Married couple reading letter from insurance company requesting Proof of Loss form

Proof of Loss Form Submissions: One Letter That Can Decide the Fate of an Insurance Claim

December 30, 2025 No Comments

A Proof of Loss submission is a critical contractual requirement that can significantly impact the outcome of an insurance claim. When a policyholder fails to submit the form—whether sworn or unsworn—within the timeframes required by the policy or state administrative rules, insurers may deny, reduce, or limit coverage regardless of the legitimacy of the underlying damage. Many policyholders mistakenly rely on contractors or assume that estimates and invoices satisfy the requirement, but courts often enforce Proof of Loss deadlines strictly once the insurer has provided written notice. Missing or improperly executing this submission can eliminate negotiating leverage, impair appraisal or litigation rights, and, in some cases, permanently bar recovery. #Proof of Loss #POL #SPOL #Deadline

Insurance Claim Deadlines That Are Frequently Missed — and Why They Matter

December 30, 2025 No Comments

Insurance policies impose strict deadlines that can significantly affect a property owner’s ability to recover full claim benefits after a loss. Commonly missed requirements include timely notice of loss, sworn proof of loss submissions, deadlines to complete repairs in order to recover depreciation, and suit limitation clauses that restrict how long a policyholder has to pursue legal action. These deadlines often continue running even while a claim is being adjusted or negotiated, and missing them can reduce or permanently bar recovery. Understanding and tracking these contractual time limits is critical to protecting coverage rights and avoiding preventable claim denials. #POL #SPOL #Suit Limitation #Proof of Loss

When a Claim Fails Before It Begins: What Leonard v. State Farm Teaches About the Value of a Public Adjuster

November 21, 2025 No Comments

The outcome of Leonard v. State Farm illustrates how insurance claims can fail when they are not properly documented, framed, or supported. The homeowner’s attorney attempted to argue for full roof replacement based on building code requirements, but the argument was misapplied and unsupported by the factual record. Critical evidence—such as detailed repairability analysis, code-based justification, and even the insurance policy itself—was missing from the case. As a result, the court found no basis to compel appraisal, no factual dispute over the scope of damage, and no grounds for breach of contract or bad faith.

The case highlights the important role a public adjuster can play in developing a strong claim foundation. A public adjuster would have documented repair feasibility, created a code-compliant narrative, established causation, and ensured the policy and supporting materials were properly presented. With the correct framing and a well-developed record, the homeowner’s position could have been significantly stronger.

Proposed Pennsylvania Legislation Threatens Homeowner Recovery Rights

October 24, 2025 No Comments

Pennsylvania’s proposed House Bill 1972 and its companion Senate Bill could drastically limit the ability of public adjusters to help homeowners and small business owners recover after property losses.

The bills would cap public adjusting fees at 15% on all claims and just 10% on catastrophe claims, impose a 15-business-day right of rescission, and ban adjusters from owning or receiving payment from construction or restoration companies. They also double bonding requirements and forbid any financial relationships or referrals between contractors and adjusters.

Supporters state the bills protect consumers, but in practice they would force many small adjusting firms out of business, leaving some policyholders without independent representation during the claims process. Without public adjusters, many insureds would face underpayment or delays, with little recourse other than costly litigation.

The legislation could represent a significant shift of power toward insurance companies, undermining consumer rights and professional advocacy in claim recovery. Public adjusters, homeowners, and small business owners are encouraged to contact their legislators and oppose these bills to preserve access to fair claim representation in Pennsylvania.

Balancing fair practices when handling insurance claims

When “Too Late” Isn’t Fair: Allstate’s Holdback Refusals and Ohio’s 60-Day Notice Rule

October 22, 2025 No Comments

Allstate and other insurers are increasingly denying replacement cost benefits by citing a 180-day deadline found in their “How We Pay for a Loss” and “Building Structure Reimbursement” provisions. Policyholders who complete repairs and request payment afterward are sometimes told their claim is “untimely” — even when no prior warning was given. Under Ohio Administrative Code 3901-1-54(G)(5), insurers must provide written notice at least 60 days before any contractual limitation expires if the claimant is not represented by counsel. Failure to do so can invalidate the carrier’s reliance on the 180-day rule. This article explains the legal duty to notify, outlines defenses against untimely denial, and offers best practices for public adjusters and policyholders to protect recovery rights when carriers fail to communicate looming deadlines.

When One Storm Becomes Three Claims: Understanding Causation and Policyholder Remedies

October 20, 2025 No Comments

When a single event, such as a lightning strike, causes multiple types of damage, some adjusters may insist the policyholder file separate claims for each resulting loss. In most cases, however, these damages should be treated as one claim arising from a single occurrence. This article explains how improper “claim splitting” can cost policyholders multiple deductibles, delay payment, and distort their claim history. It also outlines steps Ohio policyholders can take to challenge such determinations, including filing a complaint with the Ohio Department of Insurance under Administrative Code 3901-1-54, engaging a licensed public adjuster, and preserving their rights under bad faith protections.

Does Spatter Matter? The Debate Over Hail Verification and Aluminum Siding

October 7, 2025 No Comments

When hail hits, everyone starts looking for proof — and “hail spatter” often becomes the focus of debate. Does the presence or absence of spatter really determine whether damage is recent or covered? This article explores both sides of the argument, from the contractor’s field perspective to the attorney’s view of the carrier’s duty to investigate. Ultimately, while spatter can help tell the story of a storm, it’s only one clue in a much larger picture.

Intellect vs. Experience in Public Adjusting: What Truly Drives Excellence?

October 3, 2025 No Comments

Credentialing and continuing education provide public adjusters with up-to-date knowledge of policy interpretation, estimating standards, and regulatory compliance, enhancing their professionalism and credibility. However, real-world field experience offers irreplaceable insights into property damage, repair sequencing, and client communication. Rather than competing, these skill sets should complement each other. A balanced approach—where public adjusters pursue both formal training and hands-on work—leads to the most effective, productive, and accountable claims professionals.

How Matching Law Is Shaping the Future of Insurance Appraisals

September 15, 2025 No Comments

Contractors frequently refer clients to appraisal in hopes of resolving stalled insurance claims—but confusion still reigns over what the appraisal process can (and can’t) do. With new case law like Cinnamon Ridge v. State Farm reshaping expectations, it’s more important than ever for professionals to understand the evolving rules, risks, and responsibilities when negotiating claim values or recommending next steps. This article explores what appraisers need to know—and how to guide clients with clarity.

Category: Claims

Proof of Loss Form Submissions: One Letter That Can Decide the Fate of an Insurance Claim

Insurance Claim Deadlines That Are Frequently Missed — and Why They Matter

When a Claim Fails Before It Begins: What Leonard v. State Farm Teaches About the Value of a Public Adjuster

Proposed Pennsylvania Legislation Threatens Homeowner Recovery Rights

When “Too Late” Isn’t Fair: Allstate’s Holdback Refusals and Ohio’s 60-Day Notice Rule

When One Storm Becomes Three Claims: Understanding Causation and Policyholder Remedies

Intellect vs. Experience in Public Adjusting: What Truly Drives Excellence?

How Matching Law Is Shaping the Future of Insurance Appraisals

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