discussing coverage positions. Florida's claim-handling statute (s. 627.70131, F.S.) sets insurer timelines: acknowledge the claim within 14 days, begin investigation within 10 working days, give written status updates every 30 days, and pay or deny within 60 days after receiving the proof of loss.
Causation and coverage disputes
Florida applies efficient proximate cause analysis, but policies commonly contain anti-concurrent-causation language and exclusions for constant or repeated seepage, faulty workmanship, and wear and tear. Identify whether the dispute is about amount or about coverage, because the answer dictates the remedy. Appraisal resolves only the amount of loss under the appraisal clause; it cannot decide whether a peril is covered. Department of Financial Services mediation under s. 627.7015 is another route for residential property disputes. Examination under oath, sworn proof of loss, and records requests are policy conditions the insured must satisfy.
Evidence discipline
Photograph conditions before anything is moved, retain damaged materials where practical, and separate cause from extent. Never promise a payment figure before the estimate is complete, and never advise an insured on legal rights beyond referring them to counsel.
Worked example
The insurer concedes wind opened the roof but disputes whether resulting interior damage exceeds the deductible - that is an amount dispute, so appraisal applies. If the insurer says the interior damage came from pre-existing leaks, that is a causation/coverage dispute, and appraisal is improper; negotiate, mediate, or litigate instead.