Behind the Claim: Insider Tips for Faster, Fairer Insurance Payouts
- Andy Adams
- 2 days ago
- 3 min read
People love to ask claims adjusters for the inside scoop. What are the secrets to getting the best claims service, i.e. fair and prompt payment? This always makes me smile thinking about the scene from the Incredibles - The Incredibles - Insurance Claim (HDR - 4K - 5.1) where Bob is no longer a Super but has been relegated to the life of a bored claims adjuster. He tries to help clients get their claims paid and is harassed by his boss for paying too many claims!
I also remember reading The Rainmaker just as I was attending my very first claims 101 adjuster class! If you haven’t read it, The Rainmaker is a John Grisham thriller about a lawyer who uncovers multi-million dollars in medical insurance claims denials being made by a corrupt insurance company.
Thankfully, in my real-life experience, Claims Adjusters are instructed to be as you would hope and expect. In my own training we were told to be Friendly, Frank, Firm and Fair!
The Four F’s of a Great Claims Adjuster
Fair
Coverage definitions, endorsements and exclusions are written in black and white, but every claim is unique which can lead to interpretations that can be subjective. Estimates of damage are also an area that can differ depending on the software program used and/or the quality of materials (low, average, or high). Therefore, the adjuster is called to be fair and justify his reasoning for the decisions and values assigned to each claim.
Frank
Once the investigation and gathering of facts is done, delivery of the news must come as soon as possible and in clear plain language. Good news should be given quickly and bad news delivered even faster.
Firm
Adjusters need to be sure and confident in their delivery. Claim volume is an issue! If the adjuster spends too much time researching and haggling every claim, they will drown and/or burn out.
Friendly
Obviously this is a job based in customer service. For some adjusters this comes more naturally than others, but everyone is trained to build rapport and be empathetic at what is a stressful time for the customer to deal with a loss of some kind.
What to Do If Your Claim Doesn’t Feel Fair
All this being said, if you feel your claims adjuster is unfair, the best approach is to stay organized, communicate clearly, and escalate carefully when needed.
Here are practical steps that often help:
1. Review your policy carefully and understand your:
Coverage limits
Exclusions
Deductibles
Duties after a loss including;
Time-sensitive reporting deadlines and
Preservation of evidence
Mitigation of damages
2. Document everything!!! Create a file and keep:
Emails and letters
Record of dates/times of phone calls
Names of everyone you speak with
Photos, estimates, receipts, medical records, etc.
After you have a phone conversation, send a recap in writing. Good documentation is one of the strongest tools you have.
3. Ask for explanations in writing
If a payment seems too low or a claim is denied, ask:
What policy language supports the decision?
What evidence was used?
What additional information could change the outcome?
Written explanations make it easier to evaluate whether the handling is reasonable.
4. Stay calm and professional
Even when frustrated, keep communication factual and respectful. Emotional or hostile exchanges can slow progress and make cooperation harder.
5. Get independent estimates or opinions.
Depending on the claim type, consider:
Contractor estimates
Repair shop opinions
Medical evaluations
Public adjuster assessments (for property claims)
Independent documentation can strengthen your position.
6. Escalate within the insurance company
You can request:
A supervisor review
A different adjuster
The company’s claims manager
A formal internal appeal or complaint process
7. Contact your state insurance department
Every state has an insurance regulator that handles consumer complaints.
They can:
Review whether laws or regulations were followed.
Pressure insurers to respond.
Help resolve communication problems.
In Texas, for example, that would be the Texas Department of Insurance.
8. Consider professional help if the stakes are high
Depending on the situation:
A public adjuster may help with property damage disputes.
An attorney may help if there’s a major denial, delay, or suspected bad faith.
🚩 Warning Signs to Watch For:
Long unexplained delays
Repeatedly changing explanations
Ignoring evidence
Refusing to communicate
Offering settlements far below documented damages without explanation
Final Thought: Choose Your Carrier Wisely
Finally, the best insurance companies will have the best claims adjusters. Choose wisely! Do not select your insurance carrier solely on price. If you are dealing with a lower tier insurance company, a bad actor individual or just a human being who is making mistakes with your claim, do not hesitate to advocate for yourself and escalate to demand better claims service when you are not being treated properly.
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