Month: April 2025

A lovingly sarcastic look at the myths, misfires, and madness that plague the insurance claim world—brought to you by people who actually read the policy.

Welcome to the claims industry, where logic goes to die, and common sense is an optional endorsement.

We’re not here to call people out (okay maybe a little), but after reviewing thousands of claims, we’ve collected a greatest hits list of the dumbest, most misguided, or just flat-out wrong things we’ve heard adjusters, contractors, and sometimes even policyholders say with their whole chest. Let’s myth-bust a few, shall we?

❌ “Matching isn’t covered.”

Oh really? Because unless your policy explicitly excludes matching, your carrier owes to make the property whole—not patch it like a quilt from the discount bin at Michaels. Also: check state statutes. Some states require matching by law. So maybe let’s not wing it on legally binding contracts.

❌ “If it wasn’t damaged by the hail, we don’t owe for it.”

Cool. So you’re saying you’re gonna pay to fix half a roof slope, and leave the other half with 12-year old shingles, creating a mismatch and voiding the warranty? That’s not claim handling. That’s sabotage with paperwork.

❌ “You didn’t mitigate fast enough, so we’re denying coverage.”

Ah yes. Because when your kitchen ceiling caves in from a pipe burst at 3:12 AM, what you should’ve done was grab a mop and tarp and file a notarized affidavit of heroic effort within 7 minutes. Got it.

❌ “Smoke odor is cosmetic.”

Tell that to the lungs, the headaches, the HVAC system that’s recycling chemical particulates, and the insulation that smells like a burned Barbie dreamhouse. You don’t Febreze your way out of thermophoresis, friend.

❌ “We don’t owe to reinstall ‘abandoned’ materials.”

First off—what even is an “abandoned” shingle layer? If it’s nailed to the home, it’s not abandoned. It’s installed. And if it needs to be removed and replaced to restore pre-loss condition, you owe for it. Full stop.

❌ “Contractors can’t talk to the insurance company.”

They sure do when it’s convenient. Suddenly the painter is providing moisture readings and the demo crew is interpreting policy language like they’re on Law & Order: Special Claims Unit. Want less contractor confusion? Loop in a PA.

🧠 The Problem with Misinformation in Claims

The truth is, most of this nonsense doesn’t come from malice—it comes from a system that thrives on confusion, overwhelm, and delay. The less you know, the less they owe. That’s the math.

That’s why OPCC exists. We don’t scream. We don’t threaten. We don’t email in all caps. We just know what the policy says, what the law allows, and what the insured is entitled to. And if that makes us the smartasses in the room—well, at least we’re smart.

Got Something Dumb You Heard on a Claim?

Send it to us. Maybe we’ll feature it in the next edition of “Did They Really Just Say That?”​(And yes, we’ll keep you anonymous… unless it’s too good.)

The fire is out. The restoration crew came through. But your house still smells like smoke. You’re not imagining it— and you’re not overreacting. There’s real science behind why that odor lingers, and most insurers don’t want to talk about it.

When most people think about fire damage, they picture charred drywall, soot-stained ceilings, and blackened insulation. What they don’t realize is that the most pervasive and long-lasting damage from a fire isn’t always visible—it’s molecular.

If your home still smells like smoke days or even weeks after restoration, it’s not just a matter of cleaning more thoroughly. It’s a sign that the damage has gone deeper than the surface. This is where thermophoresis comes in—a scientific phenomenon few adjusters mention, but every fire claim should consider.

🔬 What Is Thermophoresis?

During a fire, temperatures inside a structure vary rapidly—intense heat near the source, cooler zones farther away. This creates ideal conditions for thermophoresis: a process where microscopic particles, like smoke and soot, migrate from hot air and deposit themselves on cooler surfaces.

This isn’t just a light dusting. Ionized smoke particles don’t simply settle—they’re actively drawn into materials like:

• Drywall
• Insulation
• Wood framing
• Electrical boxes and conduit
• HVAC systems

This invisible migration allows smoke and chemical residues to embed into areas that no surface-level cleaning can reach.

