The Field Adjuster Saw It. The Desk Adjuster Changed It.

Your Roof Was There. Your Desk Adjuster Wasn’t.

Over the years, I have written several pieces and articles—better or worse. Despite the different roles I play in this trade as a PA, CPAU, and expert, I have always tried to remain as unbiased as possible. I try to show the problems faced by both sides and, in good faith, propose solutions that might actually help. None of those articles, of course, were perfect. Such a thing does not exist. But they were good enough to get people’s attention and, at the very least, open a discussion.

This one, however, is different. This one is personal. And yes, it is going to be emotional. I am fed up and, frankly, disgusted with the way this State is allowing carriers to treat their own policyholders.

There is an ongoing debate surrounding State Farm and allegations of zero-dollar or underpaid wind and hail claims in other states. I have heard numbers from one state reaching approximately 117,000 zero-dollar claims. I have not independently verified that number, so I will leave it as something I have heard rather than present it as established fact.

But the claim I am dealing with right now is not something I heard about somewhere else. It is happening here. It involves one of the largest private-sector homeowners’ insurance carriers in Florida. And the issue that concerns me most is the alteration of field adjuster reports and estimates by desk adjuster.

When the Desk Adjuster Changes the Field Findings

We have already had this issue raised by whistleblowers—field insurance adjusters who have said that their loss estimates were changed without their permission, sometimes without even their knowledge, and then submitted under their names. Since then, what has really changed?

Florida now requires the insurer to deliver the detailed estimate within seven days after it is generated, and changes to estimates are supposed to be identified and explained. Sounds good. But does it actually solve the problem?

The way I see it, the process can still be stretched almost indefinitely. A field adjuster submits his estimate. The desk adjuster reviews it on the sixth day and requests a change. The field adjuster makes the change. Then another change is requested. And another. And another. At some point, what was supposed to be a seven-day requirement can become a revolving door of revisions.

But the bigger question, in my opinion, is not simply when the estimate is delivered. It is what a desk adjuster should be allowed to change in the first place.

My understanding, similar in some respects to the appraisal process where we document the observed loss, is that determining the physical scope of damage is the job of the person who actually inspected the property. A desk adjuster has a legitimate role. They can apply the deductible. They can apply ACV or RCV provisions, policy limits, and applicable policy conditions or exclusions.

Especially when there is no new physical evidence. Especially when the person has no meaningful construction knowledge. And especially when that decision goes directly against the findings of a seasoned, almost veteran carrier’s field adjuster who actually inspected the property.

That is a completely different issue from correcting an excessive estimate. If a field adjuster writes an unreasonable scope, by all means, review it. Challenge it. Correct it. But there is a huge difference between correcting an inflated estimate and reversing the physical findings of an experienced field adjuster and reducing a claim from full replacement to an under-deductible repair. That distinction matters.

The 27-Year-Old Roof That Is Actually 7.5 Years Old

In the particular claim I am handling, the situation becomes even more troubling. The desk adjuster is a nonresident adjuster who apparently could not properly search the public records and, based on the photographs provided by the PA and field adjuster, failed to recognize the probable age of the roof.

The roof is newer. The roofing colors and materials are consistent with Owens Corning products that have been on the market for roughly the last decade or so. Yet the claim was treated as though the roof were 27 years old, and normal wear and tear was used as part of the explanation for the reduced scope.

There are two separate factors available to verify the age. Two. Not one. So where exactly did the 27 years come from? You cannot just pull a 27-year-old roof out of thin air and then use that number to support a wear-and-tear position.

And this is precisely why I have such a problem with a person who never inspected the roof being allowed to override the findings of someone who actually did. The person sitting at the desk did not see the roof. The field adjuster did. The person sitting at the desk did not document the physical condition of the roof. The field adjuster did. The person sitting at the desk did not have new evidence showing the field findings were wrong. And yet the desk decision completely changed the outcome. That should concern everyone—not just public adjusters.

