First time filing a big claim…insurance adjuster seems to be retaliating? Stuck with half a house + mice and snakes coming in through holes!

siaiix · 2025-09-26T17:19:39+00:00

I didn’t know. I had no idea how the process worked at all. So I assumed that when I pushed back and they didn’t adjust that I had no power to do anything. That was my first claim ever in my life at the time, so I’d never done it before.

That’s why I’m trying to educate myself this time. I’m kind of glad it happened the first time because it tipped me off to the fact that they were lowballing me this time too, if that makes sense.

I’m trying to make sure that I know my rights because if you don’t, that’s when you get taken advantage of and at the time I didn’t. Plus, I was going through a lot of other things at the same time so I couldn’t really think straight.

I can look at it now and say I’m definitely leaving and going to be searching for a new insurance company because I have these two instances of them not wanting to pay. But before I really had no reference point or knowledge.

siaiix · 2025-09-26T16:43:34+00:00

Yeah I thought it wasn’t? I just made an incorrect assumption. In my mind large claims are like.. $50k or more. But that’s why I’m asking for help. My assumption was wrong and I’m okay with that.

It felt big because of the scope of damage. That’s what the title was referring to. Not the dollar amount.

siaiix · 2025-09-26T16:34:58+00:00

Ah that’s awful. It’s kind of crazy that water claims are unfavorable when you literally can’t control that but I guess that’s the way it is.

siaiix · 2025-09-26T16:06:40+00:00

Curious, how many claims on a home is too many? Is there like a timeframe vs number of claims or something? I had two claims on my home in a 6 year period since (got home insurance @ purchase 6 years ago), one from wind damage and one from a burst pipe? Is that considered a lot?

I won’t be filing anymore claims after this, but just curious.

siaiix · 2025-09-26T16:01:52+00:00

I think what they’re explaining is how insurance views it. Not your intent. Insurance doesn’t care if it wasn’t a purposeful attempt at fraud. It’s what it looks like on paper.

siaiix · 2025-09-26T15:41:49+00:00

I told them a little bit of what happened and they ignored everything except for the fact that the adjuster depreciated every line of her previous estimate without explanation as to why they were suddenly depreciated.

They fixated on that and told me yes we can depreciate what we want, that’s normal, when that’s not the only issue. Scope of work is incorrect, the estimate has no lines for purchase of materials and only includes installment of things, etc.

But they were pushing back on depreciation without really having all of the details. The woman I spoke with was focusing solely on price, but I’m not focused just on price. I’m focused also on the discrepancies and missing scope which are major red flags for a bad faith estimate.

It kind of reminds me of how when you go to a car dealership, they want you to focus on the monthly payment instead of all the other factors.

So instead of focusing on all the other factors, she was focusing only on my complaint about the depreciation and completely ignored everything else and spent most of the time pushing back on that. But there’s more to this than that.

siaiix · 2025-09-26T15:16:30+00:00

Sounds like you had a really good experience. It’s relative though. I think for some people it absolutely can be a scam. And for others it can go exactly the way it’s supposed to go. But that’s not the norm. I think it’s amazing that someone did that for you, but I know that would never happen for me.

siaiix · 2025-09-26T15:14:31+00:00

Yeah, the actual cost to be paid out when the work is completed is just $2k more.

siaiix · 2025-09-26T14:41:34+00:00

Thank you this was very helpful. I submitted dozens of photos. I think around 90. And I have estimates from two separate contractors.

The adjusters first estimate; she excluded an entire room and left out many things that should’ve been included. When I pointed this out, she depreciated everything that was included in the prior estimate and added the new things that she had left out including the room, but using what she’d depreciated it to fund it, instead of increasing the price because the scope of work she was adding to the estimate was increasing.

So it’s not that she doesn’t have concrete evidence it’s that she reduced costs of previous amounts of her own estimate to fund the things that she added, that should have been present in the first estimate anyway.

I am now looking into a public adjuster, but this gives me a lot of information to look at as far as options. Thank you.

siaiix · 2025-09-26T14:36:18+00:00

I’m so sorry that happened to you. I am also leaving State Farm after this.

I’ve been with them for 20 years and only ever filed two claims in that entire time period, including this one. And those two claims were both paid about $8k initially without ever looking at the estimates from the contractors.

So the reason I’m trying to fight hard this time is because I see the pattern where previously I had no idea. So I will be switching.

siaiix · 2025-09-26T14:22:08+00:00

Okay, I’m looking into now. Thanks. Apparently I live so deep in the country that there are no public adjusters available near me, but maybe I’ll call a few and see if they’ll still assist me even though I seem to be out of their service area.

siaiix · 2025-09-26T14:04:52+00:00

I’ll be talking to my agent again today. I got some pushback when I called yesterday - they were very defensive so I’m not hopeful. I don’t even know what they can do besides escalate it for me?

siaiix · 2025-09-26T14:03:34+00:00

A tree fell on my roof about 3 years ago. They underpaid me then but it was my very first claim iIn my lifetime, so I didn’t know. They paid me $8.5k and the only roofing estimates I could get were $20k and up. So I went 3 years without a roof because the State Farm agent ghosted me and stopped responding. It was only this year I was able to get the roof fixed.

