The Complete Insurance Claim Management Playbook
Your comprehensive guide to maximizing every insurance claim. You carry the burden of proof—the insurer pays what you can prove. This Playbook shows you exactly how to secure, document, file, respond, negotiate, and close your claim — with AI support at every step.
Open AI Response Agent
Open Document Generator
Open Claim Diary
Open Evidence Vault
Open Proof of Loss Builder
Open Coverage Decoder
How to use: Work section by section. Each area includes examples, decision trees, and an If → Then → Tool rail at the end so you always know the next best move and the right Claim Navigator tool to click.
1. Pre-Claim Preparation
Policy Documentation System
Action: Binder with dec pages, endorsements, premium proof (3y), correspondence, prior claims, renewals, coverage changes. Digital mirror in cloud with quarterly updates and shared access.
Auto-Create Folder Set AI: Policy Coverage Audit
If → Then → Tool
Can't find full policy
Request certified copy citing state timeframe
Generate Request · Open State Rules
Unsure RCV vs ACV
Run coverage decoder; flag endorsements
Coverage Decoder
Home Inventory Documentation
Room-by-room items with model/serials, purchase date, cost and current replacement, photos/video, receipts. Appraise jewelry/art every 3 years.
Start Inventory Starter Open Evidence Vault
If → Then → Tool
No receipts
Use bank/CC statements, Amazon history, photos, social posts, warranties
Ownership Proof Builder
High-value items
Get appraisals; check sub-limits and schedule
Check Sub-limits
Pre-Loss Property Documentation
Monthly exterior & systems photos with date-stamps to counter pre-existing wear arguments.
AI: Pre-Loss Checklist
If → Then → Tool
Carrier alleges pre-existing
Submit prior-condition photos & maintenance logs
Prior-Condition Brief
2. Immediate Post-Loss Actions
Hour 1–2: Safety & Mitigation
Fire: evacuate, board-up, photo from safe distance. Water: shutoff, video leak, extraction, drying, move items. Policies require reasonable mitigation—document and keep receipts.
Log Incident Upload Photos
If → Then → Tool
Home uninhabitable
Request ALE advance & lodging authorization
ALE Advance Request
Vendor demands pre-approval
Proceed emergency-only; notify carrier with photos
Mitigation Notice
Hour 2–6: Documentation
Wide→medium→close photos; serials; water/smoke lines; undamaged comparisons; diary log of time/cause/weather/witnesses/actions.
Evidence Vault Claim Diary
If → Then → Tool
Lost receipts
Bank/CC PDFs, vendor reprints, annotate inventory
Receipt Reconstruction
Hour 6–24: Initial Claim Contact
Prepare policy #, date/time, cause, report #s, temp contact, emergency spend. Use factual script. Request claim #, adjuster, inspection date, portal.
Initial Claim Notice First Call Script
If → Then → Tool
No acknowledgment in timeframe
Send Delay Notice citing statute
State Rules · Delay Notice
3. Filing Your Claim
Proof of Loss & Packet
POL: policy/claim #, date/cause, full inventory, RCV/ACV calcs, references. Packet: exec summary, room-by-room, indexed photos, 3 estimates, code upgrades, ALE projections.
Proof of Loss Builder Damage Inventory Packet Builder
If → Then → Tool
Vague "more info" demand
Request specific, itemized missing list
Specificity Request
Inventory format rejected
Convert to carrier columns; keep master
Inventory Converter
Timeline Management
Days 1–3: report/mitigate/document · Days 4–7: inventory/estimates/submit · Weeks 2–3: inspection/estimate/review · Weeks 4–6: supplements/negotiation · >6 weeks: appraisal/attorney/DOI.
Add Deadlines to Diary POL Extension Request
4. The Inspection Process
Pre-Inspection
Have policy highlights, photos/video, 3+ estimates, mitigation receipts, item list + values, code docs, question list, witness.
Copy: Walk List Add Walk List to Diary
If → Then → Tool
Adjuster limits rooms
Request full walk; log & recap in writing
Post-Inspection Recap
During Inspection
Lead room-by-room; show hidden damage; avoid speculation; defer recorded statement until prepared.