Nonresident Adjusters: Reciprocity Is Not the Same as Accountability

That brings me to another aspect of this claim: nonresident adjusters. This is one of the worst ideas I have watched develop during my career. I hear all the arguments. Catastrophes. Emergencies. Reciprocity. Not enough Florida adjusters to handle the volume. I understand all of that.

But here is the problem. During emergencies, people come into Florida, handle enormous volumes of claims, and then leave. They do the volume. They get paid. And eventually they go home. Meanwhile, Floridians are left with the mess.

And it affects both sides. Underpaid claims get reopened and reevaluated. That costs carriers money again. Policyholders spend years fighting for what they believe they are entitled to under their policies. Some cannot properly rebuild or repair their homes and simply cannot move on with their lives. That is not a good system for anyone.

I am also not convinced that reciprocity should end the discussion about competency. Under Florida’s reciprocity rules, qualifying nonresident adjusters can satisfy continuing education requirements through their home state. I understand that is the law.

But I have to ask: Is Florida insurance law exactly the same as the law in every other state? Is Florida’s construction environment exactly the same? Are our building codes, roofing practices, storm conditions, claim requirements, and insurance laws exactly the same?

If not, should a nonresident adjuster handling Florida claims at least be required to complete a minimum amount of Florida-specific CE legal and claims education? That seems like a reasonable question to me.

Because when the claim is mishandled, the policyholder does not get to send the problem back to the adjuster’s home state. The policyholder is still here.

Who Is Responsible When Everyone Is a SubContractor?

And then there is another issue that has bothered me for years: adjuster appointments and the growing use of self appointed independent adjusters. When something goes wrong, it can become very convenient to say: “We don’t know. We hire subcontractors. They’re not our employees.”

But the policyholder did not choose the adjuster. The policyholder did not hire the desk adjuster. The policyholder did not create the claims-handling structure.

If a carrier chooses the people handling its claims, directs the process, relies on their work, and uses their decisions to determine what the policyholder will or will not be paid, outsourcing should not become a shield against responsibility. There has to be accountability somewhere. This craziness needs to end.

The Claim I Am Dealing With Right Now

In this particular claim, I believe there are several statutory and regulatory violations, including, but not limited to:

And there is something else that makes this particularly difficult to ignore. The estimate itself contains a note indicating that the repair was added by the field adjuster at the desk adjuster’s request.

So this is not simply a disagreement over the price of a line item. It is not simply a carrier reviewing an estimate. It is a desk adjuster who never inspected the roof directing a material change to the scope determined by the field adjuster. And that change takes the claim from full roof replacement to a repair below the deductible, while the reasoning includes a roof age that the public record shows to be dramatically different.

What Happens When You Complain?

Before a Civil Remedy Notice, a policyholder can also make a complaint to the Florida Department of Financial Services. In my experience, I believe it is still worth having the complaint on file. But I have to be honest about what I have seen.

Too often, the complaint gets acknowledged—and then what? I do not see meaningful follow-up. I do not see requests for additional evidence. I do not see the policyholder being told what happened with the complaint. And then, a few weeks later, on another claim, you may see the very same adjuster the client complained about on the previous claim.

What does that create? The feeling that there are no consequences. That certain people are untouchable. That they can keep doing whatever they want because nothing is going to happen to them. Maybe that is not how the system is supposed to work. But that is how it can look from the other side of the desk.

Maybe It Is Time for Our Move

I normally try to keep politics out of my articles. This time, I am not going to. Maybe it is time for us to pay attention to who we elect, who they appoint, and what happens to the people who are supposed to protect the policyholder.

At the next election, vote for someone who will not sell out Florida for political ambitions. Vote for someone who will not appoint someone who strips away what may be the last line of defense for policyholders, only to leave office and go to work for an insurance corporation.

If we expect different results, at some point we have to demand different accountability. This madness has to end. The State and its institutions, including DFS, need to start protecting the public they were created to serve. They need to remember who ultimately needs protection in this system. The policyholder.