09/03/2026
“How was your day at work?”
All day. Every day. 😂
This is what a lot of the work of a Public Adjuster looks like behind the scenes.
We don’t just show up for an inspection and disappear.
We advocate.
Sometimes advocacy means writing the email nobody wants to receive—but somebody needs to send.
Below is an example of the type of correspondence our team may prepare when we believe a claim has not been fully, fairly, or comprehensively investigated.
This is the value of having an advocate in your corner.
👇 And yes… this is pretty much all day, every day. 😂
━━━━━━━━━━━━━━━━━━
EXAMPLE CORRESPONDENCE:
━━━━━━━━━━━━━━━━━━
FORMAL DISPUTE OF DENIAL – Immediate Reassignment, Reinspection & Safety Concerns – Claim ###XX
Good afternoon,
I am writing to formally dispute ###XX’s handling and denial of ###XX’s claim, Claim No. ###XX, and to request immediate reassignment of this file to a different adjuster and a complete reinspection of the property.
The manner in which this claim has been investigated and denied is extremely concerning.
###XX had already communicated to its insureds that, following management review, this was a covered loss. Coverage was confirmed verbally and/or in writing through ###XX representatives, and the insureds subsequently confirmed that the prior coverage determination and management review were documented within the claim file.
Despite ###XX’s prior confirmation of coverage, adjuster ###XX arrived for the joint inspection and, almost immediately upon entering the basement, began stating that the loss was related to the sump pump and was not covered.
I was personally present for this inspection.
I advised the adjuster that ###XX had already addressed and confirmed coverage and that we were at the property to conduct an inspection of the damages—not to predetermine or reverse a coverage determination before the property had even been fully inspected.
Unfortunately, what followed was an extraordinarily abbreviated inspection that failed to meaningfully address multiple reported areas of damage.
Basement / Water Damage
The adjuster was expressly advised that the insureds contend the sump pump did not lose power, as it remained connected to a generator during the outage.
The adjuster was also advised that professional water mitigation had not been completed. The homeowners performed emergency efforts themselves, including removing some flooring and operating fans and a dehumidifier, but substantial portions of the affected area remain unopened and unmitigated.
I specifically discussed the need for professional mitigation, including appropriate investigation and flood cuts to determine the vertical and lateral extent of moisture migration.
There is already visible discoloration in portions of the affected area, along with concern for possible microbial growth.
Despite being provided this information, ###XX’s denial letter states:
“It was determined that a power outage from the storm caused the sump pump to cease operation.”
That factual conclusion is directly contrary to the information provided to ###XX that the sump remained powered by a generator.
The same denial letter then states that water backed up from the drains and “caused damage to the basement.”
Yet ###XX issued another letter the following day stating:
“Our inspection did not reveal any accidental direct physical loss to your home.”
These two written positions are facially inconsistent.
###XX cannot reasonably state in one written determination that water entered the basement and caused damage, and then state the following day that its inspection revealed no accidental direct physical loss to the home, without providing a meaningful explanation reconciling those conclusions.
Additional Interior Damage / Electrical Concerns
The basement was not the only damage reported during the inspection.
I specifically advised the adjuster that the insureds are experiencing electrical problems in the kitchen and in one of their daughters’ bedrooms, including outlets that the family is presently unable to use.
These conditions have now been reported to one or more ###XX representatives, yet, to our knowledge, ###XX has taken no meaningful action to investigate them.
This family, including three small children, continues to reside in the home while these reported electrical abnormalities remain unresolved. ###XX is therefore being provided written notice of the potential fire and life-safety concerns associated with these conditions.
If ###XX intends to maintain its denial while declining to investigate the reported electrical issues, please state that position expressly in writing.
Please ensure the claim file reflects that ###XX has now been provided written notice of these unresolved electrical conditions and the potential safety concerns associated with them. Further delay in evaluating these conditions may result in additional damage, expense, or safety concerns for the insureds.
Roof and Exterior Damage
The adjuster also inspected the roof.
The adjuster remained on the primary roof for approximately four minutes. I observed overview photographs being taken, along with several closer photographs of one garage slope.
I did not observe the adjuster physically manipulate or examine the shingles for lifted, loosened, creased, or otherwise storm-damaged conditions.
The adjuster then spent approximately another four minutes on the shed roof.
The entire property visit lasted approximately 20 minutes.
There were additional storm-related exterior conditions reported and/or clearly visible at the property that required consideration as part of this claim.
Personal Property
There was also damaged personal property at the residence, including a large and visibly damaged trampoline in the backyard.
The affected basement contains the children’s play area and personal property.
Despite these readily apparent circumstances, the adjuster did not conduct any meaningful inquiry regarding storm-damaged personal property or ask the insureds to identify the contents damaged during this event.
Other Interior Areas Were Not Meaningfully Investigated
After leaving the basement, the adjuster did not ask whether there were additional damages to the interior of the home and did not conduct a general inspection of the remaining interior areas despite being advised that additional conditions existed.
The electrical problems in the kitchen and daughter’s bedroom were specifically brought to the adjuster’s attention.
A coverage dispute concerning the alleged source of basement water does not eliminate the need to investigate separately reported storm damage involving other portions of the dwelling, the roof, exterior property, electrical systems, and personal property.
