Public adjuster vs attorney vs appraisal: how they compare

You can dispute a property claim six ways. They differ in what they cost, who makes the decision, and whether they can deal with coverage or only with the amount. Start by naming your problem: a slow insurer, a low amount, or a denial of coverage.

Can you dispute a claim yourself?

Yes, and it costs only your time. Ask for the insurer’s estimate or its denial reasons in writing, then send your own evidence, such as a contractor’s line-by-line bid and photos. The Texas Department of Insurance notes that a company might raise its estimate after hearing your concerns.

The steps are in what to do when the offer is too low and what to do when a claim is denied.

What does a state insurance department complaint do?

It puts your problem in front of the regulator, for free. The NAIC, the association of state insurance regulators, says the department sends your complaint to the insurer, the insurer has to respond, and the department can require a company that acted improperly to fix the problem.

A complaint suits delays, silence and broken rules. It is not a ruling on your damage. The Texas department says it cannot make a company pay unless the failure to pay breaks a law or the policy, and it cannot settle disputes over facts. The claim clock shows the deadlines your insurer has to meet.

What is state mediation?

It is a meeting between you and the insurer with a neutral mediator who helps you reach an agreement. The mediator does not decide the claim. It exists only where a state runs a program.

Florida’s program covers residential property disputes of $500 or more after the deductible. The insurer pays for it and the result is not binding. If you settle, you have 3 business days to back out, as long as you have not cashed the check. North Carolina’s program runs only after a declared disaster and is free to consumers.

Other states differ. See rules by state.

How does the appraisal clause work?

Appraisal is a process written into some policies for settling a disagreement about the amount of a loss. Each side hires an appraiser, and the two appraisers choose an umpire. If the appraisers disagree, the Texas Department of Insurance says the umpire’s decision is binding on both sides.

• Cost. In Texas and Florida, you pay your own appraiser and half of the umpire’s cost. Florida’s consumer guide says an appraiser may charge a set amount or a percentage of the award.
• What it cannot do. Decide whether the policy covers the loss.
• What to check first. Whether your policy has the clause at all, and any deadline to demand it. In Florida, once you and the insurer agree to appraisal, you cannot use the state mediation program later.

United Policyholders, a nonprofit, says an appraisal can be finished in a few months, but can also become as slow and costly as a lawsuit.

What can a public adjuster do, and not do?

A public adjuster is a licensed professional you hire to handle the claim. The NAIC describes the job as estimating the damage, reviewing your coverage and negotiating a settlement for you. The insurer does not have to accept a public adjuster’s estimate.

You pay the fee, and state law shapes it:

• Florida caps it at 20% of claim payments, and at 10% for claims made in the first year after a Governor-declared emergency.
• Texas caps it at 10% of the settlement.
• Louisiana does not allow percentage fees at all.

A fee taken from the whole settlement has to be earned back first. At 10%, the adjuster must raise the payout by more than about 11.1% for you to come out ahead. At 20%, it is 25%. The fee calculator runs this for your numbers, and the contract check lists what the contract must say. Public adjuster fees has more on how the fee is set.

A public adjuster is not a lawyer. Florida and Texas both bar public adjusters from giving legal advice, and filing a lawsuit for you is legal work. The NAIC adds that some states do not let public adjusters negotiate claims at all. You can check a license in the directory.

What can an attorney do that the others cannot?

An attorney can give legal advice, argue about what the policy means, and take the insurer to court. Florida’s consumer advocate describes the attorney’s role as representing you in legal and other proceedings.

United Policyholders describes two ways attorneys charge. With a contingency fee, the attorney is paid only if you recover money: about 33% for a settlement before trial, and 33% to 40% if the case goes to trial. The other is an hourly rate. Lawsuit costs are separate from fees. The California Department of Insurance suggests getting the fee structure in writing.

United Policyholders also says a dispute limited to the value of the damage, with an insurer that is still cooperating, may not need an attorney.

Which route fits which problem?

• The insurer is slow or silent. Options: a written status request, then a complaint. See what to do when a claim is taking too long.
• The amount is too low. Options: your own line-by-line dispute first, then mediation where offered, appraisal, or a public adjuster.
• Coverage is denied. Options: a written request for the policy language, a complaint, or an attorney if the dispute is about what the policy means.

If you are unsure whether a public adjuster fits your claim, the two-minute quiz is a place to start.