2011 National Flood Insurance Program Claims Adjuster Presentation. The Role of Certified Adjusters in the NFIP

Transcription

1 2011 National Flood Insurance Program Claims Adjuster Presentation The Role of Certified Adjusters in the NFIP

2 Adjuster Qualifications Purpose Database - Identification 5 Areas of Authorization - Residential - Manufactured (Mobile) Home - Small Commercial - Large Commercial - Residential Condominium Building Association Policy (RCBAP)

3 Authorization Requirements Specialized Knowledge Certification is a Requirement - Exception: Write Your Own (WYO) Staff Adjusters

4 Flood Certification Number (FCN) ACTIVE-2010

5 NFIP CERTIFICATION FORMS

6 Certification Contacts IServices c/o Claims Department P.O. Box 310 Lanham, MD Fax Number: Obtain application at

7 Adjuster Education and Certification Assurance from WYO companies and adjusting firms that inexperienced adjusters will be supervised Responsibility of claim accuracy and quality of work Review of claims prior to payment or denial Co-signature on estimates, preliminary and final reports Mandatory annual workshop attendance Adjuster Certification cutoff date May 31, 2011

8 Adjustment Standards and Requirements, continued Authority of the Adjuster Knowledge of the Program Professionalism

9 Adjustment Standards and Requirements, continued - Claims Adjustment - Prompt Contact - Inspection - Origin of Loss - Building Scope and Estimate - Preliminary Report - Manufactured (Mobile)Home/Travel Trailer Worksheet

10 Adjustment Standards and Requirements, continued Personal Property Identification Advance Payment

11 Adjustment Standards and Requirements, continued -Replacement Cost and Actual Cash Value -Coverage Limitations -Final Report -Insured s Copy

12 Adjustment Standards and Requirements, continued Underwriting Issues - Improper Flood Zones - Incorrect Building Descriptions and Addresses - Substantial Improvement - Improper Named Insured - Two or more Buildings at the Described Location - Incorrect Mortgagee At the time of inspection, any discrepancies noted in the physical description of the insured risk, the policy or Declaration Page should be referred to the Carrier

13 Adjustment Standards and Requirements, continued -Proper Building Depreciation -Narrative Report -Prior Losses Checked -Progress Notes in File -Subrogation -Photographs -Salvage -Proof of Loss -Timely Reporting

14 Adjustment Standards and Requirements, continued Non-judgmental WYO Errors Proper Building Scope and Estimate Judgmental

15 Proper Building Scope and Estimate NFIP Estimate Format Unit cost basis Room-by-room Accurate description of rooms Room vs. offsets Line-by-line Individual line depreciation Sales tax (should be included in unit cost)

16 NFIP Reinspections Assist WYO Companies Information Needed Flood Certification Number (FCN) Policy Number Prior Loss History Declaration Page Deductible and Coverage Amounts Preliminary Report Scope Notes Progress Notes Final Report Photographs Copies of Estimates Paperwork on additional damages Elevation Certificate Narrative APDA Manufactured (Mobile) Home Worksheet

17 Detect Possible Waste & Abuse Receipts Serial Numbers Ownership Policies Waterlines Misrating Price Quotes Damaged Property Cause of Loss Late reporting of claim

18 Report Possible Waste & Abuse Immediately reported to the NFIP and the insurance company Waste and Abuse Hotline

19 NFIP Fee Schedule NFIP Fee Schedule Billing Gross Loss Increased Cost of Compliance Claims

20 NFIP Fee Schedule, continued Erroneous assignment $ Closed without payment , , , , , , , , , , , , ,175.00

21 NFIP Fee Schedule, continued 35, , $ 1, , , %, but not less than $ 1, , , %, but not less than $ 3, , and up 2.1%, but not less than $ 5,750.00

22 Disaster Response Adjuster Coordinating Office Flood Insurance Claims Office Claims Coordinating Office Flood Response Office FEMA/Joint Field Office FEMA/Area Field Office FEMA/Disaster Recovery Center (ACO) (FICO) (CCO) (FRO) (JFO) (AFO) (DRC)

23 Learning Check What are the five categories of flood certification? How is depreciation for building/personal property addressed in your scope of damages estimate? Name 3 possible waste and abuse issues. Give an example of a non-judgmental error.

