In the Middle of a Claim

What To Do Right Now

Five things every mid-claim policyholder should be doing this week.

1. Build the evidence record every day. Photos of any new damage discovered, copies of every adjuster email, contemporaneous notes after every phone call. Send yourself a written summary of every phone conversation within 24 hours so the record exists in time-stamped form.
2. Read every estimate and letter line-by-line.Wrong measurements, missing rooms, depreciated labor (illegal in California under 10 CCR §2695.9(f)(1)), absent overhead and profit, missing code upgrades — every line is challengeable. The estimate is the insurer's opening position, not a final number.
3. Respond to everything in writing.Phone calls disappear; adjusters change; files get reassigned. Email is the minimum. Certified mail for demand letters. Under 10 CCR §2695.5(b) the insurer has 15 calendar days to respond to your written communications.
4. Know your deadlines and theirs.The insurer must accept or deny within 40 days of proof of loss and pay within 30 days of acceptance (10 CCR §2695.7(b), (h)). On your side: the policy's suit-limitation period (one year for fire under §2071, 24 months for state-of-emergency losses) is the deadline that matters most. Mark it on a calendar.
5. Document insurer behavior.Missed deadlines, contradictory explanations, requests for duplicative documentation, pressure to accept a low offer — each is potential bad-faith evidence under Ins. Code §790.03(h). Keep a running log. A pattern is what matters.

Key Concepts You Need to Know

The rules that determine what you are actually owed.

• The 40-day decision rule.Once the insurer has proof of loss, it must accept or deny within 40 calendar days (10 CCR §2695.7(b)). If it needs more time, it must say so in writing — and provide a status update every 30 days thereafter. Silence is a violation.
• The 30-day payment rule.Upon acceptance of the claim (in whole or in part), the insurer must tender payment within 30 calendar days (10 CCR §2695.7(h)).
• Partial payments do not waive disputed amounts.Cashing a partial check in California does not surrender your right to pursue the rest — but always confirm in writing that you are accepting the check as a partial payment, not as full settlement. Under California Commercial Code §3311, even a check with restrictive endorsement language can be returned within 90 days.
• Appraisal resolves dollar disputes.If the carrier agrees coverage applies but disputes the amount, you can invoke appraisal under Ins. Code §2071. Binding, faster than litigation, and limited to the amount of loss — not coverage questions.
• Bad faith is a tort. In California, when an insurer unreasonably delays, denies, or underpays a claim, the violation is a tort, not just a contract breach (Gruenberg v. Aetna Ins. Co., 9 Cal.3d 566 (1973)). That opens the door to emotional-distress damages, punitive damages under Civ. Code §3294, and attorney's fees under Brandt v. Superior Court, 37 Cal.3d 813 (1985).

Common Mistakes Mid-Claim Policyholders Make

Five errors that are easier to avoid than to fix.

• Negotiating by phone only. Phone calls leave no record. Every adjuster commitment that matters needs to be in writing — either confirmed by the adjuster or memorialized by you in a follow-up email the same day.
• Cashing checks with “full and final settlement” language without responding.If the cover letter or check stub says full settlement and you have open items, write “accepted as partial payment only — all rights reserved” on the check before depositing, and send a written confirmation that same day.
• Missing the recoverable depreciation deadline.Ins. Code §2051.5(b) gives you at least 12 months from the date of the first ACV payment (36 months for state-of-emergency losses) to complete repairs and collect the depreciation holdback. Miss it and the money is forfeited.
• Accepting the insurer's preferred contractor without your own estimate.California's no-specific-contractor rule (10 CCR §2695.9(b)) means the insurer cannot require you to use a particular contractor. Get your own bid before you sign anyone's contract.
• Failing to invoke the contractor-naming regulation.When the carrier's estimate is lower than your contractor's, 10 CCR §2695.9(d) requires the insurer to name a contractor who will actually do the work for the insurer's number. Most carriers cannot. Make them try.