where contractors often get involved—but there’s a limit. “You can research local code,” O’Day explained. “You can estimate costs. But you can’t interpret coverage or apply policy exclusions. Only public adjusters or attorneys can do that on someone else’s behalf.” That itemized valuation feeds into the “proof of loss,” a formal demand under the policy. Some states require insurers to respond within 30 days. Others? “There are no teeth,” he said. “But even then, filing it is critical. Until you do, your insurer has no duty to pay. The clock doesn’t even start.” He also emphasized the importance of distinguishing between mitigation and rebuild in your documentation, especially when policy caps are in effect. “Label things clearly,” he said. “Make it easy for someone reviewing the file to say, ‘This was an emergency. This is covered separately.’” AI and the future of claims interpretation When asked about using AI tools to interpret policies, O’Day didn’t shy away. “ChatGPT is a sword,” he said. “In the hands of a master, it’s powerful. In the hands of a novice? Dangerous.” He encouraged the use of AI for insight, but cautioned against treating its output as legally binding. “Use custom prompts,” he explained. “Understand the definitions. Remember, some words are defined in statute, some in case law, and some in the policy itself.” Release the undisputed money One of O’Day’s favorite tactics is to remind insurers that if they’ve agreed to a certain value, they must pay it, regardless of what’s still in dispute. “If you say, ‘it’s $138,000,’ and I say, ‘it’s $300,000’— great,” O’Day said. “You still owe me the $138K. Pay it. That part’s not in question.” That same logic applies to checks that come before restoration contractors get involved. “Unless the check has a legal release written on it, cash it,” he advised. “Holding it doesn’t give you more leverage. It just lets them hold onto your money longer.” “Know your lane, know your rights, and do the job right from the start.” ‘Good faith’ over ‘bad faith’ When to push further When insurers partially or fully deny a claim, the key is understanding what kind of denial with which you’re dealing. “A partial denial means they’re acknowledging some damage,” O’Day said. “A full denial means they say nothing happened at all.” That difference shapes your path forward. From there, policyholders can request revisions, file complaints with the state, or trigger dispute resolution clauses, such as appraisal, arbitration, or litigation. “And yes, once you’re in those lanes, things slow down,” he admitted. “Claims move at their own pace. Sometimes it’s fast. Sometimes, it’s like molasses. But you must follow the process.” O’Day avoids accusatory language. “I never say ‘bad faith,’” he explained. “That’s for the courts. But I do ask, ‘How in good faith could you possibly decide this?’” It’s a strategic move. Calling something bad faith too soon can change how an insurer handles the file. “They’ll redact documents, shut down communication, and gear up for litigation,” he explained. “That’s not always what you want.” Do the work, know the game O’Day offered five clear takeaways: • Demand the certified policy. • Read it in full. • Fulfill your duties after loss. • Submit a formal proof of loss. • Understand what your contractor role does—and doesn’t—entitle you to do. “This stuff ’s complicated,” he said. “But it’s not impossible. Know your lane, know your rights, and do the job right from the start.” The roles of contractors and policy adjusters O’Day was clear on the limits of contractor involvement. “You’re not allowed to negotiate a claim on someone else’s behalf unless you’re licensed to do so,” he said. “But you can advocate for your own invoices and question decisions.” He encouraged contractors to ask tough questions when adjusters try to dispute line items: “Where are you calling from? Did you inspect the job? What are your qualifications? No? Okay, well then, we’ll proceed accordingly.” Jeff Cross is the media director of ISSA Media, which includes ISSA Today, Cleaning & Maintenance Management, and Cleanfax. He can be reached at JeffCross@ISSA.com or 740-973-4236. 20 | CLEANFAX ® FALL 2025
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