24 The Standard Flood Insurance Policy (SFIP)

25 The Standard Flood Insurance Policy (SFIP) Three forms Dwelling Form General Property Form Residential Condominium Building Association Policy (RCBAP) Effective 12/31/2000

26 Dwelling Form Read the policy! Know the policy! Coverage is subject to limitations, restrictions, and exclusions.

27 Available Amounts of Insurance Building Coverage Single Family $250, Family $250,000 Personal Property Coverage Residential $100,000

28 I. Agreement Direct Physical Loss Paid the correct premium Compliance with policy terms and conditions Provided accurate information and statements

29 II. Definitions FLOOD

30 Definition of Flood A general and temporary condition of partial or complete inundation of two or more acres of normally dry land area or of two or more properties from the overflow of inland or tidal waters or from the unusual and rapid accumulation or runoff of surface waters from any source. KEY CRITERIA Condition must be general Condition must be temporary Inundation must be present Occurrence must be accidental

31 Actual Cash Value (ACV) Replacement Cost Less Depreciation

32 Basement

33 Building

34 Condominium Building

35 Described Location Shown on the policy s Declaration Page This is not always the insured s mailing address

36 Direct Physical Loss By or From Flood Loss or damage to insured property, directly caused by a flood. There must be evidence of physical changes to the property

37 Elevated Building

38 Elevated Building

39 Enclosure

40 Improvements

41 Mudflow

42 Named Insured You and Your - Insured(s) shown on the Declarations Page - Your spouse, if a resident of the same household Insured(s) - Mortgagee or loss payee

43 Pollutants

44 Pre-FIRM Built or substantially improved on or before December 31, 1974, or before the effective date of the initial Flood Insurance Rate Map.

45 Post-FIRM Built or substantially improved after December 31, 1974, or on or after the effective date of the initial Flood Insurance Rate Map, whichever is later.

46 Special Flood Hazard Area (SFHA)

47 Special Flood Hazard Area (SFHA) Zones that begin with the letter A or V

48 Flood Insurance Rate Map

49 Flood Insurance Rate Map FEMA Flood Map Store

50 Where Can I find Flood Maps? FEMA s Map Service Center

51

52

53 09/28/2009

54

55

56

57 SEPTEMBER 28, 2009

58 III. Property Covered

59 III. Property Covered Coverage A- Building Property Dwelling Additions and Extensions Detached Garages (Bulletin W-08043) Materials and Supplies Building Under Construction Items that are to become a part of the building (e.g. rebar, footings, and concrete walls ) Manufactured(Mobile)Home/Travel Trailer

60 Buildings Roof Elevated walkways Exterior rigid walls Load-bearing (solid) interior walls Stairs

61 Property Covered, continued Property items covered under Coverage A Awnings and canopies Blinds Built-in dishwashers Built-in microwave ovens Carpet permanently installed over unfinished flooring

62 Property Covered, continued Coverage A Page 4 of the Dwelling Form Built-ins

63 Property Covered, continued a. Any of the following items, if installed in their functioning locations and, if necessary for operation, connected to a power source: (1) Central air conditioners (2) Cisterns and the water in them (3) Drywall for walls and ceiling in a basement and the cost of labor to nail it, unfinished and not taped (4) Electrical junction and circuit breaker boxes (Complete list under Section III - Property Covered, A.8.,a & b.)

