What to do when the loss adjuster does not accept the damages?

Imagine you suffer damage to your home or vehicle and you expect the insurance company to cover the costs. You send all the documentation, take photos, and even submit detailed quotes, yet you still receive a report that does not match your situation. This scenario is more common than it seems, and it is when we find ourselves in a situation where the loss adjuster does not accept the damages.

What can we do in this situation and how does an insurance brokerage respond? At Ambler we tell you all the details so you can have the peace of mind and security you need.

Why doesn’t the loss adjuster accept the damages? Most common causes

When the expert report does not reflect what you expect, it is usually due to a combination of factors.

Lack of evidence or proof of the claim

Although the situation may seem obvious to you, the loss adjuster is guided by evidence:

• Photographs before and after the claim.
  
• Videos where the origin of the damage can be seen.
  
• Invoices for purchase, maintenance, or previous repairs.
  
• Detailed repair quotes.
  

If the information is scarce, unclear, or fragmented, the loss adjuster may consider that the declared damages are not sufficiently proven.

Considers that the damages are not covered by the policy

Another common reason is that the expert report concludes that the type of damage you are claiming is not within the contracted coverage:

• Damage due to normal wear and tear.
  
• Leaks or dampness attributed to lack of maintenance.
  
• Aesthetic damages not included in the policy.
  
• Certain risks expressly excluded (for example, some electrical damages, old machinery, or non-updated installations).
  

The insurance company may rely on exclusions or limitations of the policy to justify why the loss adjuster does not accept the damages or only recognises a part.

Disagreement on the origin of the damage

Here the conflict is not so much the existence of damage, but its cause:

• The policyholder maintains that the damage is due, for example, to a storm.
  
• The loss adjuster concludes that the main origin is linked to poor maintenance of the roof or installation.

When discrepancies arise in the origin, the discussion shifts to the technical field: what caused the damage and what part is actually covered by your insurance.

Economic valuation different from what the policyholder expected

Sometimes the report does not deny the damage but values it below what you need to repair. This occurs, for example, when:

• The loss adjuster applies depreciation for age.
  
• Considers that certain improvements are not part of the insured risk.
  
• Uses scales or market prices different from the quotes you have provided.

Limitations or exclusions in the insurance contract

Finally, it may be that the loss adjuster does not accept the damages because they encounter:

• Sums insured below the real value of the goods (underinsurance).
  
• Sub-limits for specific guarantees (for example, water damage, electrical appliances, theft of certain goods, etc.).
  
• Excesses (franchises) that significantly reduce the compensation.
  

In these cases, even if the damage exists, the policy establishes limits that condition how much you are really entitled to. That is where the technical analysis of your brokerage makes the difference.

What to do when the loss adjuster does not accept the damages

When you receive a report that does not conform to your reality, it is crucial to follow an organised strategy.

Review your policy in detail

The first step is to thoroughly review your contract:

• Coverages: what types of damages your policy includes (water, fire, theft, natural phenomena, machinery breakdown, loss of profit, etc.).
  
• Limits and sub-limits: maximum per claim, per guarantee, per insured item.
  
• Excesses (Franchises): amounts you assume in each claim.
  
• Exclusions: assumptions in which the company does not respond (lack of maintenance, gradual damage, certain uses of the asset, etc.).

At Ambler we analyse the policy you have contracted, whether you did it with us or subscribed with another intermediary, to check how far the coverage really extends and if the expert report adjusts to what the contract indicates.

Provide more evidence

If the loss adjuster does not accept the damages due to lack of evidence or doubts about the origin, it is advisable to reinforce the file:

• Photographs and videos where the before and after can be seen.
  
• Technical reports (plumber, electrician, architect, garage, machinery technical service, etc.).
  
• Invoices for purchase or previous repairs.
  
• Detailed quotes, with a breakdown of materials and labour.
  
• Testimonies from neighbours, employees, or suppliers who witnessed the claim.

Request a second assessment: the appointed expert (Perito de Parte)

If the disagreement continues, the Spanish Insurance Contract Law allows both the insurer and the policyholder to appoint their own loss adjuster to assess the damage.

Act quickly

Deadlines matter:

• In many policies, you have 7 days to report the claim from the moment you become aware of it, unless the policy establishes a longer period.
  
• The general period for exercising actions against the insurer in property insurance is usually 2 years, according to article 23 of the Insurance Contract Law.
  
• To appoint an expert in the procedure of article 38 LCS, the party that receives the designation of the first expert usually has 8 days to appoint theirs.

Our team helps you calculate these deadlines correctly and process the documentation on time so that no door is closed.