Recorded Statement Guide
If → Then → Tool
"Wear & tear" claim
Submit pre-loss photos + weather + contractor findings
Causation Brief
Post-Inspection
Same-day summary; attach photos; list agreed vs needs review; dates for next steps.
Copy: Post-Inspection Email
5. Estimate Review & Negotiation
Line-Item Analysis (Bathroom Example)
Counter omissions: moisture-resistant board, primer + 2 coats, plumbing wax ring, mitigation days, antimicrobial, monitoring, subfloor, GFCI + inspection. Adjuster $715 vs proper $2,797.
AI: Compare Estimates Rebuttal Cover
If → Then → Tool
Omitted code items
Submit citations, inspector notes, 3 contractor lines
Code Upgrade Brief
Unreasonable depreciation
Challenge lifespan; request schedule & basis
Depreciation Challenge
Three-Estimate Strategy (Roof)
Conservative / Moderate / Comprehensive bids to anchor scope; negotiate to mid with documentation.
AI: Negotiation Script
Supplements
Hidden damage, code adds, price changes, missed items. Provide discovery photos, expert notes, estimates.
Supplement Package
6. Settlement Strategies
ACV vs RCV (Roof Example)
RCV $20k, depreciation $4k, deductible $2.5k → ACV $13.5k. Replace & submit docs to recover $4k holdback. Negotiate contractor to reduce out-of-pocket.
Conditional Acceptance
If → Then → Tool
Payment delayed after agreement
Send payment deadline reminder with statute
State Rules · Deadline Reminder
Final Settlement Negotiation
Use clause requests, item adjustments, manager escalation, written timelines; don't sign immediately.
Payment Structures
Single payment ACV/RCV two-part Milestones Direct-to-vendor
7. Dispute Resolution
Internal Appeals
Appeal: undervaluation, overlooked damage, code, policy quotes, request statutory-timed response.
Appeal Letter
If → Then → Tool
Denied as "gradual"
Submit plumber sudden-failure report + neighbor affidavit + prior inspection
Appeal Evidence Index
Appraisal
For amount-of-loss disputes; costs vs recovery; timing windows vary by policy/state.
Appraisal Readiness Appraisal Demand
Public Adjuster & DOI Complaint
When to hire PA (value/complexity). DOI complaint for delays/unfair practices/misrep.
DOI Complaint Draft
8. Post-Settlement Management
Managing Repairs
Vetting, milestone payments, lien waivers, warranties, supplement support.
Contract Checklist
If → Then → Tool
Contractor requests >30% upfront
Renegotiate milestones; require lien waivers
Milestone Schedule
RCV Recovery
Submit completion photos, invoices, proof of payment, permits/inspections, warranties to release holdback.
RCV Package Checklist
Releases & Reservations
Avoid overbroad releases; preserve supplement rights; archive 7–10 years.
Review Release Language
9. Special Circumstances
Total Loss
Emergency advance, rental, start contents from memory, obtain reports, pull purchase histories.
Emergency Advance Request
If → Then → Tool
Mortgage holds checks
Submit draw schedule + contractor contract + inspection proof
Mortgage Draw Request
Business Interruption
Docs: 3y tax returns, 12-mo P&L, projections, seasonal factors, contracts; compute lost revenue + continuing + extra expenses.
BI Calculator
Catastrophe & Multiple Policies
Wind vs flood causation; FEMA; coordinate homeowners, NFIP, auto liability, umbrella; subrogation can offset deductibles.
Dual-Policy Brief
10. Advanced Strategies
Experts & Legal
When to hire engineers, meteorologists, hygienists, cause/origin; attorney fee models based on claim size/complexity.
Expert Scope Builder
If → Then → Tool
Causation denial
Commission C&O + weather; submit rebuttal
Expert Rebuttal Brief
Bad Faith
Red flags: delays, lowball w/o basis, misrep policy, refusal to provide docs, poor investigation, unnecessary demands, threats, altered reports.
Bad Faith Log Builder
ALE & Claim File
Missed ALE: mileage, utilities, storage, pet boarding, meals, laundromat. Request full claim file under statute.
Claim File Request
11. Specific Peril Strategies
Lightning Strike
Hidden damage: HVAC boards, well pump controllers, landscape transformers, garage openers, doorbell transformers, irrigation controllers, pool/spa systems, low-voltage wiring, ISP/cable gear, security, smart hubs, appliance boards.