64 Building, continued

65 Building, continued

66 III. Property Covered Coverage B - Personal Property Tenant s Coverage Condo Unit Owner s Coverage Page 4 of the Dwelling Form

67 Special Limits - $2,500

68 Antiques Functional Value

69 III. Property Covered Coverage C - Other Coverages Debris Removal Owned anywhere Non-owned on or in insured property Removal work Federal minimum wage Not a separate limit of liability

70 III. Property Covered Coverage C - Other Coverages Who Pays to move this boat?

71 III. Property Covered Coverage C - Other Coverages Sandbags, supplies, labor $1,000 costs incurred to protect Reasonable expenses Property Removed to Safety

72 III. Property Covered Coverage C - Other Coverages Condominium Loss Assessments Condominium Unit Resulting from Flood Common Elements Loss Assessment Does Not Apply Government Body Personal Property Violation of Policy Conditions Maximum Limits of Coverage Not an Additional Limit of Liability

73 Learning Check Is Replacement Cost available for a residential duplex? If a post-firm, elevated structure has an attached garage, what coverages are afforded in the garage area? Can 10 percent of Coverage A be applied to a Detached Garage that has a sleeping space in it? Two structures are joined by a roof, at the time of a claim can the insured declare that the two structures be covered under one or two policies?

74 Increased Cost of Compliance

75 Increased Cost of Compliance (ICC) Coverage D

76 Increased Cost of Compliance (ICC)

77 Increased Cost of Compliance (ICC), continued

78 Increased Cost of Compliance (ICC), continued A structure is eligible for an ICC claim payment if the community determines that the structure is: Substantially damaged when: damage of any origin [is] sustained by a building whereby the cost of restoring the structure to its before damaged condition would equal or exceed 50 percent of the market value of the structure before the damage occurred. (see 44 CFR 59.1) OR

79 Increased Cost of Compliance (ICC), continued A Repetitive loss structure is: a building covered by a contract for flood insurance that has incurred flood-related damages on two occasions during a 10-year period ending on the date of the event for which the second claim is made, in which the cost of repairing the flood damage, on the average, equaled or exceeded 25 percent of the market value of the building at the time of each such flood event.

80 Increased Cost of Compliance (ICC), continued Date of Loss The date of loss for an ICC claim will be the date of loss for the underlying flood claim. The insured has four (4) years from the date of the declaration by the state or local official that the structure has been substantially damaged by flood to complete the ICC portion of the claim. March 14, 2006 W Memorandum to WYO Losses after June 1,2005

81 Increased Cost of Compliance (ICC) The Adjuster s Duty Informs the Insured of ICC coverage if the risk appears to be Substantially Damaged Adjuster must submit the APDA information to the NFIP Bureau and Statistical Agent by fax at (301) , mail to P.O. Box 310 Lanham, MD (W-09057, October 6, 2009) Obtain a copy of the signed construction contract that details costs to perform the mitigation activity Provide the insured with an Increase Cost of Compliance Pamphlet Verify mitigation activity is in compliance with floodplain management guidelines

82 Increased Cost of Compliance (ICC), continued ICC Claim Payment Partial payments are permitted 50 percent maximum partial payment available Reasonable time for completion not to exceed four years from date of declaration When mitigation procedures are completed

83 Increased Cost of Compliance (ICC), continued Determining Market Value Acceptable estimates of market value 1. Independent appraisals by a professional appraiser 2. Detailed estimates of the structure s ACV 3. Property appraisals used for tax assessment 4. The value of buildings taken from NFIP claims data (used as a screening tool) 5. Qualified estimates by local building departments

84 Increased Cost of Compliance (ICC), continued Role of the Local Official Regulate all development in the designated Special Flood Hazard Area (SFHA) in accordance community floodplain management laws Ensure NFIP compliance Require proper permits (including Federal and State) Ensure completed work is compliant with local floodplain management ordinance

85 Increased Cost of Compliance (ICC), continued Role of the Local Official Provide property owner a substantial damage declaration and remind the owner that ICC coverage could help offset compliance costs.

86 Increased Cost of Compliance (ICC), continued Information a Claims Representative will need from the local official The basis for the community s determination of substantial damage or repetitive loss, in writing A copy of the applicable repetitive loss provision in the community s floodplain management ordinance If the building is in a B, C, X, or D Zone, documentation as to why the building is required to undertake the mitigation action

87 Increased Cost of Compliance (ICC) continued Substantial Damage and Repetitive Loss Declaration should: Be in writing Amount of damages Market Value Flood Zone Date of local floodplain management ordinance Permit required

88 Increased Cost of Compliance (ICC) Learning Check Does ICC apply to a substantially damaged building, which is in compliance at the time of loss? Do all buildings insured by the NFIP qualify for ICC?

