The Contractor's Role in Resolving Insurance Claims Disputes

Bill Wilson's acclaimed book, When Words Collide: Resolving Insurance Coverage and Claims Disputes, includes an entire chapter dedicated to best practices for this process. Bill is famous for his admonishment to "RTFP", which, in terms safe for work, stands for "Read The FULL Policy." The policy outlines what is covered and what is excluded and as our co-host, David Princeton of Advocate Claim Service, says, Mr. Wilson's book is, "A new bible [for policy interpretations]." As Bill notes, there are areas of ambiguity in every policy potentially leading to claims disputes and/or denials. While many who have had the misfortune of working through a disputed claim have a less than savory view of the process, Bill outlines

Four Basic Reasons Insurance Claims are Denied:

1. They're not covered (or there is no legal liability for the loss);
2. There is a legitimate difference of opinion on coverage;
3. One party is committing material misrepresentation or fraud; or
4. Cranial inversion (medically, cranitis rectal inversio).

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Many restoration contractors believe reason number four always applies to "the other side", but When Words Collide presents a balanced approach to resolving disputes. While policy ignorance is a significant contributing factor, Bill states, "Most coverage disputes likely arise from legitimate differences of opinion about the intent of policy language or the proper way to interpret it." During our discussion on The DYOJO Podcast he reiterated his encouragement for all parties to work together to form reasonable resolutions.


Speaking for the Structure as an Insurance Contractor

Bill shares an example from his own property damage claim, where he thought he was making a reasonable concession with regards to a proposed scope of work for his intricate front door assembly. As a restoration contractor I could hear my fellow professionals cringing at the suggestion that a homeowner would make a compromise to benefit their insurance company, Bill reminds the audience that the claim is ultimately between the insured and the carrier. David and Bill clarified that it is important for homeowners and adjusters to receive the professional input from qualified contractors as it relates to their area of expertise; the structure.

When Words Collide presents the process for resolving insurance coverage claims and disputes; Mr. Wilson emphasizes understanding the policy as the authority and encourages the commitment of all parties to finding a reasonable resolution. As Ken Larsen shared on episode 47, the contractors role is to speak for the structure and communicate the scope necessary for restoration. To the "surprise" of all the restoration professionals in the audience, Bill soon discovered that he would have been better off following the structural assessment of his contractor. David wisely admonishes contractors to learn to effectively communicate your "because" when outlining your recommendations to the insured and the carrier.

The Process for Resolving Insurance Claim Disputes

Understanding the policy and properly interpreting the policy, as it relates to unique claims situations, has been the career long passion of author Bill Wilson. In the book and our discussion, all professionals are reminded to "RTFP" which includes knowing what you are selling, being clear with your communications, and being reasonable with your interpretations. We were glad that he took the time to discuss this important topic with us and share his insights with our DYOJO Podcast audience to help them shorten their DANG learning curve.

You can watch or listen to the full conversation of The DYOJO Podcast Episode 48 on YouTube, Spotify, or Apple (thedyojo.com/listen)