Have you ever sat down and read your homeowners insurance policy? No, I don’t mean the first few pages that is known as the declaration page(s), i mean the meat of the policy, I mean the 50 to 60 pages of the boring stuff. The part that tells you what is covered, what is it covered against and what or why it might not be covered.
Probably 95% of the people that I talk to about their homeowner or business policy have no idea even where there actual policy might be. Your policy is your contractor between you and your insurance company. However, this is a special kind of contract, it is called contract of cohesion. Which basically means that only one side, the insurance company, has the bargaining rights. Your policy is basically at take it or let it type contract. Think back when you purchased your home or business policy, your agent did not send you a copy of the policy for you to review, you did not get a chance to read it before hand and propose changes to it. More likely you called your agent told him you wanted to purchase insurance and they might of asked you a few questions. A few days later your agent called you gave you a price, you agreed and woo la you have entered into a contract for insurance. No signing a contract, no negotiations, you do even know what you have purchased until some time later you will get a copy of the policy in the mail. At that put you put it on the side and you finally loose tract of it.
This is a contract of cohesion; the insurance company gives you a take it or leave it type offer to cover your home or business under a policy that they prepare for you. So why is this so important? When the policy language is clear and unambiguous, the insured and insurer are bound by the policy, generally the insured is expected to have knowledge of the policy and will be bound by the terms no matter if they have not read or understood the terms.
Now because of the highly complex language of your policy and the highly technical nature of the policy, it may not be so easily understood by the insured. Therefore, the courts have taken the stance that if the language is found to be ambiguous, the courts should lean towards the insured since they had no bargaining rights in the contract.
An insurance adjuster is responsible for interpreting rather complex policy language and apply this language to the facts of a claim to make a determination of coverage or not. The insurance adjuster is also entrusted to deal with the insured in a good faith manner, knowing that they have the superior knowledge to the insured. To do otherwise would be an invitation of a bad faith claim against the insurer and possible extra damages beyond the contract limits.
When dealing with an insurance company you need to be on level playing ground, you need someone who can hold the insurance company for their dealings. You need someone who is actually on your side.