Insurance Guide

The first step in the process is to file a claim with your insurance company, regardless of whether the damage was caused by fire, water, wind, storms, or mold. To begin the claim process, you will need to document the incident, provide your policy details, and report the damage to your insurer either by phone or through their website.

To help streamline the process, have your policy number ready and be prepared to explain in detail what happened. If you have any supporting evidence, such as photos, videos, or other documentation, be ready to share that with your insurer as well. Be sure to take clear photos and/or videos of the damage to help support your claim.

It is important to report the incident as soon as possible, as many insurance policies have strict reporting deadlines.

An insurance adjuster is responsible for investigating your claim and helping determine your financial recovery after a loss. Their role is to validate the claim, determine what your policy covers, and calculate the costs associated with the remediation and restoration process.

An adjuster typically has four main responsibilities during a claim:

• Assess the damage to evaluate the extent of the loss and identify all necessary repairs
• Review your policy terms, deductibles, and coverage limits to confirm what is covered
• Prepare an estimate for the total cost of restoration and repairs
• Work with the restoration company to review and finalize the costs associated with remediation and restoration services

During the restoration process, documentation and estimates play a critical role in supporting the insurance claim and outlining the full scope of the loss. Together, they help tell the complete story of what happened, what caused the damage, what areas and materials were affected, and what will be required to restore the property. They also provide a detailed breakdown of the expected costs associated with remediation and repairs.

Key Elements of Documentation

• The type, cause, and extent of the damage
• Photo and video evidence documenting affected areas
• Moisture maps and moisture readings
• Daily progress logs and job updates
• Hazardous material manifests documenting the removal and disposal of materials such as mold, asbestos, or lead paint

Key Elements Included in Restoration Estimates

• The cost of emergency mitigation services to prevent further damage
• The cost of demolition and removal of damaged materials
• The cost of replacing damaged items, purchasing new materials, and labor for installation
• The cost of cleaning and restoring both the structure and its contents
• The cost of specialized equipment such as dehumidifiers, air movers, and air scrubbers
• The cost of permits, project management, and other related services

The Mitigation Approval Process is the authorization process that allows emergency response and immediate action to prevent additional property damage after a loss occurs.

Key Stages of the Mitigation Approval Process

• Securing the property to help prevent further or secondary damage
• Conducting an inspection to assess and classify the severity of the damage
• Preparing a scope of work and estimate by the restoration contractor, including the costs of labor, materials, and equipment needed for the project
• Reviewing and approving the estimate by the insurance adjuster to confirm coverage and reasonable costs
• Signing a Work Authorization or Direction to Pay form by the property owner, granting the restoration company permission to begin mitigation work
• Completing a final mitigation inspection and submitting updated documentation to the insurance company before moving forward with reconstruction and repairs

• Initial damage assessments, insurance estimates and permitting
• Demolition and debris removal
• Structural repairs
• System restoration
• Interior and exterior finishing
• Final inspection and handover

• Supplemental Estimate: The contractor prepares a detailed estimate outlining any newly discovered damage, including the additional costs for labor, materials, equipment, and repairs.
• Documentation and Notice: All supporting documentation must be submitted to the insurance company before any additional repairs or reconstruction work begins. This documentation may include photos, moisture readings, inspection reports, and updated estimates.
• Reinspection: In many cases, the insurance adjuster will reinspect the property to verify the newly discovered damage and review the supplemental estimate before determining any additional payout amounts.
• Approval and Payment: Once the supplemental damages and costs are approved, the insurance company will issue the updated payment to either the homeowner or the contractor, depending on the claim arrangement.

Insurance coverage can vary depending on the cause of the loss and the specific terms of your policy. However, many emergency restoration services are commonly covered when the damage is sudden and accidental.

Commonly covered restoration services may include:

• Water mitigation and structural drying
• Fire and smoke damage restoration
• Storm and wind damage repairs
• Content cleaning and pack-out services
• Emergency board-up and roof tarping services
• Reconstruction and repair work

To better understand the coverage available under your policy, it is important to contact your insurance provider and review your policy details, coverage limits, deductibles, and any applicable exclusions.

Proper documentation is essential for supporting an insurance claim and creating a clear record of the damage before cleanup and repairs begin. Keeping organized records can help streamline the claims process and ensure all damages and related expenses are properly documented.

Important Information to Save

• Photos and videos of the damage
• Receipts and invoices for repairs, temporary housing, or emergency services
• An inventory of damaged personal belongings and contents
• Communication records with insurance companies, contractors, and adjusters
• Insurance claim documents, estimates, and supplemental claim information
• Any additional reports, permits, or supporting documentation related to the loss and restoration process

What is a Deductible?
A deductible is the out-of-pocket amount a policyholder is responsible for paying before insurance coverage applies to the remaining approved costs of a claim.

When do Deductibles Apply?
In most cases, a deductible applies once per occurrence or loss event, such as a burst pipe, storm, or fire.

Policy Exclusions
Insurance policies may exclude coverage for damages caused by pre-existing wear and tear, faulty workmanship, lack of maintenance, or preventable neglect.

Sewage Damage Limitations
When materials are contaminated by sewage or other hazardous water sources, porous and semi-porous materials often must be removed and discarded for health and safety reasons.

Mold Coverage Limitations
Many insurance policies place limits on mold remediation coverage, commonly ranging from $1,000 to $10,000. Any remediation costs exceeding the policy limit may become the responsibility of the property owner.

Structural Coverage
Structural coverage generally applies to repairs involving the core framework of the property, such as walls, roofing systems, or the foundation, when caused by a covered loss.

Cosmetic Coverage
Cosmetic damage coverage relates to repairs that primarily affect the appearance of the property. Depending on the policy, cosmetic repairs may be limited or denied unless they are directly tied to structural damage.

Upgrading Costs
Insurance policies are designed to restore the property to its pre-loss condition. Any upgrades, remodels, or improvements beyond the original condition are typically considered out-of-pocket expenses.

Reviewing Your Policy Details
You can review your insurance policy at any time to better understand your specific coverage, exclusions, deductibles, and policy limits. Contacting your insurance provider can also help clarify what is and is not covered under your policy.