Dear David: The Public Adjuster has Gone Rogue

Dear David,

Our public adjuster has gone rogue. He is not listening to our needs and a restoration contractor they recommended has said they ethically cannot say what the public adjuster wants. The public adjuster is asking them to say the mold cleaning is larger in scope and price. The public adjuster wants us to sign a proof of loss that we know is not accurate. What can we do?

Dear Accomplice to Fraud,

Fraud is strong term, but it seems like it could fit your situation.  When a policyholder signs a proof of loss, the document can state that the information contained or attached is true and accurate under penalty of perjury. The document likely has a warranty statement in which the policyholder affirms no fraud is being attempted. Signing a proof of loss you know to be false is, in my opinion, fraud.

The restoration contractor’s objections are a firm warning sign not to complete the proof of loss. Construction work has many variables, and these variables lead to different opinions. Mold science, however, is well established. The Institute of Inspection Cleaning and Restoration Certification (“IICRC”) establishes standards for the identification and remediation of fungus. If the contractor carries this certification, it is likely their opinion is based on completion of the training. The protocol for the eradication is more objective than not.

A few options come to mind for what to do.

First, review the contract signed with the public adjuster. What are your options for terminating the agreement? This could seem extreme, but it is important to know how to separate yourself from this potential bad actor.

Second, refuse to sign a proof of loss you know to be false. Never, ever, ever, sign a proof of loss containing information known to be false. Always tell the truth when making a claim.

Third, consider reporting the situation to the state insurance commissioner’s office. In regulated states, they provide the license that allows the public adjuster to serve the general public. In making the complaint, it is important to have evidence and information to provide. This could allow regulators to investigate the matter further.

Sometimes the best cure is prevention. United Policyholders provides helpful tips and questions to ask when considering to retain a public adjuster or attorney. It is possible that question five could have saved you from this situation. While five asks for local references, question nine forces the discussion of terminating the agreement.


Want to have your question, comment, or concern addressed in an article or arrange a private conversation? Send inquiries to: info@advocateclaimservice.com.

David Princeton

David Princeton, CPCU, AMIM, AIC, CSRP, is the principal consultant of AdvocateClaimService.com, an expert witness, and contributing author of Be Intentional: Culture. He attends Marquette University Law School and previously served as a director of corporate risk and as a lead claim specialist.

Advocate Claim Service takes the anxiety out of claims. Our mission is the strategic presentation of claims to get policyholders the benefits owed under an insurance policy. Claim consulting services are provided to Policyholders, Brokers, and Attorneys. As licensed insurance professionals, we have over 35 years of insurance claims experience across a wide array of coverage lines. In addition, our Insurance and Risk Management consulting practice is well suited to provide clarity to just about any insurance program.

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