Ever wonder why some contractors get claims approved quickly while others fight for weeks over the same type of work? The difference isn’t luck—it’s understanding what adjusters are actually evaluating when they review your submission.
After working with hundreds of insurance adjusters across major carriers, we’ve decoded exactly what they’re looking for. Here’s your insider guide to getting claims approved the first time.
The Adjuster’s Primary Job (It’s Not What You Think)
Before we dive into specifics, understand this: adjusters aren’t trying to deny your claim. They’re trying to protect themselves.
Every approval an adjuster makes is scrutinized. Their managers audit files. Insurance companies track approval rates. If an adjuster approves questionable work, it’s their job on the line.
What this means for you: Make it easy for adjusters to say yes. Give them bulletproof documentation that they can confidently defend to their supervisors.
1. Photographic Evidence That Tells the Complete Story
Adjusters need to see what you saw. Not just a few snapshots—they want comprehensive visual documentation that proves the damage and justifies the scope.
What adjusters look for in photos:
- Wide shots showing overall damage extent
- Close-ups of specific damage points
- Multiple angles of each affected area
- Before, during, and after progression
- Timestamps and metadata intact
- Clear, well-lit images (not blurry or dark)
Red flags that slow approval:
- Only showing the worst damage (looks like cherry-picking)
- Photos taken after demo started (can’t verify pre-existing conditions)
- No scale reference for size-dependent claims
- Missing photos of “invisible” damage like subfloor moisture
Pro tip: Take 10x more photos than you think you need. Adjusters can’t visit every site, so your photos are their only window into the damage. Make that window crystal clear.
2. Detailed Estimates With Zero Ambiguity
Vague estimates get denied. Detailed estimates get approved. It’s that simple.
What adjusters must verify:
- Exact quantities and measurements
- Specific materials and brands
- Labor hours broken down by task
- Equipment usage with daily rates
- Justification for specialized services
Example of what NOT to do:
Drying services: $4,500
Example of what adjusters approve:
Drying Equipment & Services:
- Commercial dehumidifiers (4 units): 3 days @ $85/day = $1,020
- Air movers (12 units): 3 days @ $15/day = $540
- Daily moisture monitoring & documentation: 3 visits @ $175 = $525
- Antimicrobial treatment (850 sq ft) @ $0.45/sq ft = $382.50
- Equipment delivery, setup, and removal: $450
Total: $2,917.50See the difference? The second version answers every question before it’s asked.
3. Industry Standards and Compliance References
When you cite authoritative sources, adjusters can’t argue. You’re not giving your opinion—you’re following established protocols.
Standards adjusters respect:
- IICRC S500 (water damage restoration)
- IICRC S520 (mold remediation)
- ANSI/IICRC S800 (trauma and crime scene cleanup)
- Local building codes
- Manufacturer specifications
- EPA guidelines (for environmental concerns)
How to use them: “Per IICRC S500 Section 8.3, Category 3 water contamination requires removal and disposal of all affected porous materials including carpet, pad, and drywall. Cleaning and disinfection are insufficient for policyholder safety.”
Now the adjuster isn’t denying your recommendation—they’re denying IICRC standards. That’s a battle they won’t fight.
4. Clear Scope Justification (Not Scope Creep)
Adjusters are trained to spot scope creep—the gradual expansion of work beyond what the loss requires. You need to prove every item is necessary and directly related to the covered damage.
What adjusters question:
- Upgrades disguised as repairs
- Work in unaffected areas
- Cosmetic improvements
- “While we’re here” additions
How to justify legitimate scope:
- Connect every item to documented damage
- Explain why repair isn’t sufficient
- Note code requirements triggered by repairs
- Distinguish between covered and non-covered work
Example: “Electrical outlet replacement required due to water intrusion in wall cavity. Per NEC 406.9(B)(1), GFCI protection required for replacement receptacles in locations now mandating GFCI. Additional cost: $45 per outlet.”
You’ve just explained an “upgrade” as a code-mandated requirement. Approved.
5. Consistent, Professional Communication
Adjusters work with dozens of contractors. The ones who communicate clearly and professionally get their claims processed faster. It’s not favoritism—it’s efficiency.
What adjusters appreciate:
- Organized claim submissions (all docs in one package)
- Clear subject lines and claim numbers in emails
- Professional tone (even when frustrated)
- Prompt responses to questions
- Willingness to explain methodology
What slows you down:
- Antagonistic or demanding tone
- Incomplete information requiring multiple follow-ups
- Ignoring requests for clarification
- Going over the adjuster’s head prematurely
6. Accurate Xactimate Estimates (If Using Industry Software)
If your market uses Xactimate, adjusters expect your estimates to match their system. Mismatched pricing or incorrect codes raise immediate red flags.
Common Xactimate issues adjusters catch:
- Using residential codes for commercial work
- Incorrect unit measurements (square feet vs. linear feet)
- Outdated pricing (not using current price list)
- Missing line items for standard procedures
- Overbilling by inflating quantities
The solution: If you’re not confident in Xactimate, either invest in proper training or work with a claims specialist who lives in the software daily.
7. Proactive Supplement Documentation
Supplements are normal—hidden damage is part of restoration. But adjusters need to see why the additional work wasn’t in the original scope.
What makes supplements approvable:
- Photos of newly discovered damage
- Explanation of why it wasn’t visible initially
- Updated moisture readings or testing results
- Connection to original covered loss
- Timeline showing when discovered
What gets supplements denied:
- “We forgot to include this”
- Work already completed without approval
- No documentation of the additional damage
- Appears to be fishing for more money
The Bottom Line: Make the Adjuster’s Job Easy
Adjusters have performance metrics. Files closed per day. Approval accuracy rates. Audit scores. When you make their job easier, your claims move faster.
The ultimate adjuster checklist: ✓ Complete documentation package ✓ Detailed, itemized estimates ✓ Industry standard references ✓ Clear damage-to-scope connection ✓ Professional communication ✓ Accurate pricing and coding ✓ Proactive follow-up without being pushy
Master these elements, and you’ll become the contractor adjusters want to work with.
Want the Adjuster Advantage Without the Learning Curve?
Smart Claims™ specialists know exactly what adjusters look for because many of us have been adjusters. We speak their language, know their requirements, and structure every claim for maximum approval speed.
Need this done for you? Stop guessing what adjusters want and start submitting claims that get approved the first time. Submit your claim to Smart Claims™ and experience the difference expertise makes.