Countering the “Wear and Tear” Restoration Adjuster Argument

Restoration contractor negotiates insurance claim payout with adjuster If you’re a restoration contractor who has spent any time negotiating with adjusters, you’ve probably encountered insurance adjusters denying a water damage claim, citing “wear and tear” policy exclusions. The right strategies can empower you to successfully counter this argument in some scenarios. At One Claim Solution, our restoration adjuster billing experts successfully negotiate thousands of claims on behalf of our restoration contractors. Hear advice from Josh Ehmke, OCS Co-Founder and General Counsel, about how your restoration business can counter the “wear and tear” restoration adjuster billing argument.

What is the “Wear and Tear” Argument?

The “wear and tear” argument is a common argument that restoration adjusters use to deny water damage insurance claims. With this argument, insurance adjusters argue that if a water loss is caused by normal, everyday wear and tear, the carrier isn’t responsible for paying the restoration bill.

Why Do Restoration Insurance Adjusters Use the “Wear and Tear” Argument?

Most insurance policies exclude coverage for wear and tear water damage. One common water damage loss caused by wear and tear is when old pipes gradually begin to rot and leak. These kinds of slow leaks can cause a lot of water damage before they’re found since they slowly worsen over time. Because carriers want to protect themselves against responsibility for those kinds of common, natural “wear and tear” water damage losses, they exclude them from most homeowner insurance policies.

Since “wear and tear” water damage is excluded in policies, many restoration insurance adjusters will argue that a water loss is due to “wear and tear” to avoid paying. If the water damage is due to solely wear and tear, there isn’t very much you can do to counter this argument from insurance adjusters. But if the water loss is caused by a sudden event or a combination of wear and tear and a sudden event, there are things you can do as a restoration contractor to counter this argument.

How Restoration Contractors Can Counter the “Wear and Tear” Argument Used by Restoration Adjusters

So how can you counter the “wear and tear” argument as a restoration contractor? While policies can differ, most cover sudden, accidental losses. So to get your restoration work covered by an insurance provider, you need to be able to link the water damage to a sudden event, accidental event.

Collect Documentation to Support Sudden Water Loss Claims

“If more contractors would do a better job of documenting the actual cause of loss, that would solve so many problems,” Josh explains. “Being able to document and justify those charges is important on your end to be able to help the insurance adjusters do their job.” Here is some documentation Josh suggests restoration contractors collect to use as evidence to support sudden water loss insurance claims:

A detailed written report of what the first responder encountered when arriving on site.
Photos and videos.
An audio recording or written statement from the policyholder explaining the water loss and the events leading up to it.

The goal of your documentation is to approve that a loss is both accidental and sudden. “[Be] careful that when you are documenting things, that you’re actually documenting the current loss that’s in place right then and there,” Josh cautions.

Educate Water Damage First Responders on Documentation Strategies

The first person on site for a water damage loss is key to collecting valuable documentation to be used later on during insurance billing negotiations. It’s important to train your technicians and your plumbing partners about the kind of documentation needed to successfully support restoration insurance claims.

Fight for Partial Coverage for Water Damage Losses with Both “Wear and Tear” and Sudden, Accidental Damage

Sometimes, “wear and tear” damage and sudden, accidental damage happen at the same time. For example, maybe a client requested your water damage restoration services after their toilet supply line broke. During restoration, you discovered water damage inside the wall from a rotting, leaky pipe. The toilet supply line is sudden, accidental damage. But the rotting, leaky pipe is “wear and tear” damage.

In scenarios where these kinds of losses coexist, some adjusters will deny the whole claim, citing “wear and tear” policy exclusions. If this happens, fight for payment for the portion of your work related to the sudden, accidental toilet supply line damage. Use the documentation you’ve gathered to support your billing.

Enlist the Help of Restoration Adjuster Billing Experts

One of the easiest ways to negotiate your restoration company’s insurance claims is to leave this responsibility to a team of restoration adjuster billing experts. At One Claim Solution, our restoration billing specialists speak with adjusters and negotiate higher payouts on behalf of our restoration contractors.

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