🧪 Ionized Smoke: More Than Just a Smell

The moment materials begin to burn—plastics, fabrics, sealants, paint—they release complex chemical compounds. Many of these are ionized: meaning they carry an electric charge that makes them unusually adhesive and mobile.

Once ionized, smoke becomes more than just an airborne irritant. It becomes a chemical traveler, drawn through outlets, into ductwork, beneath baseboards, and behind drywall. These particles bond chemically with the building itself, creating the persistent, acrid odor homeowners describe long after repairs begin.

This is why your home can be cleared for reentry and still smell like the disaster just happened.

👃 Why “It Still Smells” Is a Valid Complaint

Unfortunately, some insurance adjusters—and even some restoration contractors—treat odor like an afterthought. But persistent smoke odor isn’t cosmetic. It’s a warning sign that smoke and chemical residue still exist in the home.

If the smell lingers, the damage lingers. It means thermophoretic smoke particles have likely penetrated the structure and weren’t fully addressed.

These are not superficial effects. Smoke can:

• Signal ongoing chemical degradation
• Remain trapped in porous surfaces
• Reactivate with heat or humidity
• Affect indoor air quality and health

🧰 What Real Remediation Looks Like

Carriers often aim for what we call “visual clearance.” If it looks clean and smells okay during their walkthrough, they consider the job done. But for properties affected by smoke, true remediation means addressing what’s beneath the surface.

Effective restoration may require:

• Removing contaminated insulation
• Sealing exposed structural wood
• Replacing affected HVAC ductwork
• Using thermal fogging, hydroxyl generators, or ozone treatments
• Applying odor-neutralizing encapsulants to affected framing.

These aren’t upgrades—they’re necessary steps when ionized smoke has permeated the structure. Skipping them can lead to long term odor issues, structural degradation, and even respiratory health concerns.

🧠 Why Carriers Push Back—and Why You Shouldn’t

Restoration at this level costs more. It takes more time. It may involve testing, retesting, and documentation that carriers don’t want to acknowledge. But when your home still smells, when your clothes reek after spending an hour inside, or when your guests ask “Did something burn in here?”—you know something wasn’t handled properly.

We’ve seen insurers approve wipe-downs when sealing was required. We’ve seen HVAC systems left untouched despite direct exposure. And we’ve reversed denials and reopenings by simply explaining the science that was ignored in the initial scope.

✅ If It Still Smells, It’s Not Over

You’re not imagining it. You’re not being sensitive. You’re noticing what the restoration team missed—and what the insurance company doesn’t want to pay for.

At Only Plans Claims & Consulting, we bring both advocacy and scientific literacy to every smoke damage claim. We know what thermophoresis is. We know how to prove its effects. And

we know how to speak the language carriers respond to—because surface-level doesn’t cut it when the real damage is hiding in your walls.

The fire may be out—but the claim isn’t finished until your home is truly clean.

You filed the claim. You followed the steps. The damage is real.​

So why did the insurance company say no?

For most policyholders, a claim denial feels like a dead end. After all the disruption, documentation, and emotional energy that comes with damage to your home or business, getting a denial letter isn’t just frustrating—it’s deeply deflating.

But what many people don’t realize is this:​

A denial isn’t final. And it isn’t always right.

At OPCC, we’ve reviewed hundreds of denied claims that turned out to be under-documented, misinterpreted, or simply wrongly assessed. Not because the adjuster was malicious, but because the system is built to favor the carrier’s interpretation—until you challenge it.

🧠 Why Denials Happen (and Why They Stick)

Insurance policies are dense, multi-layered contracts—filled with definitions, exceptions, and conditions that only make sense if you’ve spent time inside the system. Carriers count on this.

They know that most people won’t dig into the fine print or question an adjuster’s conclusion.

So when a claim gets denied, it’s often explained away with vague, well-worn phrases:

• “Wear and tear”
• “No storm-related damage observed”
• “Not a sudden and accidental event”
• “Policy does not cover this type of loss”

But what those explanations lack is context. Was the inspection thorough? Was the right date of  loss applied? Was policy language accurately interpreted—or selectively enforced?

Most importantly: Was your side of the story ever fully presented?

