When Insurance Adjusters Can Be Liable for Errors & Omissions

According to our attorneys, they say ‘Yes’. Insurance adjusters in Texas can be liable for independent acts, errors and omissions (E&O) when they violate insurance codes, breach contracts or negligently handle claims. The primary reason for this is that insurance adjusters, who are trustees, have specific duties and obligations to fulfill when investigating and processing a claim. Failing to honor these duties can open adjusters up to liability and lawsuits.  We are not attorneys.  We are not adjusters.  We are roofing contractors who guide and navigate the chaos and headache for you.

It’s important to note that this liability is not limited to company adjusters (i.e., adjusters who are staff of insurance companies). It can also impact independent and public adjusters.

If you believe an insurance adjuster has made an error or omission that compromised your claim, contact Roofing Professionals of Texas.

We have decades of experience handling thousands of insurance claims on behalf of consumers. Perseverant, enthusiastic, diligent and relentless… we have the skills, knowledge and resources to effectively prevent bad faith insurance practices and help our clients get what is owed to them. We are ready to explain your options during your free consultation.

Has an insurer undercut, compromised or denied your valid hail damage claim?

Adjusters’ errors and omissions can take many forms, some of the most common of which include:

1.    Failing to acknowledge the claim – Adjusters are legally required to promptly respond to new claim submissions and communications regarding the claim. Ignoring claims and failing to communicate with the claimant can constitute an unfair settlement practice for which an adjuster can be liable.

2.    Making misleading or false statements – Written or oral statements an adjuster makes to deceive a contractor or policyholder can open the adjuster up to liability. These statements are typically made in an effort to undercut or deny the claim – or to get a policyholder to withdraw the claim. For example, insurance adjusters may make misleading or deceptive statements like (but not exclusive to):

·         The policy doesn’t cover the damage associated with the claim, despite the fact that the damage IS covered.

·         The policy only covers part of the damage and necessary repairs, despite the fact that all of the repair costs (including O&P) SHOULD BE covered per the policy.

·         You need to accept this settlement offer because it’s the best you’ll get, despite the fact that claim IS worth more and that negotiating IS a viable option.

·         You don’t need to or shouldn’t retain a lawyer because a lawyer can’t help you, despite the fact that an attorney CAN help you protect your rights, interests and claim.

3.    Failing to provide complete, accurate claim information to the provider – When a property damage claim is submitted, the insurance adjuster should collect certain information as part of the claims process. This information should then be promptly and accurately passed onto the insurance provider. Failing to collect all of the necessary information or failing to accurately provide all of the necessary information to the insurance provider can be the basis of an E&O claim against the adjuster.

4.    Failing to meet claim deadlines – Property damage claims (like many other types of insurance claims) are time sensitive. If the adjuster misses a filing deadline for a claim (for any reason), that adjuster can be held accountable for the error.

5.    Breaching the contract – The insurance policy is a contract between the policyholder and the insurance provider. Although the adjuster is not specifically a party to the contract, (s)he can be personally liable for mishandling the claim. For example, when an adjuster fails to reasonably investigate a claim or when (s)he relies on unqualified “experts” to assist in the claims investigation, (s)he can be liable for breach of contract.

It’s important to point out that these are not the only ways in which insurance adjusters may open themselves up to E&O liability.

4 Red Flags You May Have an Errors & Omission Claim against an Insurance Adjuster

Here are a few common warning signs that an adjuster may have been professionally negligent in handling your claim:

1.    The adjuster is unresponsive to your claim submission or fails to promptly respond to any of your inquiries regarding the claim.

2.    The adjuster uses ambiguous, convoluted or conflicting language when explaining your coverage or the claims process.

3.    The adjuster uses high-pressure tactics to try to coerce you into accepting a low settlement offer.

4.    The adjuster denies your claim without providing any (or a valid reason) for the denial in writing.

If you have experienced any of these (or other) questionable incidents when dealing with your insurance adjuster, contact Roofing Professionals of Texas to provide you with a no cost assessment.