Welcome to our November Edition of our Claims Technical Spotlight!
In this series, we showcase the expertise and dedication of our claims consultants as they navigate complex insurance claims to secure the best outcomes for our clients.
This month, we’re highlighting Montana, one of our experienced consultants who recently worked on a challenging case involving multiple revisions from the insurer.
Case Overview
Montana initially received a scope of works from the insurer estimating repairs at $123,000. However, shortly after approval, the insurer retracted and presented a new scope at a significantly lower estimate of $90,000. Over the next few months, Montana worked tirelessly to contest the revised assessment, advocating for a fair settlement aligned with industry standards. After filing an Internal Dispute Resolution (IDR), Montana successfully negotiated a final settlement based on a more reasonable scope of $107,000, allowing our client to proceed with the necessary repairs to their home.
Here’s an inside look at Montana’s approach to securing this result:
Q: What was your strategy to get the insurance company to understand the scope of the claim?
Montana: I presented detailed evidence to the insurer, advocating for a full roof replacement at an amount that was fair and reasonable based on industry standards. This approach helped build a strong case for the client.
Q: Knowing this client was vulnerable, how did you manage them?
Montana: I took extra care to explain the process in simple terms to ensure the client was comfortable with every decision. Regular updates helped reassure them and alleviate some of the stress that can come with a prolonged claims process.
Q. What was the biggest challenge and how did you overcome it?
Montana: The biggest challenge was struggling with the insurer to get the submitted scope of works from our preferred repairer approved. After 3 months and countless hours of work trying to have decision overturned I resorted to requesting that the unfair panel builder be removed and got the initial scope of works from $90k to $123k approved.
Q. Did you use any specific negotiation techniques that were especially effective in this case?
Montana: Referring back to where the panel builder had made mistakes and the quality of their workmanship was of concern. Picking apart their reports and finding the errors and explaining to the insurer why it was unfair to deem the lower scope of works as fair and reasonable simply because it was the cheapest quote.
Q: What was the red flag that pushed you to go to the Internal Disputes Resolution?
Montana: When the insurer informed us that the original scope had been sent in error, then substituted it with a scope that was $43,000 less, it raised significant concerns. I felt it was necessary to escalate to an Internal Dispute Resolution to advocate for a fair outcome.
Q: What has this experience taught you about managing complex claims moving forward?Montana: This case reinforced the importance of perseverance. When one argument doesn’t resonate, it’s essential to approach it from a different angle. Never give up—persistence is key in claims advocacy.
Montana’s commitment to her clients exemplifies the dedication and skill our team brings to every case. Stay tuned for more insights in next month’s spotlight, where we continue to highlight the experts behind our success.
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