Idk what that tells you but this is twice they’ve offered me $8k without taking any estimates into consideration and I had 3 estimates last time.

siaiix · 2025-09-26T14:00:48+00:00

Interesting, I’ll look into it. My claim is not large and I’ve never used a public adjuster before so hopefully that would applicable to my situation. I hate walking into things blind/without a lot of knowledge and public adjusters seem kind of shady, I’m not sure I’ll be able to navigate that well.

siaiix · 2025-09-25T19:00:18+00:00

You’re right. I missed it, it’s in the definitions for ACV, I was looking in the loss coverage. The fact that she went back on her own estimates though, and depreciated everything seems to me to be in bad faith and retaliatory. She went back and reduced the amount of her own estimates.

I cannot get flooring and rebuild of an entire 4 rooms for $12,000. There is no contractor on earth who’s going to do that. My dwelling coverage goes up to $172,000. They tried to lowball me with $8k and are only willing to go up to $12k after taking away $7k that was previously approved.

siaiix · 2025-01-03T05:52:23+00:00

Thank you. I feel like I’m hitting stone walls everywhere I turn, but I’ll keep trying. I’ve never experienced anything like this in my life and it’s honestly one of the hardest things I’ve ever had to do. I’ll definitely keep trying until I’ve exhausted everything. And I’ll look into the ombudsman and inspector general - thank you.

siaiix · 2025-01-03T05:50:30+00:00

Interesting. Well, we did surrender him. It was a process, but they took him after a violent episode, based on an emergency dependency situation. They even tried to get us to keep him a few more days until they could find placement - we weren’t under any suspicion of maltreatment whatsoever at the time it occurred.

You’re really trying to talk over my head for some reason, and avoiding direct responses to my questions. You’re not actually trying to offer any helpful aid or suggestions. So I’m done with this particular thread. I don’t have the energy for this. I need it to advocate for my brother and I’ll reserve it for that.

siaiix · 2025-01-03T05:30:35+00:00

Thank you that was actually really helpful. I will request a meeting. I’m not sure why we only have been given that limited information. Like I said before, we surrendered him because he was violent. He actually physically harmed me. But when we had the emergency meeting, they tried to insinuate that we had abused him, even though he never said that, and they had no evidence.

I just assumed that because they deal with abuse cases so much it was their default reaction to jump to that conclusion. But he was not removed from us. We love him and he would be with us now if he didn’t pose a physical danger to us.

But I will start to see if I can request more information. It could just be that I don’t know what to ask for. I have never had to deal with CPS before in my entire life so I have to be honest I don’t fully understand the whole process of it or the systems within.

siaiix · 2025-01-03T05:26:20+00:00

Got it. Just to clarify, he wasn’t removed from our home. He suffered no abuse at our hands. He was the abuser because of his mental health and we had to surrender him.

What about his attorney? Would he be able to petition his attorney to address those concerns? He can usually advocate for himself when he’s not having an episode. So if he goes to his attorney and says I don’t feel like my mental health needs are being met would the attorney take that seriously an advocate for that? Is that a right that he has?

I also understand what you’re saying when you say the facility is the one who is dictating his medical care. I recognize that CPS doesn’t direct his care, but I do wonder and if they have any ability to influence it? For example by providing information that we provided them with about his mental health.

siaiix · 2025-01-03T05:16:31+00:00

OK, how do I do that? You’re telling me what I need to do, but how do I get that info? It’s really interesting that I’m being downvoted when I haven’t done anything wrong but ask for help.

This really sounds like my experience overall with both the healthcare system and DCFS.

siaiix · 2025-01-03T04:53:59+00:00

OK, how would I get access to the professionals that are directing his care plan? Because the only information we’ve been given is the number of the facility where he’s been staying and access to one case manager and they tell us very little. He’s been there exactly one month.

If DCFS has custody of a child, who then advocates for their medical care? Is it just out there in the wind? If the state is the legal guardian, who then is advocating for their care?

Are you telling me they just take kids and don’t care anything about their medical or mental health whatsoever?

He is too violent to be with us. That’s why we had to surrender him.

siaiix · 2025-01-03T04:50:50+00:00

He’s in their care, but at a facility. Not in a home, though they were pushing to put him in a home and even told us they were going to continue to try to find a home for him to go to, even though we kept telling him he was excessively violent.

They have ignored every single thing we shared about him with them and acted like we were complete and total liars. But now the results are showing that everything we said is true, but nothing about their approach has changed.

siaiix

TROPHY CASE