89 Increased Cost of Compliance (ICC) Learning Check Exceptions: Buildings insured under the Group Flood Insurance Policy. Units insured under a condo unit owner policy. Buildings in Emergency Program

90 Increased Cost of Compliance (ICC) Maximum Coverage Available Under ICC: $30,000 No separate deductible Payment amount can not exceed the statutory maximum: $250,000 - single family $500,000 - non-residential $250,000 - residential condo x no. of units.

91 Increased Cost of Compliance (ICC) Learning Check Should mortgagee name(s) be included on the ICC partial and final payment checks? No, ICC payments are subject to Coverage D and do not require naming a mortgage.

92 Increased Cost of Compliance (ICC) Learning Check There is no assignment of Coverage D except: To the community when it is in conjunction with a FEMA project such as the Hazard Mitigation Grant Program (HMGP).

93 Increased Cost of Compliance (ICC) Learning Check Who determines substantial damage? The Building/Local Official is the Authority in determining Substantial Damage.

94 2011 National Flood Insurance Program Claims Adjuster Presentation

95 The Standard Flood Insurance Policy (SFIP) Property Not Covered

96 IV. Property Not Covered Personal property not inside a fully enclosed building Open Structures Boathouses Building and personal property located entirely in, on, or over water Recreational Vehicles -Exception: travel trailers Self-propelled Vehicles or Machines including their parts and equipment

97 Property Not Covered, continued Underground structures Those portions of walks, walkways, decks, driveways, patios, and other surfaces, located outside the perimeter, exterior walls of the insured building Containers, including related equipment Buildings or units and their contents if more than 49 percent of the ACV is below ground

98 Property Not Covered, continued Fences, retaining walls, sea walls, bulkheads, wharves, piers, and docks Condominium property owned in common Aircraft or watercraft, their furnishings and equipment Swimming pools and their equipment Coastal Barrier Resources Act property Hot tubs and spas not bathroom fixtures

99 Exclusions

100 V. Exclusions Loss of Use Including loss of revenue and access Business Interruption Additional Living Expenses Cost of Compliance Except for ICC coverage Any other Economic Loss

101 Exclusions, continued Flood Already in Progress Policy Term Additional Coverage Earth Movement Earthquake Landslide Land Subsidence Sinkholes Destabilization or Movement of Land Gradual Erosion

102 Exclusions, continued Pressure or weight of ice Freezing or thawing Rain, snow, sleet, hail, or water spray Water, moisture, mildew, or mold damage Confined to the dwelling Within your control Failure, stoppage, or breakage Failure to inspect and maintain

103 Mold

104 Exclusions, continued Water or waterborne material Sewer backup Sump pump Seepage Pressure or weight of water Power, heating, or cooling failure Theft, fire, explosion, wind, or windstorm Intentional flooding Increased risk Federal Government Testing for or monitoring of pollutants

105 Hydrostatic Pressure

106 Learning Check Under what conditions would the NFIP pay for testing/monitoring of a condition of mold? During your investigation of a flood loss, should you document other damage to the structure from a source other than flood?

107 VI. Deductibles Shown on Declaration Page Separate deductibles for building and contents Buildings Under Construction Deductible doubled Does Not Apply to Loss Avoidance Measures Condominium Loss Assessment Increased Cost of Compliance

108 VI. Deductibles- October 1, 2009 Changes Regular Program The standard deductibles for Pre and Post-FIRM properties in Non-Special Hazard Areas (B,C,X.A99 & D) will be increased from $ to $1, The standard deductible for Pre-FIRM properties in Special Flood Hazard Areas (A&V zones), will be increased from $1, to $2, The standard deductible for Post-FIRM properties in Special Flood Hazard Areas (A&V zones), will be increased from $ to $1,

109 VI. Deductibles- October 1, 2009 Changes Regular Program, Continued The standard deductible for Pre-FIRM properties in Special Flood Hazard Areas (A&V zones) and rated using elevation certificate figures will be increased from $ to $1, Emergency Program: The standard deductible will be increased from $1, to $2, for all Pre and Post-FIRM properties.

