What the Loss Adjuster Will Ask You

Who they are, and who they act for

A loss adjuster is appointed by the insurer to investigate the claim and recommend how it should be settled. They are usually independent of the insurer as a business, and often genuinely fair, but they are not your representative. A loss assessor is the other thing: someone you hire, who acts for you, usually for a percentage.

On smaller escape of water claims there may be no adjuster at all, just a handler on the phone and a contractor sent to survey. On anything involving a lifted floor, a ceiling down, or a dispute between flats, expect an adjuster.

The questions, in the order they usually come

When did you first notice something wrong?

This is the important one and it is asked early, casually, while the adjuster is still taking their coat off. It is the gradual damage test. The Financial Ombudsman's guidance to insurers on gradual damage says they should consider whether the customer "couldn't reasonably have been aware of the damage happening gradually" and whether they "made the insurance claim, or took reasonable action, as soon as they could reasonably have known about the problem".

Answer with a date if you have one and with "I do not know" if you do not. Do not say "oh, it has probably been going on a while" to sound reasonable. That sentence has ended claims.

What did you do when you noticed?

They are checking that you mitigated: turned the water off, moved what could be moved, got someone out. Anything you did counts, including the bucket and the towels, and photographs of it count more.

Who have you had out, and what did they find?

Where the detection report does its work. An adjuster who is handed a dated report with pressure test figures, moisture readings against a dry reference and thermal images with the scale showing has most of their site visit done for them. An adjuster handed an invoice has to reconstruct it themselves, and everything they cannot verify becomes a question.

Where exactly is the leak, and how do you know?

Not a room. A point. Read what an insurer-ready report contains for the form that answer needs to take.

Why did that much floor have to come up?

The trace and access question. Every square metre opened has to be justified by the method that pointed at it. This is the single strongest argument for non-invasive detection first: a report showing that thermal imaging and tracer gas narrowed the search before anything was cut is a report where the access cost defends itself.

When was the system last serviced or checked?

Maintenance. The NRLA's guidance on escape of water claims makes the point plainly for landlords, that "proactive maintenance is not only good practice, but it also strengthens your position should a claim arise". If you have boiler service records, a landlord gas safety record, or a receipt from the last plumber, have them out.

Is the property occupied, and was it occupied when this happened?

Unoccupancy clauses are real and many policies restrict cover after a period of vacancy. Answer accurately.

What is damaged, and what do you want done about it?

Room by room. Distinguish buildings from contents as you go: plaster, screed, flooring, kitchen units and decoration sit on the buildings policy, while furniture and appliances sit on contents.

What to have on the table before they arrive

• The detection report, printed, with the photographs in it.
• Your own photographs, dated, including the ones from the first day.
• Meter readings if the leak was on the supply, with dates. See water bills and meters.
• A one-page timeline: first symptom, first call, who attended, what happened on each date.
• Service records, receipts and any previous plumbing invoices for the same area.
• Your policy schedule, so you can see the trace and access limit and the excess rather than being told them.

What they will look at without asking

Whether the damage pattern matches the story. Water stains have a history written in them: a tide line that has dried and been re-wetted several times looks different from a single event, and an adjuster with a moisture meter can tell the difference between material that is wet now and material that is stained from something that dried out two winters ago. This is not a trap. It is the reason a report that records readings at the time of attendance is worth having, because those readings cannot be taken retrospectively once a floor has dried.

They will also look at whether the repair proposed is the smallest one that works. The Financial Ombudsman notes that sometimes "the only way to carry out an effective and lasting repair to the insured damage is to carry out work on damage that isn't insured", and expects insurers to cover that where it is genuinely necessary rather than precautionary. A scope that repairs the failed section and reinstates what was opened is defensible; a scope that re-pipes a flat because the pipework is old is not.

Where people get themselves into trouble

• Estimating dates to be helpful. "Maybe eighteen months?" is now a recorded admission of eighteen months of known damage.
• Stripping out before anyone sees it. Once the ceiling is in a skip, the evidence is in a skip. Dry, ventilate and protect, but do not demolish.
• Letting the claim cover damage that pre-dated the leak. Adding the crack you have always hated to the schedule puts the honest parts of the claim under suspicion.
• Agreeing a cash settlement before the full extent is known. Screed and joists hold water for weeks. What looks like one ceiling in week one can be a floor structure in week four.

If you disagree with the outcome

The adjuster recommends; the insurer decides. If the decision goes against you, ask for it in writing with the policy term relied on quoted in full, then use the insurer's complaints process. Where an exclusion is being relied on, the Financial Ombudsman's position is that the burden sits with the insurer: "if you're relying on an exclusion, then it's your responsibility to prove it applies to the claim." The Ombudsman can look at the complaint once the insurer has issued a final response or eight weeks have passed.

What we can do at that stage is narrow: we can confirm what we found, what we measured and when. We do not argue cover. If you have not had detection done yet, trace, access and reinstatement explains what the visit involves, and what to ask a trace and access plumber covers what to check before booking anybody.