Claims Handling and Investigation
This domain tests the practical sequence of a property claim: contract, notice, investigation, documentation, coverage analysis, proof of loss, negotiation, and closing. The public adjuster must keep the insured informed and must not delay a claim without good cause.
Core rules
- Document the loss with photographs, video, measurements, receipts, and a room-by-room inventory. Preserve evidence before repairs or disposal.
- Separate covered damage from excluded causes. Prepare a scope that matches the policy's measuring standard (ACV versus RCV).
- Submit a sworn proof of loss when required and support it with the inventory and estimates. Do not sign or submit figures you cannot substantiate.
- Negotiate in writing; memorialize offers, counteroffers, and the insurer's coverage position. If the dispute is about amount, appraisal may be available; coverage disputes are different.
Worked example
A kitchen fire damages cabinets, flooring, and a range. The insurer's scope omits cabinet replacement and smoke remediation. The adjuster photographs the pre-loss condition, obtains two contractor bids, prepares a contents inventory with ages and replacement costs, and sends a line-by-line rebuttal. Reasoning: the rebuttal ties each disputed item to damage evidence and policy language, giving the insurer a factual basis to revise the scope.
Traps
Negotiating before completing a coverage analysis. Missing proof-of-loss or suit deadlines. Discarding damaged property before inspection. Giving legal opinions about coverage disputes. Letting a contractor's estimate become the only evidence without verifying scope and pricing.