Restoration Invoice Line Items That Get The Most Pushback From Adjusters

Restoration contractors often find themselves negotiating with insurance adjusters, trying to defend and get paid for the charges on their invoices. At One Claim Solution, we have negotiated with every major insurance carrier in the U.S. and numerous regional carriers. Here are the line items that we see get the most pushback, what contractors can do to prevent pushback, and how contractors can defend these items when they are negotiating with adjusters.

Line Items That Get the Most Pushback

Here are some of the line items that Stephen Smith, an Account Manager at OCS, sees adjusters push back against the most:

Decontamination
Protective gear
Thermal imaging
Administrative labor
Emergency service calls

How Adjusters Try to Get Out of Paying These Line Items

One common way carriers try to get out of paying these charges is by arguing that something is just “the cost of doing business” and, therefore, not billable. “It’s an argument that has tons of holes in it,” Stephen says. “They can never give you a list of things that are considered cost of doing business.” Since the goal of any adjuster is to pay out less, it’s in their interest to argue as many line items as possible just come with the territory of being a restoration contractor and can’t be billed. In reality, there are no hard and fast rules about what is billable.

Another way adjusters try to avoid paying for line items is by arguing they were unnecessary. For example, if a contractor bills for decontamination efforts after Category 3 water damage, an adjuster might argue that the contamination wasn’t that severe and that special protective and sanitation measures were overkill.

How Restoration Contractors Can Defend Line Items Against Pushback from Adjusters

Things like thermal imaging, decontamination, emergency calls, and admin labor cost restorers money. If you’re unable to get insurers to pay out for these line items, that cost has to come out of your profit. Fortunately, with the right defense strategy, you can be more successful in getting carriers to pay for these items. Here are some of the tactics OCS recommends you use.

Cite Industry Standards

If an adjuster takes issue with how you performed a job, you can defend your approach by showing how it aligned with industry standards. If an adjuster tries to say something you did wasn’t necessary, you can point to the IICRC S500 and say, “Here is why it was necessary.”

Documentation

Documentation is a powerful weapon against the argument that something you billed for was unnecessary. If an adjuster argues that water damage was less extensive than you claim, you can provide them with documentation of thermal imaging to prove them wrong. If an adjuster argues that decontamination efforts were unnecessary, you can provide them pictures of the damage. To learn more about using documentation to support your invoices, read our recent article.

Involve the Property Owner

Property owners can be a powerful advocate for you when you are negotiating with their insurer. Build a relationship with the property owners you are working for, and take the time to explain why you are doing what you are doing during the restoration process. Not only is this good customer service, it’s also smart business sense if you ever need their help persuading a carrier to pay out.

Get Expert Help

Defending your invoices can be time-consuming and difficult. If you’re in over your head or tired of devoting so much time to sitting on the phone with adjusters, consider turning to billing experts or attorneys for help.

At One Claim Solutions, we have both restoration billing specialists and attorneys dedicated to helping our contractors maximize their profits and get paid faster. Subscribe to our newsletter if you want to learn more about navigating the restoration industry and insurance negotiations.