Indiana Unfair Claim Settlement Practices
In my capacity as the insureds’ public adjuster, I am not making a legal determination regarding statutory liability. However, the documented handling of this claim raises significant claim-handling concerns that warrant supervisory and compliance review in light of Indiana Code § 27-4-1-4.5, including the following provisions:
IC § 27-4-1-4.5(1) – Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
###XX’s denial expressly relies upon a factual conclusion that the sump pump ceased operation because of the power outage despite ###XX having been advised that the sump remained powered by a generator.
Additionally, ###XX previously confirmed coverage following management review, yet that determination now appears to have been disregarded without a reasonable explanation.
IC § 27-4-1-4.5(3) – Failing to adopt and implement reasonable standards for the prompt investigation of claims.
An approximately 20-minute inspection in which substantial portions of reported damage were not meaningfully investigated—including reported electrical problems, personal property damage, remaining water damage, other interior conditions, and exterior storm damage—raises serious questions regarding whether a reasonable investigation standard was followed.
IC § 27-4-1-4.5(4) – Refusing to pay claims without conducting a reasonable investigation based upon all available information.
The denial appears to have been issued without adequately considering all information made available to ###XX, including:
The insureds’ statement that the sump remained powered by a generator;
###XX’s prior confirmation of coverage;
The incomplete professional mitigation;
Existing discoloration and possible microbial growth;
Reported electrical abnormalities;
Other interior damages;
Roof and exterior conditions; and
Personal property damage.
Of particular concern, ###XX’s first denial letter is dated the same day as the inspection.
The circumstances give every appearance that the coverage conclusion had already been reached rather than being the product of a complete and objective investigation of all reported damages.
IC § 27-4-1-4.5(6) – Not attempting in good faith to effectuate prompt, fair, and equitable settlements of claims in which liability has become reasonably clear.
###XX had previously communicated coverage following management review.
Rather than fully investigating and adjusting all reported damages after that determination, the file was subsequently returned to a denial position that appears inconsistent with the prior ###XX communication, the information presented by the insureds, and even ###XX’s own subsequent written correspondence.
IC § 27-4-1-4.5(14) – Failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim.
While ###XX’s first denial letter quotes a water exclusion, it does not meaningfully reconcile that exclusion with the actual facts presented by the insureds, including their representation that the sump remained operational.
Nor does ###XX explain how it can conclude in one letter that water entered the residence and “caused damage to the basement,” yet state the following day that the inspection revealed no accidental direct physical loss to the home.
Most importantly, neither letter meaningfully addresses the other storm-related damages separately reported during the inspection.
A denial concerning one alleged mechanism of basement water intrusion does not eliminate the need to reasonably investigate other reported storm damage under the policy.
Immediate Reassignment and Complete Reinspection Required
At this point, we have lost confidence that this property was independently, objectively, and comprehensively evaluated during the initial inspection.
Accordingly, we are requesting that ###XX:
Immediately reassign this claim to a different qualified adjuster;
Schedule a complete reinspection of the property, including the basement, remaining interior areas, reported electrical conditions, roof, shed, exterior, and damaged personal property;
Review and preserve all prior claim notes, recorded telephone calls, emails, internal communications, and management communications concerning ###XX’s prior confirmation that this loss was covered;
Provide the written and/or recorded documentation reflecting ###XX’s prior coverage determination following management review;
Explain in writing the factual basis for ###XX’s assertion that the sump pump ceased operating when the insureds advised that it remained powered by a generator;
Explain the material inconsistency between ###XX’s first denial letter acknowledging that water caused damage to the basement and its subsequent letter stating that no accidental direct physical loss was observed;
Provide the complete inspection documentation generated by ###XX, including photographs, reports, diagrams, measurements, notes, and any estimate or evaluation prepared from the inspection;
Identify ###XX’s capacity and status in handling this Indiana claim, including whether this individual was acting as an employee of ###XX, an independent adjuster, external vendor/resource, or in another capacity. If ###XX was acting under an adjuster license, please provide the applicable license state, license type, and license number; and
Immediately confirm that the insureds may proceed with professional water mitigation and a qualified electrical evaluation.
Immediate Safety and Mitigation Concerns
Professional water mitigation has not been completed, and visible discoloration and possible microbial growth are already developing in portions of the affected area. Continued delay may increase both the extent of the damage and the ultimate remediation required.
###XX has also been expressly notified of unresolved electrical problems affecting the kitchen and a child’s bedroom in a home occupied by three small children.
Please confirm immediately that the insureds may proceed with professional water mitigation and a qualified electrical evaluation.
If ###XX is directing the insureds to delay either of these necessary protective measures, please state that instruction in writing and provide the factual and policy basis for that position.
This correspondence serves as written notice of these conditions. Please document these concerns within the claim file and promptly advise how ###XX intends to address the requested mitigation and electrical evaluation.
The insureds purchased an insurance policy from ###XX with the reasonable expectation that covered storm damage would be fully, fairly, and objectively investigated and adjusted.
They are entitled to more than a predetermined coverage conclusion followed by an approximately 20-minute inspection that failed to meaningfully investigate multiple categories of specifically reported damage.
We expect this matter to be addressed promptly through reassignment, a comprehensive reinspection, appropriate investigation of the reported conditions, and a good-faith evaluation of all damages resulting from this storm event.
Please have a claim supervisor or manager contact our office promptly regarding reassignment and scheduling of the reinspection.
Thank you,
-Team PSA
Public Adjuster
###XX
