The Underpayment Decoder™

How to use the Decoder

On any underpaid claim, walk through the 12 patterns below. Mark each as:

• Applies strongly: clear pattern, strong counter available
• Applies partially: some elements present
• Doesn't apply: no evidence of this pattern

Patterns marked "applies" become the core of your supplemental claim or appraisal position.

The 12 Patterns

1. Scope reduction

Carrier's Xactimate estimate omits specific line items. Look for:

• Demo and haul-away
• Drying equipment hours
• Protection and containment
• Labor minimums
• Overhead and profit

Counter: Full Xactimate re-estimate; document every omitted item.

2. Sudden vs. gradual reclassification

Water losses recharacterized from sudden (covered) to gradual (excluded).

Counter: Plumber's diagnosis; timeline of discovery; failure-mode expert analysis.

3. Depreciation games

ACV paid; RCV holdback withheld, sometimes never released. Or excessive contents depreciation.

Counter: Submit completed-repair invoices; challenge contents depreciation with specific evidence.

4. Code-upgrade omissions

Law and ordinance coverage not applied to current building code requirements.

Counter: Declarations page review confirms L&O. Licensed contractor's statement on current code requirements.

5. Matching denial

Damaged items can't be matched; carrier pays partial replacement only.

Counter: Fla. Stat. 626.9744. Manufacturer letter on matching unavailability. Continuous-area replacement scope.

6. Contents underscoring

Personal property under-valued, aggressively depreciated, or specific categories under-scheduled.

Counter: Full room-by-room inventory. Replacement cost research. Scheduled personal property endorsements.

7. ALE / Loss of Use limitation

ALE period cut short, meals not covered, reasonable-and-necessary invoked too aggressively.

Counter: Every receipt. Displacement timeline. Monthly ALE reports.

8. Wear-and-tear attribution

Storm or event damage attributed to normal aging.

Counter: Pre-loss condition documentation. Weather correlation. Independent engineering analysis.

9. Cosmetic damage exclusions

Metal roof hail damage denied as "aesthetic only."

Counter: Functional impact analysis. Manufacturer warranty impact. Fla. Stat. 626.9744 matching.

10. Scope-of-loss disputes

Carrier claims damaged items pre-existed or damage is less extensive than documented.

Counter: Pre-loss documentation. Dated post-loss photos. Contractor's written scope.

11. Overhead & profit omission

O&P not included on claims requiring general contractor coordination of 3+ trades.

Counter: Trade-count analysis. General contractor requirement documentation. Industry standard support.

12. Statutory-deadline manipulation

Carrier misses Fla. Stat. 627.70131 deadlines as pressure tactic.

Counter: Delay Log™. Written demands. DFS complaint. CRN.

Your decoder scorecard

Print and work through:

From scorecard to claim

Each "applies" entry becomes:

• A specific line item in the Xactimate re-estimate (patterns 1, 3, 4, 6, 7, 11)
• A specific legal or factual argument (patterns 2, 5, 8, 9, 10)
• A specific procedural escalation (pattern 12)

The Decoder in action

Common scenarios:

Roof claim with minimal scope

Patterns 1 (scope), 4 (L&O), 5 (matching), 8 (wear-and-tear), 9 (cosmetic), 11 (O&P) all typically apply.

Water loss with low settlement

Patterns 1 (scope), 2 (sudden/gradual), 3 (depreciation), 6 (contents) commonly apply.

Hurricane claim denied under deductible

Patterns 1 (scope), 4 (code), 5 (matching), 10 (scope-of-loss) typically apply and often push the claim above the deductible.

Request a free decoder review

Send us your carrier's estimate and any correspondence. We'll run the Decoder and tell you which patterns apply, and what the likely gap is. Free claim review.

Downloadable one-pager

A printable one-pager of the 12 patterns with the scorecard is in preparation; once finalized it will be available here for download.