Full-System Inspection Plan
If → Then → Tool
Only obvious electronics listed
Submit technician reports + itemized systems
Lightning Supplement
Theft & Vandalism
Police report essentials; ownership proof via receipts/statements/photos/social posts/registrations/warranties/riders/appraisals.
Ownership Proof Builder
Water (Burst Pipes) / Wind & Hail
Moisture mapping; occupancy evidence (winter); weather docs; matching & uniformity with manufacturer discontinuation + code.
Moisture Map Brief Matching & Uniformity Brief
12. Property Type Specializations
Condominiums (Master vs HO-6)
Master: structure/common; HO-6: interior/contents; loss assessment coverage; betterments/improvements.
Condo Coordination Plan
If → Then → Tool
Master deductible passed to unit
Invoke loss assessment coverage; cite bylaws & policy
Loss Assessment Claim
Rental / Vacation Homes
Loss of rent: lease, rent roll, comps, manager letter, occupancy rates. Vacancy disputes: utilities, security logs, smart data, inspections.
Fair Rental Value Calculator Vacancy Rebuttal
13. Insurance Company Tactics Deep Dive
Common Tactics & Counters
Lowball anchoring → Counter with 3 estimates + codes
Delay loops → Statutory timelines + DOI leverage
Vague RFIs → Specificity demand
Pre-existing / wear & tear → Pre-loss photos + maintenance logs
Excessive depreciation → Market lifespan sources
Scope minimization → Room-by-room walk list + photos
AI: Letter Tactic Detector
If → Then → Tool Endless RFIs
Request itemized needs + decision date
Specificity Request
Carrier cherry-picks expert lines
Submit full-scope expert summary + exhibits
Expert Exhibit Pack
14. State-by-State Claim Requirements
Timelines You Must Track
Acknowledgment window Investigation period Decision/deny deadlines Prompt payment rules Communication cadence Interest/penalties Open State Rules Insert Citations
If → Then → Tool Carrier misses a statutory deadline
Send notice with rule cite; copy DOI if recurring
Deadline Enforcement Notice
15. Complex Coverage Intersections
Coordinating Multiple Policies
Homeowners, NFIP, auto liability, umbrella, condo master. Sequence claims; avoid double recovery; use subrogation to recoup deductible.
AI: Coverage Intersection Map
If → Then → Tool Cause overlaps (wind/flood)
Commission causation report; apportion damages
Causation Brief
16. Advanced Documentation Strategies
Evidence Hygiene
OCR PDFs Consistent filenames Date-embed Originals + watermarked copies Exhibit indexes Timeline synthesis Auto-Create Folder Set
If → Then → Tool Carrier claims "insufficient documentation"
Request itemized missing list; provide exhibit index
Specificity Request
17. Contractor & Vendor Management
Vetting & Contracts
Verify license/insurance, references, written scope, warranty, insurance compliance, lien waivers, change-order process, supplement assistance.
Contract Checklist
If → Then → Tool Contract lacks milestones
Add milestone payment schedule tied to inspections
Milestone Schedule
18. Time-Sensitive Emergency Actions
48-Hour Window
Board-up/tarping Dry-out & dehumidify Secure openings Prevent mold Document receipts Notify carrier Mitigation Notice
If → Then → Tool Carrier disputes emergency spend
Provide policy duty citations + photos + invoices
Duty-to-Mitigate Brief
19. Maximum Recovery Strategies
Levers
Code upgrades Comparable pricing Multiple estimates Supplements Depreciation recovery Timeline leverage AI: Max Recovery Plan
20. Dealing with Claim Denials
Denial Playbook
Request full basis (policy clause + facts + photos); gather counter-evidence; file structured appeal; consider DOI and legal review.
Denial Appeal
If → Then → Tool Carrier refuses underlying evidence
Request claim file per statute
Claim File Request
Final Thoughts & Best Practices
The 10 Commandments of Claim Management
Document everything
Never accept first offer
Understand your policy
Mitigate immediately
Get multiple estimates
Be persistent
Know your rights (state rules)
Get help when needed
Stay organized
Think long-term (supplements)
Disclaimer: Educational content, not legal advice. For legal questions, consult an attorney in your state.