Ask an Expert: What if I disagree with my insurance adjuster?

by John and Theresa Kightlinger

It is an all-too-common occurrence when, after an accident, an insurance company
may go from being your protection, to being your adversary. You pay it every
month of every year to take care of you in case of an unfortunate event. And when
you need it the most, it covers your loss in such a way as to say, “we care
enough to do the very least.”

One such instance recently came to our attention. A loyal customer of ours was involved in an accident, and brought a 2016 Ford Explorer to the shop for repair.

We then disassembled the vehicle and wrote an initial estimate for $10,647.38. The pictures and our estimate were sent to the insurance appraiser in Colorado, who — with an obvious attempt to ignore the proper repair — returned with a modified estimate of only $3,629.40. (A deficit of more than $7,000 to repair the vehicle correctly.)

This is a regular occurrence in the day-to-day operations of body shops vs. insurance companies all across the country. The body shops, (highly trained professionals whose sole job is to REPAIR vehicles correctly) have to fight the insurance adjuster (a highly trained professional whose sole job is to PAY for vehicles to be repaired) to come to an agreement of how much a proper repair actually costs.

Here we are 45 days in and five supplements later totaling $5,800.95. This is after numerous emails and phone calls from the customer to the insurance company. The customer is a very important part of this, without them letting the insurance company know that this is unacceptable is the only way we got this far.

There is still more than $1,200 not being covered. No one from the insurance company
even came out to look at the vehicle. In the meantime, there are administration costs, storage and stall tie-up charges totaling $1,600.00, so now the total owed is $2,800.00. We are going to submit a sixth supplement to try to cover more of these costs for the customer.

Day after day, at shop after shop, the insurance adjuster cuts corners in what the company is willing to pay. Typically, this shows up in the refusal to pay for original manufacturer’s (OEM) parts, instead opting for third-party or aftermarket parts because they are cheaper; thereby padding the company’s profit margins.

The biggest problem (of many) with this process is the fact that aftermarket parts do not have any documented safety and crash-test proof of being identical to OEM parts. And therefore, they can put the insured at risk with substandard parts, and they seem to be OK with that.

Additionally, when an insurance adjuster refuses to pay for the complete and proper repairs, it typically leaves the insured with a vehicle that has lesser quality parts, which will absolutely affect the value of the car when it comes time to trade it in or sell it.

In the case of one of our customers, the insurance adjuster (and his supervisors) in question absolutely refused to budge, five times so far, or renegotiate their willingness to accommodate the cost of performing the proper repair. And after doing our best to reason with the company, we will encourage our customer to invoke the “Appraisal Clause” of the insurance policy.

The appraisal clause is how you (the insured) settle a dispute with an insurance company with whom you have come to an impasse. It requires both parties (the insured and the insurance company) to provide an independent adjuster to survey the damage to the vehicle, and to agree upon an actual dollar amount to be paid for the proper repair. Both adjusters must agree, or the case is moved to immediate (and final) arbitration.

It is important for consumers to understand that you have only three options: 1) Accept the insurance company’s estimate and receive a poor quality repair. 2) Accept what the body shop says is the correct and safe repair, and come up with the difference out of your pocket. 3) Invoke the appraisal clause and agree to the final outcome.

The appraisal clause is a powerful tool that can help consumers make wrongs right. In many cases, just the mere mention of invoking the appraisal clause will trigger the insurance companies to pay the proper amount, as it becomes an expensive venture to hire an outside appraisal firm – and in most cases, they end up paying close to the full amount anyway. In essence, it’s a way of calling the bluff of the insurance company, and getting it to accept responsibility for their role: that of paying for the proper repair, instead of padding their pockets with profits.

I am not licensed to practice law and this information is not meant to be legal advice. This is for the sole purpose of informing people of their rights. Consumers need to know their rights, as they exist in the terms of their contract with the insurance company they choose to protect their property. Not all insurance companies are the same. They also should choose a body shop that will stand firm for thorough, proper repairs that put the emphasis on safety, value and quality of repair – none of which should ever be compromised in the name of profiteering.

John and Theresa Kightlinger own My Body Shop at 401 N. Clinton St., Stockbridge.The couple have lived in the area and raised their children here over the past 20 years. John has been in the auto body business since 1985, and Theresa began work at General Motors after high school. Between the two, they have been working on cars for more than 75 years.