Expert Q&A: What Do You Do if Your Insurance Claim Is Denied?

James H. Bushart Missouri Public Adjuster

At Signature Exteriors, a St. Charles, Missouri-based roofing contractor, we’re proud to work with such a fantastic community of related experts, from insurance agents to home inspectors and even our own in-house roofing team. We wanted to share their expertise with our customers and readers, so we created an “Expert’s Corner” on our blog in which we interview these highly talented professionals.

Today's interview is with Public Adjuster Jim Bushart.

First of all, what is a Public Adjuster and is it the same thing as an adjuster or an Independent Adjuster?

There are three different types of insurance adjusters.

  1. First, there is the “insurance company adjuster” who is employed by the insurance company and who is required by law to protect the rights and interests of the insurance company.
  2. Second is the “independent adjuster” who is also contracted by the insurance company and who is required by contract and law to protect the rights and interests of the insurance company.
  3. Third is the “licensed public adjuster” who is contracted by the policy holder to protect the interests of the policy holder and to negotiate a fair and reasonable settlement for an insured loss. A licensed Public Insurance Adjuster is an expert on loss adjustment and the recovery process, and is employed by the policyholder — not the insurance company.

The Public Adjuster assists you, the policyholder, with his or her intimate knowledge of insurance policies and negotiation techniques in preparing, filing and managing the payment of insurance claims regarding property loss. He or she works on your behalf and does NOT work for the insurance company. 

If your insurance company provides an adjuster at no charge, why would you hire a Public Adjuster? And why can't my contractor just be my "Public Adjuster"?

The best way to answer this question is with a question: If someone were suing you, would it be in your interest to save money and allow their lawyer to represent you in the hope of arriving at a fair resolution? Probably not.

Nor is it reasonable to expect their adjuster — with a legal and contractual duty to protect your insurance company’s best interest — to represent you in negotiation a settlement for your claim.

Contractors may be prohibited by law from representing homeowners with insurance claims for work that they are contracted to perform, depending upon your state, based upon the apparent conflict of interest.

Additionally, most homeowners prefer to have their contractor working for, and answering directly to, them for the work that will be performed rather than allow compromises between their contractor and insurance company that may result in work that falls short of their expectations.

If an insurance claim is denied, what steps should be taken by the customer? What are his or her options?

A policyholder whose claim is denied or underpaid can, of course, accept the decision of their insurance company and proceed out-of-pocket to restore their property.  

If they are fully versed in ALL the provisions and conditions of their insurance policy, home restoration, and the state rules and regulations that govern the insurance claim process, they can continue to negotiate with their insurance company for a fair resolution.

In those cases where the policyholders are not fully versed and prepared to go it alone, they can consult with an attorney or licensed public adjuster who can represent them in their negotiations with their insurance company. 

Most state laws prohibit building or restoration contractors who are being paid to perform the repair or restoration work from representing the policyholder with the insurance claim, due to the apparent conflict of interest. 

What are the typical reasons that a homeowner’s claim will be denied?

Many policyholders are unaware that it is their duty to prove their claim. This means that the policyholder has the duty to prove that the damage they have incurred is covered under their policy and, additionally, the amount of money it will cost to restore them to their original condition. Failure to sufficiently prove their loss will result in a denial or an underpayment of their claim. 

Sometimes claims are denied for legitimate reasons that are clearly explained in the insurance policy, but quite often claims are denied or underpaid because of improper claim procedures, incorrectly applied interpretations of an insurance policy, insufficient communication between the adjuster and the policyholder, or other actions taken by the insurance company’s adjuster as he performs his duty to protect the interests of his employer. 

If you decide to use a Public Adjuster, what is the best way to find and hire one who is reputable?

First, ensure that the Public Adjuster is currently licensed in the state where the insured property is located.  

Next, unless the Public Adjuster was already referred to you by someone that you know and trust, ask for three to five of the Public Adjuster’s past clients that you can personally contact and interview. While every claim is different, every past client should still be able to tell you if their Public Adjuster worked diligently in their interests, kept them fully informed as he worked toward the resolution of their claim, and was professional in his demeanor as their representative to their insurance company.

Last, be sure that it is your idea to file an insurance claim and to hire a Public Adjuster. Never be pressured by anyone showing up at your house and soliciting you to sign a contract immediately following a loss.

No licensed Public Adjuster should ever make any promises or guarantees as to the outcome of any claim.  

Today's Q&A was with Public Adjuster James H. Bushart of Missouri. He has been working independently as a licensed public adjuster for over five years, applying skills that he acquired as a paralegal handling claims for and against the United States Air Force and as a municipal building inspector and code enforcer.

Find him at or on Facebook at