110 VII. General Conditions A. Pairs and Sets Settlement ACV of article Value of that portion as it relates to the set

111 General Conditions, continued B. Concealment or Fraud Policy voidance, fines, civil penalties, and imprisonment

112 General Conditions, continued Not Eligible for Coverage Non-participating community Property not eligible for coverage

113 General Conditions, continued C. Other Insurance Prorated Primary up to other deductible Unless the SFIP is primary Other policy states it is excess coverage

114 General Conditions, continued C. Other Insurance Condominium Units RCBAP is primary Dwelling Form is excess

115 General Conditions, continued G. Reduction and Reformation of Coverage Must be corrected and correct premium paid (Bulletin W-05021) Policy limits vs. premium paid Notice to WYO underwriting must be sent

116 General Conditions, continued I. Conditions Suspending or Restricting Insurance Increased hazard within the control or knowledge of the insured

117 General Conditions, continued J. Requirements in Case of Loss (insured failed to comply) Non-Waiver Agreement Reservation of Rights

118 General Conditions, continued L. No Benefit to Bailee - Bailee Goods - No Coverage M. Loss Payment - Proof of Loss, 60 days from receipt by the company to pay claim - Signed form, 90 days -Received within 60 days from date of loss (Including Supplements)

119 General Conditions, continued N. Abandonment Insured may not abandon damaged or undamaged property to us

120 General Conditions, continued O. Salvage - Insured s option - Reduced payment - Insured buyback

121 General Conditions, continued P. Appraisal Insured and adjuster fail to agree on price Two appraisers Umpire

122 General Conditions, continued Q. Mortgage Clause Mortgagee s interest is protected R. Suit Against Us Filed in US District Court within 12 months of denial letter S. Subrogation Insured s right to recover is transferred to the insurer if the loss is paid under the SFIP

123 General Conditions, continued T. Continuous Lake Flooding 90 continuous days Total loss Closed Basin Lakes Total loss

124 General Conditions, continued U. Duplicate Policies Not Allowed Insured s choice Combine policy coverage limits Effective date is the date of the later of the two policies

125 General Conditions, continued V. Loss Settlement Replacement Cost Special Loss Actual Cash Value

126 General Conditions, continued ACV A 2-, 3-, or 4-family dwelling Unit not used exclusively for single family dwelling Detached garages Personal property Appliances, carpets, and carpet pads Outdoor awnings, antennas or aerials of any type, other equipment Abandoned property (debris at described location) Dwelling not primary residence

127 Amount of Insurance Required Not included in calculation: Footings, foundations, piers, other structures or devices that are below the lowest floor and that support all or part of the dwelling If no basement, supports listed above that are inside the foundation walls Excavations and underground flues, pipes, wiring, and drains ICC limit of liability

128 VIII. Liberalization Clause Broadened coverage No requirement for additional premium Automatically applies to insurance if change implementation date is within 60 days before, or during, the policy term Additional premium required Does not fall within this clause

129 IX. What Law Governs Federal Government Regulations issued by FEMA National Flood Insurance Act of 1968, as amended Federal common law Not subject to state insurance departments or state and local courts

130 Pop Quiz

131 General Property Form Read the policy! Know the policy! Coverage is subject to limitations, restrictions, and exclusions.

