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How an Insurance Claim Works

A straight answer to the question we hear most after water and mold damage: how does the insurance side actually work? Below is the process, the vocabulary you'll hear, and where homeowners usually get stuck — in plain language, without promises about what your particular policy will pay.

The six steps of a typical claim

1. Report the loss to your insurer

Call your insurance company's claims line as soon as you've made the property safe. Your policy has a notification deadline (often a few days). Give them the date, cause and what you've observed — photos help. You do not need a contractor's estimate to open a claim.

2. Stop further damage — keep the receipts

Your policy generally expects you to prevent additional damage. In practice that means shutting off water, moving furniture off wet carpet, and calling a restoration crew for extraction and drying. Keep every receipt; emergency mitigation costs are normally part of a covered claim.

3. Understand your deductible

The deductible is the amount you pay yourself before the insurer pays anything. A $1,000 deductible on a $6,000 covered loss means the insurer settles up to $5,000 and you cover $1,000. Some water claims, including high-risk flood policies, have a separate or percentage-based deductible.

4. The adjuster inspects and scopes the damage

Your insurer sends a claims adjuster to inspect the property and write a scope of work. This is where careful documentation matters — moisture readings, photos, and a documented drying plan help the scope reflect what actually happened rather than what's visible.

5. Estimates and Xactimate

Most insurance carriers scope restoration work in Xactimate, the industry estimating software that prices each line item (drywall removal, drying equipment, deodorization) against regional unit costs. Pure Resto writes its estimates in Xactimate too, so the two documents speak the same language and discrepancies are easier to spot.

6. Approval, work and payment

Once the scope is approved, work proceeds. Payments often come in stages: the initial approved scope, then a supplement if hidden damage is found once walls open. You are responsible for your deductible and any work that falls outside coverage.

What usually shapes the settlement

Cause of loss

Sudden events (burst pipe, appliance failure) are typically covered. Gradual leaks, neglect and rising floodwater usually aren't.

Documentation

Photos taken before cleanup, moisture readings and itemized scopes support the claim far better than a verbal description later.

Policy limits

Your dwelling limit and sub-limits (especially for mold) cap what the insurer pays regardless of the damage size.

Fair wear and tear

Older materials may be adjusted for depreciation. Replacement-cost policies handle this differently from actual-cash-value policies.

Pure Resto is a restoration company, not a public adjuster or an attorney. Nothing on this page is legal or insurance advice — your policy wording controls what is covered.

Insurance claim questions, answered

Does home insurance cover water damage from a burst pipe?+
Sudden, accidental water damage such as a burst pipe or appliance failure is typically covered under standard homeowners policies. Damage from gradual seepage, poor maintenance or flooding from rising water is usually excluded — and storm flooding requires a separate flood policy.
Is mold covered?+
Mold that results from a covered water event is often covered, but many policies cap mold remediation — frequently at $10,000 or less, sometimes with exclusions. Mold from long-term leaks or humidity is usually not covered. Check your policy's mold sub-limit before work begins.
What is loss of use?+
Also called Additional Living Expenses (ALE). When your home is uninhabitable during repairs, this coverage can pay for temporary housing and some extra living costs like meals above your normal spending. It's subject to your policy limits and requires documentation such as hotel receipts.
Will you bill my insurance directly?+
In many cases, yes. Pure Resto works with all major carriers and can bill the insurer directly for the approved scope of work. Any amount outside what the policy covers — typically your deductible — is discussed in writing with you before work begins.
Can I choose my own restoration company?+
In Maryland you generally have the right to hire the contractor you trust for a covered loss. Some insurers may recommend a preferred vendor, but the choice of restoration company is yours.
What if the adjuster's estimate seems too low?+
Estimates are based on what was visible at the inspection. If hidden damage is found once demolition starts — saturated framing, mold behind drywall — that's documented and submitted as a supplement to the original scope. Many claims have a supplement.

A claim is easier with a documented job

We photograph the damage, take moisture readings, and write estimates in Xactimate so your adjuster has the same detail we do.