Public Adjusters: Strengthening Claims with Third-Party Validation

Why Third-Party Inspections are Critical in Insurance Claims

Public insurance adjusters work on behalf of policyholders to ensure they receive a fair and justified settlement for property damage claims. However, insurance carriers often dispute the extent, causation, and scope of damage, leading to delays, underpayments, or outright denials.

By incorporating third-party environmental inspections, testing and damage assessments from a firm like Auxilium Environmental, PAs provide indisputable, scientific evidence that strengthens claims and aligns with policyholder rights.

How Third-Party Environmental Inspections Validate Claims:

Scientific Objectivity Against Carrier Disputes:

• Insurance adjusters rely on internal assessments that may be biased toward minimizing payouts. Independent assessments, mold, IAQ, and hazardous material testing provides defensible, third-party data.

• Example: A claim for mold remediation may be denied based on “pre-existing conditions” unless verified moisture mapping demonstrates water intrusion occurred due to the covered peril (storm, pipe burst, etc.).

  
  

Expediting Claim Approval with Data-Backed Reports:

• Third-party testing provides quantified damage assessments, enabling adjusters to approve claims faster and reducing pushback.

• Regulatory compliance reports ensure losses meet local and federal safety requirements, preventing disputes over health hazards.

  
  

Proving Indemnity & Justifying the Full Cost of Restoration:

• Many policies cover “like kind and quality” (LKQ) repairs, which means the insurer must return the property to its pre-loss condition.

• Without third-party verification, a carrier may approve partial drying efforts when full moisture remediation and mold prevention are required to achieve true indemnity.

• Our environmental documentation substantiates these costs, forcing the insurer to meet their contractual obligations.

Policy Language & Legal Precedents Supporting Third-Party Inspections:

Homeowner’s Insurance Policies Covering Environmental Testing:

• Many policies include coverage for mold, hazardous materials, and IAQ testing under ordinance or law provisions.

• Example Policy Clause: “If a covered loss requires environmental testing, the policyholder is entitled to reasonable testing and evaluation costs for contamination mitigation.”

Settlements & Legal Cases Supporting Independent Testing:

• Court rulings (e.g., Water Loss vs. Carrier Disputes) have upheld that third-party environmental testing provides critical evidence in litigation and dispute resolution.

• Example: A Florida appellate court ruled that policyholders are entitled to third-party validation when the insurer’s assessment is challenged (Referencing Fla. Stat. § 627.70132).

Overcoming Cost Concerns: How PAs Can Justify Our Services

Some PAs hesitate to involve environmental inspection firms due to added costs. However, our services are often recoverable under policy terms:

• Coverage under Professional Testing & Consulting Fees

• Claim Supplements When Necessary for Code Compliance

• Negotiation Leverage for Fair Settlement Values

By utilizing Auxilium Environmental’s reports, public adjusters safeguard their clients' settlements while avoiding unnecessary disputes.