The Claims Game Tactics: How Shady Strategies Impact Your Settlement

Insurance companies promise to protect us when disaster strikes. Yet for many property managers, contractors, and facility managers, the reality is riddled with insurance claim denials. Far too often, these denials stem from questionable tactics designed to protect the insurer's bottom line rather than provide the support policyholders expect.

At Velocity Public Insurance Adjusters, we see first-hand everyday how these strategies can leave policyholders financially strained and emotionally drained. By understanding the common tactics insurers use, you can better navigate the claims process, challenge unfair denials, and secure the compensation you deserve.

Contact Us Now!

Navigating the Claims Game: How Insurance Claim Denials Happen

The process of filing an insurance claim seems straightforward, but the reality is often more complex. Understanding the key stages of the claims process can help property managers and contractors anticipate challenges:

1) Claim Submission

This includes submitting the claim in a timely manner and gathering evidence such as photos of damage, repair estimates, and proof of loss forms.

2) Investigation

The insurer assesses the claim, often sending adjusters to inspect the damage. This step is critical, as these subjective evaluations can influence the outcome.

3) Decision

After the investigation, the insurer denies, delays, or underpays the claim, frequently relying on ambiguous policy language to justify their perceived outcome.

For instance, commercial property managers facing water damage from burst pipes may encounter denials based on claims that the damage was “gradual” rather than “sudden and accidental.” These denials, rooted in vague policy terms, highlight the importance of expert advocacy. Public adjusters play a crucial role in ensuring claims are accurately evaluated and resolved fairly.

Common Tactics Leading to Insurance Claim Denials

Insurers employ several psychological and procedural tactics to deny or underpay claims. Recognizing these strategies can help policyholders counteract them effectively:

1) Ambiguity in Policy Language

Vague terminology such as "wear and tear" or "gradual damage" often leaves room for interpretation—usually in favor of the insurer. Policyholders dealing with insurance claim denials often find that these terms are cited to avoid paying legitimate claims. For example, a facility manager handling water damage from a plumbing failure might face a denial based on the insurer's subjective interpretation of "maintenance-related issues." Public adjusters can demystify these terms, ensuring claimants understand their rights.

2) Delay Tactics

Insurers may intentionally prolong the process by requesting unnecessary documentation or extending the investigation timeline. These delays can leave property managers in limbo, unable to make repairs or resume normal operations. According to the National Association of Insurance Commissioners (NAIC), delays are among the most common complaints about insurers. Working with a public adjuster ensures that claims stay on track, preventing unnecessary setbacks.

3) Overwhelming Claimants with Jargon

Complex policy terms, inaccurate repair estimates, and using perceived legal language can create confusion, making it impossible for claimants to advocate for themselves. This tactic is particularly challenging for multi-family and commercial property managers or contractors juggling multiple claims-handling responsibilities.

4) Manipulative Interview Techniques

During recorded statements or inspections, insurers may use leading questions or intimidation to weaken a claimant’s case. For instance, a contractor property owner or their asset manager might feel pressured into inadvertently admitting fault during a lengthy interrogation.

Consequences of Denied Insurance Claims

The impact of insurance claim denials extends far beyond the initial financial setback. Property managers, contractors, and facility managers may face:

• Operational Disruptions: Denied claims can delay critical repairs, affecting tenants, staff, or production schedules.
• Out-of-Pocket Costs: When claims are underpaid or denied, policyholders often bear the financial burden.
• Erosion of Trust: Repeated denials or delays foster distrust toward the insurance industry.

By understanding the psychology behind these denials, policyholders can better prepare themselves to challenge unfair decisions.

Countering Insurance Claim Denials

To successfully navigate the claims process and counter these tactics, policyholders should take the following steps:

1) Understand Your Policy

Familiarize yourself with your coverage, including exclusions and conditions. A public adjuster can help you identify potential red flags before filing a claim.

2) Document Thoroughly

Provide detailed evidence of the damage, including photographs, repair estimates, and receipts. Accurate documentation strengthens your case and reduces opportunities for insurers to deny claims.

3) Challenge Ambiguous Denials

If your insurer denies a claim based on vague language, request a clear explanation. Public adjusters excel at challenging these denials, leveraging their expertise to advocate for fair settlements.

4) Seek Expert Advocacy

Public adjusters are first-party property damage advocates who ensure policyholders receive what they’re entitled to. The National Association of Public Insurance Adjusters (NAPIA) notes that settlements are often significantly higher when public adjusters are involved.

Why Insurance Claim Denials Are So Common

Statistics from the Office of Program Policy Analysis and Government Accountability (OPPAGA) reveal that insurance carriers often act in their own interests rather than those of policyholders. Denials, delays, and underpayments are systemic issues, underscoring the importance of having knowledgeable advocates.

Turning the Tables on Insurance Companies

Understanding the tactics behind insurance claim denials is the first step toward protecting yourself. Whether you’re dealing with water damage, vandalism, or fire damage, having an experienced public adjuster by your side can make all the difference.

Don’t let insurers dictate your settlement. Armed with knowledge and expert support, you can challenge denials, expedite the process, and secure the compensation you deserve.

Insurance claim denials don’t have to be the final word. Schedule a call with Velocity Public Insurance Adjusters for a free claim and policy review. Let us help you navigate the complex world of insurance claims with confidence.