Administrative Review Process for Hurricane Sandy Claims

Transcription

1 Administrative Review Process for Hurricane Sandy Claims

2 Initial Outreach Letter FEMA will notify National Flood Insurance Program policyholders who experienced flooding due to Hurricane Sandy that they have an opportunity to have their file reviewed A letter will be sent by Zip Code to claimants who experienced damage from Sandy between Oct. 27, 2012 and Nov. 6, 2012 Policyholders with engineer reports will receive letters first Policyholders who want to have their file reviewed can contact us by phone or Presenter s Name June 17,

3 Contact the Hurricane Sandy NFIP Review Hotline By phone: By website and Callers will be asked a set of qualifying questions related to their policy Those who are eligible to proceed will be asked a second set of questions related to Hurricane Sandy Presenter s Name June 17,

4 FEMA Receives the File and Initiates the Review The call center will forward collected data on the policyholder to the claims processing team by FEMA will request the policyholder s file from their insurance company and forward it to the NFIP review office within two business days These files are then assigned to a highly skilled NFIP-certified adjuster; files with engineering reports are reviewed by an engineer that is not currently under investigation Presenter s Name June 17,

5 FEMA Receives the File and Initiates the Review, cont d The claims processing team will send a letter to the policyholder acknowledging that they have received their file The highly skilled NFIP-certified adjuster will contact the Write Your Own insurance company, vendors or direct service agent to order complete files Presenter s Name June 17,

6 The Adjuster Contacts the Policyholder The adjuster will work with the policyholder throughout the review process and advise the policyholder on how to submit new information to include in the review Policyholders have 14 days from the date the caseworker contacts them to submit new information If there is no new information, the review begins right away The review process may be suspended if the policyholder has indicated that they have new information and cannot be reached by the adjuster for 30 days Presenter s Name June 17,

7 The Adjuster Contacts the Policyholder, cont d Adjusters and engineers will verify that the file includes all of the necessary documentation The caseworker will explain to the policyholder what is covered or not covered under their policy and answer any questions the policyholder may have Property visits may be conducted if needed Presenter s Name June 17,

8 The SBA, HUD, and Other Granting Agencies Federal agencies cannot provide disaster assistance for damages or losses covered by insurance If additional payments are possible, the policyholder may be required to repay other granting or contracting entities if there is a duplication of benefits Presenter s Name June 17,

9 Requesting a Neutral 3 rd Party If the policyholder disagrees with the adjusters recommendations, they have the opportunity to utilize a neutral 3 rd party to assist in making the final recommendation After a neutral is requested, they will review the file and contact the policyholder to discuss any concerns. The neutral will examine information in the file and documentation, and will ask questions of the adjuster and the policyholder. Presenter s Name June 17,

10 Requesting a Neutral 3 rd Party cont. The neutral may suggest a hearing involving the policyholder, the adjuster and the neutral. A hearing is not necessary; it is an option for the policyholder. This neutral party will make a recommendation to FEMA. FEMA will give substantial weight to the neutral party s recommendation. Presenter s Name June 17,

11 Results of Review After the claim is reviewed, the policyholder will be notified of the results by phone and in writing Proof of Loss: policyholder s statement of the amount of money being requested, signed to and sworn to, with supporting documentation Payment will be made by the insurance company Once all parties involved have been notified of the results, the process is complete Presenter s Name June 17,

12 Resources Hurricane Sandy Flood Insurance Claims Review Documentation Checklist NFIP Request for Review of Hurricane Sandy File Form Fact Sheet- How the Hurricane Sandy Claims Review Process Works Fact Sheet- What is Covered (and not covered), under your Flood Insurance Policy Frequently Asked Questions- Hurricane Sandy National Flood Insurance Program Claims Review Infographic Sandy Claims Review Process Presenter s Name June 17,

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