Ch 2 · Anatomy of a Claim
Module 2.1
The Initial Inspection
The 6 questions during walk-through. The 5 critical decisions before you sign. Pre-prep + post-walk handoff.
12 min read
What you'll learn
The walk-in. What to look for in the first 30 minutes. The questions that determine whether you sign the claim. The 5 critical decisions before you commit.
2.1.1 What the initial inspection accomplishes
The initial inspection is investigative. Goal: determine whether the loss is:
- Worth filing ($ + complexity justify your fee)
- Covered (under the policy)
- Causation-defensible (you can argue the cause)
- Right for you (your skills, schedule, capacity)
If all 4 = yes → sign the claim. If any = no → walk away.
You're not obligated to take every claim. Walking away protects your reputation + your time.
2.1.2 Before you arrive
Pre-inspection prep
- Get the basics by phone: address, type of loss, date of loss, claim filed yet?
- Carrier name if known
- Approximate scope ("water in master bath" vs "whole-home fire")
- Photos if homeowner can text any
- Policy if available — get it before the visit
What to bring
- Tape measure / laser distance measurer
- Camera (phone w/ good camera fine)
- Moisture meter (water claims)
- Ladder (for roof inspections — only if licensed + insured)
- Notebook / tablet for note-taking
- Standard PA contract (in case you sign on the spot)
- Business cards
2.1.3 The walkthrough — the 6 questions
Walk every affected area + adjacent areas. For each:
Question 1 — Is it worth filing?
Loss size threshold (rough):
| Loss type | Min worth filing |
|---|---|
| Residential — clear coverage | $5K+ |
| Residential — disputed | $15K+ |
| Commercial | $25K+ |
| Hurricane / total loss | Always |
Below threshold: PA fee may exceed gain. Walk.
Question 2 — Is there enough damage?
Visual scope sufficient to justify a meaningful claim?
- Roof — at least 25-50% damage indicators?
- Water — multiple rooms / hidden areas?
- Fire — beyond surface smoke?
- Mold — multiple areas / hidden?
Question 3 — Is there coverage?
Quick policy review if available:
- Standard homeowner / commercial policy?
- Coverage period covers the loss?
- Cause of loss is covered peril?
- Sub-limits aren't already exhausted?
- No obvious exclusion (flood, earth movement, vacancy)?
If you don't have the policy yet — defer this.
Question 4 — What will the estimate look like?
Rough scope mental math:
- How many trades?
- Material grade in this home?
- Code upgrade exposure (older home)?
- Matching potential?
- Contents involvement?
- ALE potential?
Build a back-of-napkin RCV estimate. Worth signing up for?
Question 5 — Is the flooring continuous?
Florida matching statute angle. Damaged floor + continuous to other rooms = bigger claim.
Question 6 — Can you defend the causation?
Storm vs wear. Sudden vs gradual. Wind vs flood. Fire vs arson.
Honest assessment: if causation is the carrier's strong defense, this claim may be a loser. Walk if you can't credibly defend.
2.1.4 Questions for the homeowner
Frame as conversation, not interrogation:
| Question | What you're learning |
|---|---|
| When did you first notice the damage? | Date of loss + sudden vs gradual |
| What were you doing when you noticed? | Sudden vs gradual reinforcement |
| Have you called anyone out (plumber, roofer)? | Existing expert reports |
| Have any repairs been done? | Mitigation status; remaining scope |
| Did you take photos when it first happened? | Your initial documentation |
| Have you filed a claim in the past? | Prior claim history |
| Do you have a copy of your policy? | Coverage analysis |
| Has the carrier inspected yet? | Stage of claim |
| What did the carrier say so far? | Carrier's initial position |
| Have you signed anything? | Releases, AOBs, etc. |
2.1.5 The "play devil's advocate" exercise
Before signing, mentally play the carrier's adjuster:
- What's the carrier going to argue caused this?
- What exclusion will they cite?
- What evidence will they show?
- What expert will they hire?
If the carrier has a strong play and you don't have a counter — walk or be transparent w/ the homeowner about the difficulty.
2.1.6 The 5 critical decisions
Before you sign:
Decision 1 — Take the claim or pass
Based on Questions 1-6 + devil's advocate exercise.
Decision 2 — Set fee structure
Within statute caps:
- Hurricane in year 1: 10%
- Otherwise: 10-20%
For complex / risky claims → 15-20%. For clean / clear claims → 10-15%.
Decision 3 — Set timeline expectations
Be honest:
- Standard residential: 60-180 days
- Hurricane / commercial: 6-18 months
- Litigation: 12-36 months
Decision 4 — Identify needed experts
What independent experts will you need?
- Engineer (causation disputes)
- Plumber (water claims)
- Roofer (roof claims)
- Mold inspector (water w/ mold)
- Contents inventory specialist (large losses)
Decision 5 — Identify potential PA limits / attorney needs
Foresee the path:
- ROR likely?
- EUO likely?
- Litigation likely?
- Coverage denial possible?
If yes → mention attorney involvement upfront. Don't surprise the homeowner later.
2.1.7 The contract signing
If you decide to take the claim + the homeowner agrees:
- Sign your DFS-compliant PA contract (Module 1.4.3)
- Provide the homeowner copy
- File w/ DFS within 30 days
- Note 3-day cancellation right (5 business days during emergency)
- Note 60-day estimate delivery requirement (§ 626.854(12))
2.1.8 If you decide to pass
Reasons to walk:
- Loss too small relative to PA fee
- Coverage problem you can't overcome
- Causation favors carrier
- Homeowner is uncooperative / dishonest
- Already signed a release / AOB
- You're at capacity
Be honest with the homeowner:
- "Based on what I see, I'd recommend [DIY / different specialist / attorney]"
- "I don't think this claim justifies a PA fee"
- "Coverage looks problematic — get an attorney first"
You build long-term reputation by not taking claims you can't win.
2.1.9 Action steps
- Pre-inspection prep — basics + photos + policy if possible
- Walk the loss + adjacent areas systematically
- Run the 6 questions mentally as you walk
- Ask the homeowner the 10 questions
- Play devil's advocate before deciding
- Make the 5 critical decisions before signing
- Sign + file w/ DFS if taking the claim
- Walk away cleanly if not
Next: 2.2 The DICE Method — Policy Review in 5 Minutes.
Educational. Not legal advice. PA conduct is governed by § 626.854. Verify current Florida Statutes before relying on any specific approach.