The Biggest Shell Game in Insurance
Let’s talk about one of the least discussed truths in property insurance—something that feels more like a magic trick than a consumer protection system.
You buy a policy. That policy is a contract. It outlines what’s covered, what’s excluded, and how claims are supposed to work. Simple enough, right?
But when a claim happens, insurance companies don’t follow your policy as written. Instead, they follow internal documents you’ll never see.
Documents like:
- Operating Guidelines (OGs)
- Standard Operating Procedures (SOPs)
- Best Practices
But what’s in these documents? You’ll never know. They’re considered confidential—even though they directly affect the outcome of your claim.
These documents dictate what their adjuster is allowed to do, how coverage is interpreted, and often, how little the company can get away with paying you.
And no, they won’t give you access to those documents—not without a courtroom fight. In a way, they are like some sacred scroll—just not for the policyholder.
we did some research and found a Real-World Example:
In State Farm v. O’Sullivan, internal documents used by adjusters were requested in discovery and initially withheld. The court ruled that those documents—SOPs, training materials, and OGs—were directly relevant to how the claim was handled and thus subject to disclosure. It took a legal battle just to peek behind the curtain.
So let’s break this down:
- A consumer buys a policy.
- Pays their premiums.
- Files a claim after suffering a loss.
- The adjuster shows up and follows secret, internal guidelines the consumer can’t see.
- And the final decision is based on something outside the contract.
That’s not just frustrating. That’s institutionalized opacity.
What Needs to Change
If secret internal documents and adjusting procedures are the actual rules used in claims handling, then policyholders deserve access. This isn’t proprietary—it’s a matter of accountability.
After all, policyholders fund the industry, they pay the salaries and built the buildings.
They deserve more than secret documents and third-party decision-makers.
Transparency is overdue
Access to internal claims rules should be a right—not a courtroom fight. Secret internal documents instruct their adjusters how to handle claims, what they’re allowed to approve, and yes—how to keep payouts in check.
Think about that.
You buy coverage, pay your premiums for years, and when you suffer a loss, your insurance company pulls out a completely different set of rules to decide what you’re owed.
That’s not just frustrating—it’s unfair.
These internal documents drive decisions that affect real people. Families. Businesses. Homes. And the people footing the bill—the policyholders—aren’t allowed to see what’s really guiding those decisions?
It’s not right.
If these internal documents are the real playbook, they shouldn’t be kept behind the curtain. Policyholders deserve to see the rules they’re actually playing by. We need transparency about how this works—and give people a fair shot when it matters most.
If you’ve suffered a property loss and your claim was denied or underpaid, contact Claims Aid Consultants Public Adjusters for a free, no-obligation claim review throughout the State of Florida. We ONLY work for you, not the insurance company.
No Recovery – No Fee
Call (772) 249-7988 or (954) 48-CLAIM
Claims Aid Consultants Public Adjusters 
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