Common Claim Issues

Claim Denied or Below Deductible? The Risk of Going

It Alone.

Picture this common situation for property owners in Oklahoma City: A hailstorm passes through, leaving dents on siding or shingles looking bruised. Or perhaps a minor plumbing leak causes a water stain on the ceiling. You report the damage to your insurance company, meet their adjuster, answer their questions honestly, and wait for their assessment, trusting the process.

The Unexpected Roadblock: Then comes the news: Your claim is denied. The adjuster might cite "pre-existing damage," "wear and tear," "faulty workmanship," or state the hail or wind wasn't severe enough to cause the damage observed. Alternatively, they might agree a covered event did cause damage, but issue an estimate for repairs that conveniently falls just below your policy's deductible amount. In either case, the result is the same: the insurance company pays nothing, and you're left footing the bill for repairs you believed were covered.

The Challenge for Policyholders: When you handle the claim yourself, challenging these outcomes effectively can feel impossible.

● You likely lack the specialized software to create a counter-estimate proving higher costs.

● You may not have the expertise to definitively argue against "wear and tear" or prove the specific storm did cause the damage (which might require meteorological data).

● You might not know the specific policy provisions or state regulations that support your claim for damages potentially missed or undervalued by the insurer.

● Without expert documentation and negotiation leverage, policyholders often feel forced to accept the denial or the below- deductible assessment, paying significant amounts out-of-pocket.

How Expert Representation Makes a Difference: This scenario highlights the value of having an expert advocate from Complex Process Solutions on your side. Our licensed Public Adjusters routinely handle these exact situations. We conduct thorough inspections specifically looking for evidence to counter common denial reasons or identify the fullscope of damage that pushes repair costs well above the deductible. We use objective data (including meteorological reports when needed), detailed estimates, and expert negotiation tactics based on policy facts to fight for the coverage you paid for.

If your claim was denied or deemed below deductible, don't just accept it. Contact Complex Process Solutions for a free consultation. We can review the insurer's findings and advise if you have grounds to successfully challenge the decision.

Commercial Claim UNDERPAID (Client Goes It Alone First)

● Headline: Commercial Settlement Too Low? Protecting Your Property Investment.

● The Situation: A hail storm sweeps through Oklahoma City, causing significant

damage to the large, flat roof of your commercial building or strip mall. You promptly

file a claim. The insurance company's adjuster performs an inspection and provides a

settlement offer. However, bids from reputable commercial roofing contractors to

perform the necessary repairs (meeting commercial codes and using appropriate

materials) come in substantially higher than the insurer's offer.

● The Challenge: Going it alone, you're now faced with covering a large shortfall

out-of-pocket, accepting subpar repairs that could lead to future problems, or trying to

negotiate complex commercial construction costs and code requirements with an

experienced insurance adjuster – all while trying to manage your business or

property.

● How CPS Intervenes: When brought in, Complex Process Solutions conducts a

detailed assessment using expertise specific to commercial roofing systems. We

identify the full scope required by code, account for necessary insulation, flashing

details, or underlying structural checks often missed. We prepare a comprehensive

estimate reflecting actual commercial replacement costs and negotiate assertively

with the insurer, armed with evidence and expertise, to secure the supplemental

funds needed for a proper, long-lasting repair that protects your investment.

Commercial Claim DENIED (Client Goes It Alone First)

● Headline: Commercial Property Claim Wrongfully Denied? We Fight for Your

Coverage.

● The Situation: A major water pipe bursts overnight in your multi-story office building,

causing extensive damage across several floors. You report the claim immediately.

After investigation, the insurer denies the claim, perhaps citing "long-term seepage"

or "lack of maintenance" as the cause (policy exclusions), rather than a sudden and

accidental covered event.

● The Challenge: As the property owner or manager, disputing this denial requires

proving the actual cause and timing of the loss. This often involves technical

arguments about plumbing systems, wear and tear vs. sudden failure, and precise

interpretation of policy exclusions – difficult tasks without specialized expertise and

evidence. You face potentially catastrophic repair costs and business disruption.

