What happens when the insurer’s loss adjuster and yours do not reach an agreement

One of the most common questions when someone decides to properly claim against their insurance company is this:
“What if the loss adjusters don’t reach an agreement?”

It’s a logical concern.
But the reality is that the system is specifically designed to manage that situation.

As we already explained when analyzing why many insurance claims are not legal issues but technical ones, the conflict usually lies in the damage valuation, not in the policy wording.
👉 Technical valuation conflict

Why most insurance claims are resolved by agreement

In the insurance sector, more than 95% of cases involving technical discrepancies end in an agreement between the parties.

This is not a matter of luck or coincidence.
It is a direct consequence of how the loss assessment system is designed.

A system designed to resolve, not to block

Damage valuation:

• is complex
• involves multiple items
• requires technical interpretation
• allows reasonable valuation ranges

For this reason, regulations provide for:

• the appointment of policyholder-appointed loss adjusters
• joint review of damages
• and only as a last resort, a third loss adjuster

The goal is not to escalate the conflict, but to resolve it technically.

Disagreement between adjusters is normal (and part of the process)

When two loss adjusters disagree:

• it does not imply conflict
• it does not mean the case is blocked
• it is not a failure of the claim

It is a natural part of a serious technical assessment.

Insurers, the insurer’s adjuster, and the policyholder’s adjuster all understand that the system is designed to reach a point of agreement.

Our experience: agreements without a third adjuster in 98.3% of cases

At MataSeguros, 98.3% of cases are closed without the need to appoint a third loss adjuster.

This step is only taken in very specific situations, such as:

• very large valuation discrepancies
• complete omission of areas (for example, an entire floor not valued)
• persistent technical refusals without solid justification

This result is not accidental.
It is the outcome of a methodology based on:

• specialized technical training
• specific training in loss adjuster negotiation
• real experience in complex claims
• deep understanding of how the other party operates

This approach follows the same logic we explain when addressing why starting with a policyholder-appointed loss adjuster is often better than going to court, as the goal is to resolve issues before escalating the conflict.

👉 Policyholder adjuster better than court

What happens when the dispute is not technical, but policy-related

In some cases, the disagreement is not about the damage, but about how the policy is interpreted.

In these situations, very often:

• going to court is not necessary
• nor is appointing a third adjuster

A clarification of criteria, a formal query, or reference to applicable case law can be enough to unblock the case.

The case of the Insurance Compensation Consortium (CCS)

In claims handled by the Insurance Compensation Consortium, disputes are often interpretative:

• how the damage fits within coverage
• the scope of the policy
• applicable criteria

In these cases, requesting clarification, interpretation, or contrasting with legal doctrine and case law is often sufficient to move forward, without the need to litigate.

Conclusion

Disagreement between loss adjusters does not block the process.
It organizes it.

The system is designed so that the vast majority of claims are resolved through technical agreement, and experience shows that this is exactly what happens.

Only when discrepancies are truly significant do higher-level mechanisms come into play, always with the goal of closing the claim fairly and technically.

Does it make sense to review how your case is being handled?

If your claim is stalled or the valuation does not reflect the real damage, a technical review can clarify the way forward.

👉 Request an independent technical review of my claim