📂 The Case for a Second Look

We’ve seen denials reversed not because something new happened—but because we reframed  the original evidence, translated it into language the carrier couldn’t ignore, and held them to the standards built into their own policy.

That might mean:

• Showing how hail impact occurred beneath a roof’s surface
• Demonstrating how code upgrade coverage applies during repairs
• Using thermal imaging to detect smoke or water intrusion that wasn’t visible during the initial inspection
• Or simply reminding the insurer of their statutory obligation to investigate fairly and promptly

🔄 Reopening a Claim Isn’t About Conflict. It’s About Clarity.

What we do isn’t about “fighting” the insurance company. It’s about leveling the playing field.

Carriers have adjusters, engineers, consultants, and policy counsel working for them. You should too.

When you bring in OPCC after a denial, we:

• Review the full policy, not just the denial
• Analyze the inspection data, estimate, and photos
• Bring in our own findings if needed—thermal, drone, microscopic, or lab-based
• Build a documented position that speaks to the actual language of the contract

And when necessary, we escalate—through appraisal, rebuttal letters, or collaboration with legal professionals if the claim justifies it.

⚠️ Before You Give Up, Ask One More Question:

Is the denial the truth—or just the carrier’s version of it?

The difference between a denied claim and a paid claim is often less about the loss itself, and more about how the loss is presented, supported, and defended.

If you’ve received a denial and something doesn’t feel right—it probably isn’t.

Let’s take a look together.

They’re playing to minimize payouts. You’d better play to win.”

Most policyholders think filing an insurance claim is simple: You report the damage, they send someone out, and a fair check follows shortly after.

If only it were that easy.

The truth? Insurance is a high-stakes, rules-heavy game—and most people are playing  checkers on a chessboard built by the carrier.

At Only Plans Claims & Consulting, we’ve seen this firsthand. From subtle denials buried in confusing language to delay tactics disguised as “procedural steps,” the claims process is designed to serve one purpose: protect the carrier’s bottom line.

Here’s why strategy matters, and how the right advocate can turn the game in your favor.

🎯 The Board Is Set Before You Even File

The policy you bought? It’s a contract—written by the insurance company, not you. That contract is filled with:

• Exclusions you didn’t see
• Time-sensitive requirements
• Language that looks open-ended but is actually restrictive

The minute a loss happens, the clock starts ticking. Every email, every inspection, every form—it all becomes part of the game. And unlike checkers, where every piece moves the same, this board has layers.

🧩 Claims Are Tactical—Not Just Technical

A roofing contractor may know the damage. A mitigation company may know the moisture levels. But who knows how to argue for coverage based on policy interpretation, documented evidence, and case law?

That’s where strategy wins.

The carrier may say:

• “That’s wear and tear.”
• “This isn’t a covered peril.”
• “You didn’t mitigate fast enough.”
• “We only owe for spot repairs.”

But with a skilled advocate, you can counter with:

• Building code mandates
• Manufacturer installation specs
• Thermal imaging proof
• Policy language with supporting case precedent

You’re not arguing feelings—you’re moving pieces with purpose.

👣 Every Step Must Be Calculated

• Filing too soon? They may say it wasn’t properly documented.
• Filing too late? They may say it’s excluded.
• Not having your own estimate? They’ll lowball you and call it a day.
• Accepting partial payment? They may close the file without warning.

This is why OPCC treats every claim like a chess match. Not because we’re dramatic, but because you only get one shot to get it right.

🧠 Why Advocacy Isn’t Optional—It’s Strategic

An experienced public adjuster doesn’t just show up to represent you—they show up with:

• An understanding of carrier behavior.
• Knowledge of how claims are built, denied, reopened, and paid.
• A playbook built on real outcomes, not guesswork.

We know when to press, when to pause, and when to bring in reinforcement. We speak carrier, contractor, code compliance, and coverage fluently. And we know when they’re bluffing.

💥 Closing Thought: Play Smart, Not Fast

Insurance companies rely on confusion, fatigue, and delay. But with the right guidance, the board changes.

If your claim is denied, delayed, or underpaid—remember:

This isn’t checkers. It’s chess.​

We know how to play. And we play to win.