Dear David: Why Does Doing the “Right Thing” Get Me in Trouble?

Dear David,

Why does doing the “right thing” get me in trouble? Having been a contractor for over a decade, I know a thing or two about insurance coverage. Recently, my customer’s adjuster didn’t seem to understand how insurance coverage worked. I took the time to write them a professional email explaining how the coverage applied to the loss. Months later, I received a letter from the state Department of Insurance. Why can’t I have an opinion about insurance coverage?

Dear “Right Thing,”

Opinions are not the problem; it is what you do with them. Sharing an opinion about insurance coverage can be a violation of state licensing. States seem to license contractors, insurance professionals, and attorneys to some degree. Sometimes doing the “right thing” for the policyholder is to recognize a line and not cross it.

A policyholder often has four layers of help when it comes to an insurance claim. The first layer is self-help. United Policyholders, a non-profit insurance consumer advocacy group, has many self-help resources. Having supported United Policyholders for the last couple of years, their resources appear to be very good. A policyholder seems to have a wide lane to express opinions about damages, coverage, and the law. A contractor’s leeway is not as broad.

Second, a contractor can help a policyholder with the claim process. The scope of the help is an important factor. Many contractors help by reaching an agreed scope and price on the repairs. They also tend to deal with the questions and details those adjusters need to complete their files and issue payment. Some contractors rely on an assignment of benefits, but as a resent Blog article from Merlin Law Group demonstrates, contractors need to be careful they do not cross the line into public adjusting when arguing coverage.

A contractor seems to have the greatest leeway in their ability to express opinions about the scope and cost of repairs. A contractor could be wise not to speak to coverage or the law. A potential warning sign of a line being crossed is reading the insurance policy. Some go further by interpreting its meaning and expressing an opinion about what the coverage should or should not do. This appears to be the place for a public adjuster.

Third, public adjusters can help a policyholder with the claim process. Some states have rules in place that prevent a public adjuster from also being a repairing contractor and vice versa. The scope of a public adjuster license can vary. Being licensed in Wisconsin, Illinois, Texas, Colorado, Washington, and Hawaii the scope of the services that are offered in each state varies. Staying within the confines of the license is an important part of being a licensed professional.

A public adjuster appears to have the greatest flexibility to express opinions about damages and insurance coverage. The issue seems like a line could be crossed when a public adjuster interprets the meaning of the law. Yet, this line does not appear to be very bright and has many shades of gray. In my experience, being aware of the law and developments is part of being a professional. Expressing the meaning of the law seems like a role for an attorney.

Finally, attorneys can also help a policyholder with presenting the claim, explaining the law, and representing the policyholder to the extent of their client’s direction and agreement. In my experience, I have never seen a lawyer attempt to serve as a contractor. I have heard about persons with law degrees acting as public adjusters. The attorney’s lane seems almost as wide as the policyholder’s. One possible exception—an attorney must usually be competent in an area of law.

For those that cannot resist doing the “right thing” it is important to have an awareness of what a license does and does not allow. That awareness can make you a strong advocate for the customer. Contractors and attorneys often refer policyholders to Advocate Claim Service because we perform a distinct professional service. Early intervention by proper professionals tends to have better results. After all, would you want a customer calling a roofer when a pipe breaks?

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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