Claims handling, investigation, and adjusting practices
Domain 3 - Claims handling, investigation, and adjusting practices
This domain tests the claim file from first notice to settlement: acknowledgment, investigation, coverage analysis, documentation, communication, and good-faith negotiation. Iowa expects an adjuster to act promptly, investigate before denying, and explain decisions in writing.
Core practices
- Acknowledge the claim promptly, identify the insured and policy, and open a claim file. Contact the insured, explain the process, and request only information reasonably needed.
- Investigate before deciding. Inspect the risk, photograph and measure damage, obtain inventories, estimates, and expert reports, and separate covered from excluded causes. Document who said what and when.
- Evaluate coverage under the declarations, insuring agreement, exclusions, and conditions. Apply the deductible, valuation method, and any sublimits. Send a written explanation for a denial or partial denial, citing the policy language.
- A public adjuster represents the insured, not the insurer. Use a written contract, avoid conflicts, keep claim funds separate, and do not solicit at a disaster scene before Iowa's statutory waiting period expires.
- Negotiate in good faith. Do not misrepresent policy terms, delay without reason, or offer substantially less than the supported claim to force litigation.
Worked example
A burst supply line damages a kitchen. The insured also reports long-term staining under the sink. The adjuster inspects, finds sudden discharge from a failed fitting, and finds repeated seepage staining. The policy covers sudden discharge but excludes repeated leakage. The adjuster pays for the sudden damage, excludes the stained cabinet floor, and sends a written explanation. The file shows photographs, the plumber's report, and the policy exclusion.
Traps
- Denying before inspecting or obtaining the policy.
- Treating the insured's stated cause as proved.
- Missing an exclusion or a sublimit.
- Negotiating without a written public adjuster contract.
- Mixing claim funds with business funds.