● How CPS Intervenes: Complex Process Solutions meticulously reviews the denial,

your policy, and the circumstances surrounding the loss. We can engage engineers

or leak detection specialists to pinpoint the exact cause and timing of the failure.

Leveraging tools like our Meteorological Consulting (if weather is potentially

relevant) and maintenance records, we build a fact-based rebuttal to the insurer's

denial, demonstrating that the loss is covered under your policy. We handle the

formal dispute process, presenting evidence and negotiating to overturn the wrongful

denial.

Damage BELOW DEDUCTIBLE (Client Goes It Alone First)

● Headline: Damage Below Your Commercial Deductible? A Thorough Assessment

Can Change Everything.

● The Situation: Following a severe windstorm in the Oklahoma City area, you notice

damage to rooftop HVAC units, exterior signage, and perhaps some siding on your

commercial property. You file a claim. The insurance adjuster assesses the damage

but provides an estimate that falls below your significant commercial property

deductible (which might be $10,000, $25,000, or even a percentage of the property

value). The insurer closes the claim with no payment.

● The Challenge: While the initial assessment suggests no payout, you suspect the

true cost to properly repair or replace commercial-grade equipment and materials,

potentially including required code upgrades, might be higher. Accepting the initial

assessment leaves you absorbing substantial repair costs that might actually be

covered if the full scope were recognized.

● How CPS Intervenes: We conduct a comprehensive inspection specifically looking

at commercial systems and code requirements. Often, damage to HVAC requires

specialized evaluation, or siding replacement necessitates matching across large

areas, or local codes mandate upgrades when certain thresholds of damage are

reached. Complex Process Solutions creates a detailed estimate reflecting these

actual commercial costs and requirements. If this comprehensive estimate exceeds

the deductible, we present the findings to the insurer and negotiate for the coverage

you're entitled to, potentially turning a no-payment situation into a significant

recovery.

PA (Complex Process Solutions) Engaged IMMEDIATELY After Loss

● Headline: Protect Your Business & Maximize Recovery: Engage CPS From Day

One.

● The Situation: Your commercial property suffers a major event – a fire, tornado,

significant structural collapse, or widespread flooding. Recognizing the complexityand potential for massive disruption, you contact Complex Process Solutions immediately, perhaps utilizing a 24/7 emergency contact.

● Immediate Expert Action: We provide urgent guidance on:

○ Safety and Security: Ensuring personnel safety and securing the property.

○ Mitigation: Coordinating large-scale mitigation efforts (water extraction, smoke remediation, temporary shoring) and ensuring costs are documented correctly for coverage.

○ Policy Duties: Navigating complex commercial policy requirements from the start.

○ Evidence Preservation: Guiding initial documentation critical for complex claims.

● Proactive Claim Management: CPS formally notifies the insurer and takes control

of the entire process. We coordinate all necessary experts early on – structural

engineers, industrial hygienists, equipment specialists, inventory teams, and forensic

accountants (for Business Interruption/Loss of Rents). We perform our own proactive,

comprehensive damage assessment, meticulously documenting property damage,

contents/inventory loss, and the factors impacting business interruption. We manage

all communication, build the claim based on complete data, and negotiate assertively

from a position of strength, aiming to minimize downtime and maximize financial

recovery across all applicable coverages.

● The Benefit: Engaging CPS immediately streamlines the complex commercial claim

process, protects your interests powerfully from the outset, ensures all avenues of

recovery (including Business Interruption) are pursued professionally, and allows you

to focus more on business continuity while we handle the intricacies of the claim.

How We Work For You

The Insurance Claim Process and how we obtain the maximum amount on your claim.

Commercial Claims Process

We handle the entire insurance claims process so you can concentrate on running your life.

Homeowners Claims Process

Complex Process Solution is the Public Adjusting Firm that provides Peace of Mind found when you know that your trusted ally is representing your best interest.

Multi Family Claims Process

Our Expert Public Adjusters file the claim for you, prepare a scope of work, prepare a detailed estimate of repairs, negotiate and settle Commercial, Homeowners and Multifamily Insurance Claims.