MODULE 3: PROTOCOLS & ESTIMATES
Working Within Coverage Limits
When Protocol Exceeds Coverage
The Reality You'll Face
What do you do?
The Constraints
- Can't ignore part of the protocol - that's not proper remediation
- Can't force insurance to pay more - that's not how insurance works
- Can't do $15,000 of work for free - that's not how business works
The gap between what's needed and what's covered.
This is the challenging reality of mold remediation.
Understanding the Gap
Protocol = What's Needed
IEP writes based on building needs, not insurance coverage. That's their job.
Limit = What's Covered
Policy contract defines maximum. Often $10K in Florida, varies elsewhere.
These often don't match. The gap falls to someone.
Usually the customer. Sometimes you - if you don't handle it correctly.
Four Strategies
1. Prioritization
Work with IEP to identify critical vs. secondary
2. Customer Payment
Customer pays the gap
3. Limit Increase
Customer requests higher limit from insurance
4. Supplements
Additional scope within the limit cap
STRATEGY 1
Prioritization
Work with the IEP to identify what's most critical.
- Not all protocol items are equally urgent
- Some address active, severe contamination
- Others address minor areas or preventive measures
- Some IEPs will write phased protocols
STRATEGY 1
Phased Approach
Ask the IEP: "If we had to phase this work due to coverage constraints, what's highest priority?"
Phase 1: Critical
Active, severe contamination areas
Must be addressed immediately
Phase 2: Secondary
Minor areas, preventive measures
Can wait if needed
Get the IEP's input in writing. Document the prioritization.
STRATEGY 2
Customer Payment
The customer is the property owner. They're responsible for their property.
- Insurance helps, but limits are limits
- If work costs more than the limit, customer is responsible for the difference
- This conversation happens BEFORE work starts, not after
STRATEGY 2
The Exact Script
"Your insurance covers up to $10,000 for mold remediation. The protocol requires approximately $18,000 of work. Insurance will pay up to their limit. You would be responsible for approximately $8,000. How would you like to proceed?"
Then let them decide.
STRATEGY 2
Customer Options
Pay the Difference
They want property fixed properly
Payment Plan
If you offer them - get it in writing
Partial Scope
Critical items only, within coverage
Wait and Save
Do Phase 2 later when they have funds
Whatever they decide, get it in writing.
Never Start Without Acknowledgment
Never start work with a limit gap
without written acknowledgment.
Otherwise you may end up with a $15,000 invoice and a customer who says:
"I thought insurance covered all of it."
STRATEGY 3
Limit Increase Request
- Some policies allow customers to request a limit increase
- Customer contacts their insurance company
- Asks if additional coverage can be purchased (endorsement)
- Not common, not guaranteed, but worth exploring on larger jobs
Don't count on this. Many policies don't allow it.
This is the customer's action to take, not yours.
STRATEGY 4
Supplements
Supplements work differently in mold than water.
Water Supplement
Ask for more funds because you discovered more damage. Often approved.
Mold Supplement
Can't exceed the limit cap. Argues for different allocation within the limit.
If limit is $10K and you've billed $10K, a supplement won't add more money.
The limit is the limit.
The Conversation Framework
- Facts: "I've reviewed your coverage and the protocol."
- Coverage: "Your policy provides $10,000 for mold."
- Scope: "The protocol calls for approximately $18,000."
- Gap: "The remaining $8,000 would be your responsibility."
- Options: Present their choices
- Decision: "What would you like to do?"
When Customer Won't Decide
If the customer won't acknowledge the gap or make a decision...
Don't start work.
Starting work without clarity on payment responsibility = you absorbing the gap.
Recap
- Protocol scope often exceeds coverage - that's reality
- Prioritize with IEP help - phase if needed
- Customer pays the gap - conversation BEFORE work
- Limit increase - customer requests from insurance (not guaranteed)
- Supplements - useful only if room within limit
- Document everything in writing before you start
Coming Up Next
Building the Estimate
Putting it all together - from protocol to final package.
ACTION ITEM
Your Next Step
Prepare your coverage limit conversation script.
Write out exactly what you'll say.
Practice it.
Have it ready for your next mold job where scope exceeds coverage.
See you in the next lesson.