I spent 8 years working as a claims adjuster for one of the biggest insurance companies in the country. I processed thousands of claims. I denied claims I probably shouldn't have. I approved claims that made my supervisors angry. I learned how the system actually works — and it has very little to do with the commercials you see on TV.
Let me tell you something that will make you uncomfortable: insurance companies are not in the business of paying claims. They're in the business of collecting premiums and investing that money. Claims are a cost of doing business, and like any cost, they try to minimize it. That's not evil — it's just capitalism. But you need to understand it if you want to get fair treatment.
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Here's the first secret: the adjuster who handles your claim is not your friend. They're not your enemy either. They're an employee with metrics to meet. My target was to settle 85% of claims within 30 days and keep the average payout below a certain threshold. If I went over that threshold too often, I got a talking-to from my manager. If I went under it consistently, I got a bonus.
That bonus structure is the key to understanding everything. Adjusters who pay out less get rewarded. Adjusters who pay out more get flagged. It's not explicit — nobody says "deny valid claims" — but the incentive is clear.
I remember a claim from 2017. A woman named Patricia had her basement flood after a pipe burst. She had water damage coverage, but the company tried to deny it because the pipe was "old." The policy didn't exclude old pipes. There was no rust exclusion. But the adjuster before me had flagged it as "potential wear and tear" to reduce the payout. I looked at the photos. The pipe was 12 years old. That's not old for a copper pipe. I approved the claim for $18,000. My manager called me into his office and asked why I didn't push back on the wear and tear angle. I told him because it wasn't wear and tear. He gave me a look that said "you're not a team player" and moved on.
That was the moment I started looking for an exit. I couldn't keep doing this.
Here's the second secret: documentation is everything. The difference between a claim that pays out fully and one that gets reduced by 40% is usually documentation. Photos, receipts, police reports, medical records — the more you have, the harder it is for an adjuster to push back. When I had a claim with 50 photos, detailed receipts, and a police report, I approved it quickly because I knew I couldn't defend a denial if it went to arbitration. When I had a claim with 3 photos and a handwritten note, I had leverage to negotiate down.
After a hailstorm in 2019, I processed 200 auto claims in two weeks. The people who had photos of every dent, every crack, every piece of glass — they got full payouts. The people who said "my car was damaged in the storm" with no photos? They got lowball offers because I had to estimate the damage based on similar claims. And my estimates were conservative. That's what the system rewards.
The third secret: timing matters. If you file a claim immediately after an incident, while the evidence is fresh and your memory is clear, you have a huge advantage. Wait two weeks, and the adjuster starts wondering why you waited. Wait two months, and they start looking for reasons to deny. I saw claims denied because the damage "could have been caused by something else" when the delay gave the company wiggle room.
The fourth secret, and this is the big one: most people accept the first offer. Don't. The first offer is almost always low. It's a starting point, not an ending point. When I made an offer, I expected to negotiate. If someone accepted immediately, I knew I had room to spare. If someone pushed back with documentation and comparable estimates, I usually increased the offer by 20-40%. That's not because I was generous — it's because their evidence was strong and I knew I'd lose in arbitration.
I left the claims world in 2020 and became an independent broker specifically because I was tired of being on the wrong side of these conversations. Now I help people prepare their claims before they file them. I tell them what photos to take, what documentation to gather, what language to use. And I tell them to never accept the first offer without pushing back.
The system isn't designed to be fair. It's designed to be profitable. But if you understand how it works, you can make it work for you instead of against you. That's what this site is about. Not selling you policies — teaching you how to get what you paid for when you actually need it.
— Marcus, Denver
