The Illusion of Policy Coverage

Why is it that I have yet to come across a single insurance policy explicitly excluding the approval of more than three days for drying water damage, yet countless times I’ve been met with the familiar refrain: “According to our guidelines, we won’t approve beyond that?” The inconsistency here is staggering. We can excuse the insurance adjuster for not knowing the intricacies of how long it truly takes to dry out different homes after water damage—after all, they aren’t restoration experts. That much is understandable. What’s perplexing, however, is why they are so quick to assume an authoritative stance, dictating protocols as if they were.

In this article, I’m flipping the script and borrowing from their playbook. I will speak on a topic they claim I’m not allowed to: policy. If insurance adjusters, without the necessary background, knowledge, or certification, can confidently make statements about mold—a serious issue that poses genuine risks to human health—then surely, I can offer my perspective on policy matters, which don’t directly endanger lives. It seems only fair, right? If we’re entering the realm of opinion-based expertise, I have every right to weigh in on something that affects my clients and my business, just as much as they do.

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Let’s consider the implications of this approach. Insurance adjusters, who may have little to no hands-on experience with water mitigation or restoration, confidently reject expert recommendations based on arbitrary guidelines rather than actual conditions on the ground. These guidelines appear to be designed more for cost control than ensuring proper restoration. Yet, when contractors—those of us who actually specialize in the work—offer our professional opinions, they’re often dismissed as if we’re overstepping our bounds. Why is the burden of proof on us to justify what is, in reality, common sense?

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Homeowners purchase insurance policies under the belief that in times of need, their homes will be restored to pre-loss condition according to professional standards. Yet, far too often, the reality falls short of this expectation. Many homeowners find themselves caught between a restoration company that knows the right way to repair the damage and an insurance carrier that imposes arbitrary guidelines with little or no basis in policy—or, more importantly, in professional repair standards. These carrier-imposed restrictions can leave homes partially repaired, with homeowners assuming they are fully covered when they are not.

The Illusion of Policy Coverage

At the heart of the issue is a simple misunderstanding: most policyholders believe that their insurance policy guarantees proper restoration of their home in the event of damage. The reality, however, is that many insurance carriers impose repair restrictions or approve limited scopes of work based on guidelines that are completely unrelated to the language in the policy.

These guidelines are often arbitrary, designed more to reduce the carrier’s expenses than to ensure a quality restoration for the homeowner. They might limit drying times, the use of specific materials, or certain necessary repairs, regardless of what a professional contractor deems essential. This puts contractors in the awkward position of either following these guidelines and delivering subpar work or absorbing costs to meet professional standards.

Let’s consider an example involving water damage. A professional restoration company may determine that drying a water-damaged area will take five to seven days, based on the materials, humidity levels, and the severity of the damage. However, the insurance carrier may have an internal guideline that only approves drying for a maximum of three days—regardless of the unique circumstances of the home in question. The guideline has nothing to do with actual drying requirements; it is purely a cost-saving measure.

In cases like this, the insurance adjuster may deny extending the drying process beyond three days, even though doing so increases the likelihood of mold growth and structural damage. This is not just inconvenient for the homeowner—it’s dangerous. By imposing these arbitrary timeframes, the carrier is effectively compromising the long-term safety and integrity of the home.

This disconnect is not limited to water damage. Carriers often impose limits on the types of materials used in repairs, such as refusing to pay for high-quality, durable replacements and instead approving only substandard alternatives. A homeowner who originally had solid wood flooring may find that their carrier only approves cheap laminate for the repairs. Again, these decisions are driven not by policy language or professional standards but by internal carrier guidelines designed to keep costs down.

Insurance adjusters are the gatekeepers of this process. They often have little experience in construction or restoration and are forced to rely on carrier-imposed guidelines that dictate how the repair process should unfold. Many adjusters are bound by these guidelines and must operate within their constraints, regardless of what a licensed contractor or restoration expert recommends.

In some cases, adjusters will reject certain repairs or refuse to approve necessary materials, leaving contractors in a difficult position. If they want to get paid, they may have to compromise the quality of their work to fit the adjuster’s guidelines—guidelines that are far removed from the professional standards contractors are trained to follow.

This is where the tension between insurance carriers, adjusters, and contractors comes to a head: adjusters are working to protect the carrier’s bottom line, while contractors are trying to maintain the integrity of their work. Unfortunately, it’s often the homeowner who suffers the consequences of this conflict.

Homeowners are left in a precarious position, often unaware that the work being done on their home is below industry standards or that certain repairs are being skipped entirely because the carrier won’t approve them. What makes this worse is that many homeowners don’t realize that their insurance policy does not mandate these restrictions. They assume the adjuster’s word is final when, in fact, many of these decisions are driven by internal guidelines that have no basis in the actual policy or professional judgment.

The long-term consequences can be significant. Improperly dried homes are at greater risk for mold, which can lead to health problems and further structural damage down the line. Substandard materials may wear out faster, requiring additional repairs just a few years later. These problems, of course, are not covered by the insurance policy, leaving homeowners to foot the bill for issues that could have been avoided had proper repairs been made in the first place.

It’s critical for homeowners to understand that they have the right to push back against arbitrary guidelines. If a contractor says that a repair requires more time or better materials, homeowners should advocate for their right to have their home restored to its original condition, according to professional standards.

In some cases, this may require hiring a public adjuster or even an attorney to challenge the carrier’s decisions. Homeowners should also familiarize themselves with their policy to understand exactly what is covered and to recognize when the insurance carrier is operating outside of those terms.

Contractors, too, need to take a stand when they are asked to compromise their professional integrity. They should educate homeowners about the implications of following carrier-imposed guidelines and ensure that the work they do meets professional standards, even if that means pushing back against the insurance adjuster.

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We know that no two homes are the same when it comes to water damage. Factors such as the age of the property, type of materials used, and the severity of the water intrusion all play critical roles in determining how long it will take to dry a structure properly. A rigid three-day limit ignores these complexities, risking incomplete drying and potential secondary damage, such as mold growth. Ironically, the very issue adjusters have been told to speak on—mold—is exacerbated by their own misguided guidelines.

So, why not flip the script? If insurance adjusters feel qualified to weigh in on drying times and mold mitigation, which can have real-life consequences for the health of the occupants, then as a contractor, shouldn’t I be equally entitled to share my views on policy matters, especially when those policies directly impact my ability to do my job properly?

At the end of the day, the goal should be to restore properties to their pre-loss condition, minimizing health risks and further damage. It’s time we acknowledge that blindly following guidelines without understanding the nuances of each situation does more harm than good. If adjusters can take liberties in areas beyond their expertise, contractors should be afforded the same latitude when it comes to advocating for the most effective restoration practices.

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