What to do if the insurer rejects the claim?

Sometimes the company directly rejects the claim. Faced with this situation, the usual course of action is:

1. Letter of claim to the insurer
   
   • Submit a reasoned letter (preferably by burofax or reliable means) where you explain why you do not agree, provide evidence, and ask for a review.
     
   • The company usually has up to 2 months to respond before you can go to the Directorate General of Insurance and Pension Funds (DGSFP).
     
2. Customer service or customer advocate
   
   • Insurers must have these channels to process claims.
     
   • Consumer and customer service regulations set maximum response times and reinforce the obligation to respond to your claims in a reasonable time.
     
3. Claim before the DGSFP
   
   • If the company’s response does not convince you or does not arrive on time, you can go to the DGSFP Complaints Service, which has up to 90 days to resolve cases involving consumers.
     
   • The DGSFP report is not a sentence, but it carries significant weight and many insurers correct their position when the supervisor’s criterion is unfavourable to them.
     
4. Judicial route
   
   • When the loss adjuster does not accept the damages, the company maintains the rejection, and the amount at stake justifies it, you can go to the courts.

What happens if I do not agree with the expert report?

Being dissatisfied with the report is very common and you have several cards on the table to deal with the situation:

• Ask for written clarification from the loss adjuster through the company or your broker: what they took into account, what they left out, and why.
  
• Provide new documentation that the loss adjuster did not initially assess (invoices, technical reports, photographs).
  
• Request a new visit if changes or urgent repairs have occurred or if all damaged areas could not be accessed during the first visit.
  
• Appoint an appointed expert and initiate the contradictory expert assessment provided for in article 38 LCS, when the discrepancy focuses on the amount of the damage.
  

In practice, many differences are resolved in this phase, especially in home, business, or vehicle claims. When the loss adjuster does not accept the damages initially but is presented with well-structured additional information, it is common for them to partially or totally modify their report.

What does it mean for an expert to be challenged (Recusado)?

The concept of challenging (recusation) of experts appears mainly when the conflict reaches the judicial sphere.

• In a judicial procedure, the expert appointed by the court can be challenged if there is any cause of lack of impartiality included in the Civil Procedure Law and the Organic Law of the Judiciary.
  
• Common causes for challenging include, for example, having previously worked for the opposing party on the same matter or having a direct relationship of interest with one of the parties.
  

In contrast, experts appointed directly by each party (appointed experts) are not “challenged” in a strict sense, but their report may be objected to or impugned, questioning its objectivity or technical conclusions.

The role of an insurance brokerage in these cases

When the loss adjuster does not accept the damages, you are not obliged to face the insurer alone. At Ambler, we act as your technical and negotiating ally.

Support during claim management

From the initial notification of the claim, we help you to:

• Prepare the declaration clearly and coherently.
  
• Gather the basic documentation from the start (photos, invoices, reports).
  
• Coordinate with the company’s loss adjuster and clarify doubts about their visit.

Professional review of coverages

We review your policy and verify whether the partial or total rejection of the claim is justified:

• If exclusions have been applied excessively.
  
• If underinsurance exists, but the proportional rule has been incorrectly applied.
  
• If the company is interpreting a clause very restrictively.

Direct negotiation with the insurer

Not all discrepancies have to end up in court. Very often, a well-planned technical negotiation achieves that the company reconsiders its position when the loss adjuster does not accept the damages initially.

• We speak with the insurer in their own technical language.
  
• We present ordered reports and documentation.
  
• We argue why the coverage should apply or why the valuation should be reviewed.
  

Advice on activating the contradictory expert assessment

When appropriate, we explain step by step how article 38 LCS works:

• Appointment of the appointed expert.
  
• Deadlines and formal communications.
  
• Designation of a third expert if there is no agreement between the first two.

Customer defence to obtain the correct compensation

If the insurer maintains its position and the amount of the claim justifies it, we collaborate with specialised firms to prepare possible claims before the DGSFP or legal actions, always with a solid documentary and expert basis.

Thus, we support both private individuals (home, car, health, business) and companies in sectors such as industry, construction, technology, food, or real estate, and we adjust the strategy to each type of risk.

Protect what is yours

When the loss adjuster does not accept the damages, you are not alone. From Ambler we support you so you can review your policy, present all the necessary evidence, and, if necessary, request a contradictory expert assessment. Our goal is to defend your rights and ensure that you receive the compensation that truly corresponds to you, so that you obtain peace of mind and security throughout the process. Shall we talk? Don’t let uncertainty paralyse you. Let us help you resolve your case quickly and effectively.