HighgroundClaims/Playbook

Common Insurer Tactics

Insurance companies are publicly traded corporations with a fiduciary duty to shareholders. Every dollar paid on your claim is a dollar off their bottom line. Understanding their playbook is the first step to countering it.

The Three D's: Deny, Delay, Defend

This is the industry's documented strategy for managing claims costs.

Deny

What it looks like:

  • -"This isn't covered under your policy"
  • -"This is gradual damage, not sudden and accidental"
  • -"This is a maintenance issue"
  • -"Your claim was filed too late"

How to counter:

  • -Get the denial in writing — always
  • -Ask for the specific policy language they're citing
  • -Read the exclusion yourself — they sometimes misapply it
  • -Get an independent assessment of the cause
  • -In Colorado, an improper denial can trigger bad faith (see Colorado Rights)

Delay

What it looks like:

  • -Adjuster doesn't return calls for weeks
  • -"We need more documentation" (repeated requests for things already sent)
  • -Transferring your file to a new adjuster mid-claim
  • -"We're still reviewing" with no timeline

How to counter:

  • -Document every communication attempt with dates and times
  • -Send a written demand for a response by a specific date
  • -Reference Colorado's statutory timelines (see Colorado Rights)
  • -Excessive delay can itself be evidence of bad faith

Defend

What it looks like:

  • -Hiring an engineer to write a report supporting denial
  • -"Independent" medical examinations that aren't independent
  • -Lowball offers designed to exhaust you into settling

How to counter:

  • -Get your own expert opinions
  • -Don't accept the first offer — it's a starting point, not a final number
  • -Know that their "independent" experts are paid by the insurer

Specific Tactics to Watch For

The lowball first offer

The insurer's first estimate is almost always below actual repair cost. They know most homeowners don't have the energy to fight. The gap between their first offer and a fair settlement can be 2-5x.

Counter: Get your own contractor estimate before responding to their offer.

Xactimate manipulation

Xactimate is the software used to write repair estimates. Both your contractor and the insurer's adjuster likely use it. But settings matter:

  • -The insurer may use "new construction" pricing (lower) instead of "repair" pricing
  • -They may exclude overhead and profit (O&P) that contractors legitimately charge
  • -They may use line items that don't match the actual repair scope

Counter: Ask your contractor to also use Xactimate. A line-by-line comparison reveals where the gaps are.

Depreciation games

On an ACV (Actual Cash Value) payout, the insurer depreciates your materials. A 10-year-old carpet might be depreciated 70%. But:

  • -Depreciation should be reasonable and documented
  • -Some items (drywall, framing) depreciate slowly
  • -Labor should NEVER be depreciated — you can't hire a "used" contractor
  • -Recoverable depreciation should be released when you complete repairs

Counter: Challenge any depreciation schedule that seems excessive. Ask for the depreciation formula they used.

Scope creep denial

You report water damage to your basement. Repairs require removing drywall, which reveals mold behind it. The insurer says "mold is excluded."

Counter: If the mold was caused by the covered water event, it may still be covered under Colorado's efficient proximate cause doctrine. The covered peril started the chain.

The "friendly" adjuster

The adjuster seems helpful, sympathetic, on your side. They might be. But remember:

  • -Staff adjusters work for the insurer
  • -Independent adjusters are contracted by the insurer
  • -Both are paid by the entity trying to minimize your claim
  • -Being friendly and being adversarial to your interests are not mutually exclusive

Counter: Be polite, be professional, but document everything and don't confuse friendliness with advocacy.

The recorded statement trap

"We just need a recorded statement for the file." This is an opportunity for the insurer to get you to say something they can use against you.

  • -"How long do you think it's been leaking?" → they'll use "gradual" to deny
  • -"Did you notice anything before?" → they'll argue you failed to maintain
  • -"What do you think caused it?" → you're not an expert, don't speculate

Counter: You can decline a recorded statement in most situations. If you do give one, keep answers short and factual. "I don't know" is a valid answer.

The partial payment pressure

They send you a check for a fraction of the repair cost with language suggesting it's the "final payment." Cashing it doesn't necessarily waive your rights (in Colorado), but it creates pressure to settle.

Counter: You can cash partial payments and still dispute the total in Colorado. But write on the check or in a letter: "Accepted as partial payment only. Full claim amount disputed."

When Tactics Cross Into Bad Faith

In Colorado, there's a line between hard negotiation and bad faith claims handling. See Colorado Rights for the specific triggers and what to do about them.

General information, not legal advice. For advice specific to your situation, consult a licensed professional.

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