How to handle insurance claims and adjustors

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James Gray
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1 March 22, 2014 How to handle insurance claims and adjustors Connie Phillips Insurance Michael Matthai Restoration

2 When should I contact my insurance agent? When should I actually file a claim with the insurance carrier?

3 When a claim is made or a lawsuit is filed, what do I do? Physical Property Damage vs. Liability Lawsuit

4 Are my limit adequate? Is the claim covered? The cheapest policy is not always the best coverage! Replacement Cost verses Actual Cash Value Coinsurance Penalty verses Blanket Coverage What does Additional Insured mean to you?

5 How do I negotiate with the claims adjustor?

6 Understand the stakeholder roles involved in your loss. Step by step process when you employ a restoration company Know what you are entitled to as the insured party after your property is stabilized; how advocate your loss for yourself.

7 Property Manager / Home Owner Adjuster Insurance Broker Restoration Company

8 Place a call to your insurance agent. Contact the restoration company of your choice. Review your responsibilities under your insurance policy for cleaning up the residence to prevent additional damage. Upon the arrival of the restoration company, thoroughly walk through your home with their rep. and discuss what needs to be cleaned. Take plenty of pictures.

9 The restoration company will provide an estimate or contract for their services. a. Not all cleaning services provided are covered under your insurance company. b. If there are questions or concerns with the services provided, take them up with the restoration company, not the insurance company.

10 Once you sign this contract, the home owner is responsible for paying the restoration company for the work described. Most insurance claims will cover the cost of cleanup by the restoration company. Acquire documentation showing drying progress and completion. In the following weeks after the cleanup, monitor the area for excess moisture or dampness that remains.

11 Know the Insurance Bill of Rights How to advocate your loss for yourself

12 Insurance Claim Negotiations Connie Phillips, LUTCF, CIC, CSA Connie Phillips Insurance The Phillips Condominium Group Mike Matthai, LEED GA-ASD-MRT Business Development C&C Complete Services C

13 C&C Complete Services Restoration Companies & Insurance claims- Overview Topic Insurance claims management Overview/ Main Points Understand the stakeholder roles involved in your loss. Step by step process when you employ a restoration company Know what you are entitled to as the insured party after your property is stabilized; how advocate your loss for yourself. We will discuss: Board members and community managers sometimes find challenges with their insurance claims. Insurance companies owe reasonable compensation to restore the property to pre-loss conditions. Do not settle for less; know the insured bill of rights. Stakeholders roles- Home Owner/ Property Manager Know what your insurance policy requires you to do following a major loss. Determine if source unit has affected adjacent units. o Get those involved with proper restoration protocols. If you have insurance coverage questions, ask your broker/agent for answers. Choose a well respected restoration company to clean your home. Your property/community manager, BBB ratings or internet based review services are helpful. However, it is a good idea to identify a company before you have an incident. Ask if they are IICRC certified. This is the most well recognized governing organization for the restoration industry. The insurance industry recognizes their standards and procedures for restoration. o IICRC (Institute of Inspection, Cleaning and Restoration Certification is non-profit organization with certifications programs and standards. An IICRC firm must demonstrate proof of insurance; provide education and training for technicians. o For more information, go to: Read the restoration company s contract carefully and keep a copy.

14 Response time is crucial to preventing further damage, including mold issues. Any delay can lead to a much costly reconstruction. Begin repairs to your home promptly following the clean up service. Stakeholders roles- Adjuster The adjuster operates on behalf of the insurer aka Direct or Private Adjuster. Adjusters may handle "property claims" involving damage to buildings and structures. Public adjusters work exclusively for the policyholder. This means there should be no inherent conflict of interest when it comes to advocating on the policyholders behalf to the insurance company. An adjuster will frequently verify that coverage applies through an insurance policy, investigate liability for the damages caused, and make compensation to the person based on their physical property damages. Specific duties include: Notifying the insurer of a covered loss as defined under the policy of insurance Responding to claims in a timely manner Filing paperwork Communicating with policy holders Investigate liability Assess damages Research, detail and substantiate each aspect of the claim, including building damage, contents, and extra living expense claims. Prepare a detailed damages report based on monthly updated insurance cost software for the purpose of making an offer of settlement to the insured. If needed for specialty cost coding, negotiate with product/service providers on time and cost of repairs for the purpose of making an offer of settlement to the insured. Ensuring accurate procedures Protect the interest of the insurance company the adjuster represents, when dealing with claimants. Stakeholders roles- Insurance Broker Provided by Connie Phillips Stakeholders roles- Restoration Company The restoration contractor operates on behalf of the insured.

15 Restoration companies are usually first responders following significant damage from floods, fires, sewage backups and other major events. The job of a restoration company is to clean up the mess and to preserve and protect the home and its contents so further damage will not occur. Ask if they are IICRC certified; this will ensure the work is completed according to industry standards. IICRC (Institute of Inspection, Cleaning and Restoration Certification is non-profit organization with certifications programs and standards. An IICRC firm must demonstrate proof of insurance; provide education and training for technicians. o For more information, go to: The Restoration Industry Association (RIA) is a trade association of cleaning and restoration professionals offering education and training. o For more information, go to: Restoration companies do not repair your home unless they are licensed to do home improvements and have a separate contract with you for home repairs. Prepare a detailed damages report based on monthly updated insurance cost software for the purpose of making a precise invoice to provide to the insurer. Specific duties include: Responding to the emergency within 2 hours or in a timely manner Filing paperwork and photo documentation. Communicating with policy holders. Assess damage and clean in accordance with industry standards. Prepare a detailed damages report based on monthly updated insurance cost software for the purpose of making an offer of settlement to the insured. Protect the interest of the insured, when dealing with claimants. Step by step process when you employ a restoration company 1. After the major catastrophe, place a call to your insurance agent. 2. Contact the restoration company of your choice. You are not obligated to hire the company your insurance company refers. 3. Review your responsibilities under your insurance policy for cleaning up the residence to prevent additional damage. 4. Upon the arrival of the restoration company, thoroughly walk through your home with their rep. and discuss what needs to be cleaned. Your insurance agent or adjuster may recommend what and how you home should be cleaned but in the end it is your decision. 5. Take plenty of pictures. This has been helpful in the event there is a discrepancy with the claim. 6. The restoration company will provide an estimate or contract for their services. Read it and make sure all work is described in it, and then sign off if it meets the agreement. a. Not all cleaning services provided are covered under your insurance company; check with the assigned adjuster for clarification.

16 b. If there are questions or concerns with the services provided, take them up with the restoration company, not the insurance company. 7. Once you sign this contract, the home owner is responsible for paying the restoration company for the work described. Most insurance claims will cover the cost of cleanup by the restoration company. 8. Acquire documentation showing drying progress and completion. 9. In the following weeks after the cleanup, monitor the area for excess moisture or dampness that remains. Know what you are entitled to as the insured party after the property is stabilized. You may take and be fully compensated for the cost of the emergency steps to safeguard your property from further damage after a loss. In fact you have the obligation to do so under the terms of your policy. The insurance company may not be liable for additional expenses if you fail to provide such protection. If you have secured adequate coverage, you are entitled to be paid for the fair cost of the fully restoring your home/property to its pre-damage condition. o You are, however, not insured for the repair of unrelated problems such as code deficiencies and or prior damage. You are entitled to employ and should insist upon a fully licensed and insured repair firm of good reputation. o If you choose not to employ such a firm, the consequences and liability for any injury, damage or other actions will rest with you, the property owner. You are entitled to employ a firm with sufficient experience and stability in the community to stand behind its work and warranty responsibilities. o The repair contract and its execution are strictly between you and the contractor. Your insurance company does not warrant or guarantee the performance of any firm you hire. You are entitled to materials and workmanship fully equivalent to your existing installation in like kind and quality o The insurance company has no obligation to improve your existing installation. You are not required to accept the lowest bidder. Nowhere in your policy do the word, Cheapest, Low or Lowest Price occur. o Repair rates should correspond to prevailing standards in your area for work of good quality. You are entitled to receive a detailed listing of the scope or repairs and quantities of materials to be provided, before work begins. o Provision for hidden or latent problems relating to the damage should be spelled out in as much detail as possible.

17 If substantial disagreement arises between you and the insurance company over the amount of the loss, you are entitled to request arbitration (appraisal) as described under the terms of the policy lines of the standard homeowners form which spells out the procedures for settling differences without resorting to lawsuit. o The insurance company is also entitled to this provision, which may be invoked at any time prior to settlement, regardless of whether or not you have received advanced payments. You are entitled to receive payment from the insurance company within the time specified by the policy and your state insurance regulations, which are designed to prevent insurance companies from using delay and personal hardship to compel a lower settlement. o The policy also has time requirements for the policyholder, within which you must prepare and submit your claim. Ask your adjuster about these requirements at the outset so that you can be in compliance.

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