132 General Property Form, continued Insures non-residential and other residential property and their contents Other residential Hotels, motels (occupancy six months or more) Tourist homes, rooming houses (more than five or more lodgers) Residential (except hotels and motels) more than four dwelling units Incidental business occupancy is permitted if less than 25% of total floor area

133 General Property Form, continued Available Amounts of Insurance Building Coverage Other Residential $250,000 Non-Residential $500,000 Personal Property Coverage Residential $100,000 Non-Residential $500,000

134 General Property Form, continued II. Definitions 27. Stock Merchandise held in storage or for sale, raw materials, and in-process finished goods including supplies used in their packaging and shipping

135 General Property Form, continued Definitions, continued Stock includes Parts and equipment for self-propelled vehicles Furnishings and equipment for watercraft Spas and hot tubs, including their equipment Swimming pool equipment

136 General Property Form, continued III. Property Covered Coverage A - Building Property Awnings and canopies Blinds Carpet permanently installed over unfinished floor Central air conditioners Elevator equipment Fire sprinkler system see page 3 of 18 of the General Property Form

137 General Property Form, continued Property Covered, continued Coverage B Building/Personal Property policy Personal property must be within a fully enclosed insured building Personal Property only policy Located within the described building

138 General Property Form, continued Other Coverages Coverage C Pollution Damage Direct loss from flood $10,000 limit Not an additional limit of liability Cannot exceed property value Does not include testing or monitoring

139 General Property Form, continued IV. Property Not Covered Personal property owned or in the care, custody, or control of a unit owner - Except as described under Coverage B A residential condominium building

140 General Property Form, continued Condominiums Two types Residential Condominium Building Association Policy (RCBAP) General Property Form

141 General Property Form, continued Condominiums Tenant coverage -10 percent extension Timeshares Coverage General Property RCBAP

142 Residential Condominium Building Association Policy (RCBAP) Read the policy! Know the policy! Coverage is subject to limitations, restrictions, and exclusions.

143 RCBAP, continued Insures a residential condominium building

144 RCBAP, continued Available Amounts of Insurance The maximum building coverage for a Residential Condominium Building Association policy is $250,000 times the number of units.

145 RCBAP Adjusting Issues Adjuster should obtain a copy of: The condominium master documents that are applicable Insurance documents Adjusters must provide a detailed industry acceptable replacement cost evaluation List of unit owners List of additional insurance Underwriting issues must be reported to the company immediately Adjuster must be RCBAP certified by the NFIP

146 RCBAP, continued Co-insurance Clause (80%) Did Should X Amount of Loss = Loss Payment (apply deductible) 180, ,000 X 150,000 = 135,000 (135, =134,500)

147 Learning Check Under a General Property Form for non-residential property, a tenant has building coverage. Should the adjuster obtain the lease agreement for the file? Under what conditions can a General Property Form provide Replacement Cost Coverage? A condominium association has $670, in coverage. The building has a replacement cost of $1,200, How much would be paid on a$125, loss with a $10, deductible?

148 Learning Check Answer $1,200,000X80% = 960, They should have had to meet 80% minimum required prior to applying co-penalty. 670,000/960,000= 70% ITV 70%X 125, = 87, deductible of 10, = $77, claim payable

149 Flood Insurance Reform Act of 2004

150 Flood Insurance Reform Act of 2004 provide simple and complete information to policyholders at the time of purchase, renewal and at the time of a flood loss.

151 Flood Insurance Reform Act of 2004 Section 202. Supplemental Forms Exact Coverage being Purchased Exact Exclusions from Coverages How Items are Valued Loss History of Property Number and Dollars

152 Flood Insurance Reform Act of 2004 Section 203. Acknowledgement Form Sent to the Insured Received Policy, Supplemental Forms, and Personal Property not covered by Building Property coverage, but is available To be signed by the Insured at the time of purchase and renewal, acknowledging policyholder has been given a copy of the flood policy, any supplemental forms, and has been informed to purchase coverage for contents/possessions.

153 Flood Insurance Reform Act of 2004 Section 204. Flood Insurance Claims Handbook Easy to read, but complete, given to the Policyholder at the time of purchase, renewal and at the time of loss and to all insurance companies, agents and adjusters Contain all Information about Claims Proof of Loss Requirements Settlements Filing Settling a Claim under NFIP

154 Flood Insurance Reform Act of 2004 Section 205. Appeals of Decision Relating to Flood Insurance Coverage Formal Appeals Process Adjusters, Agent, Adjuster s Supervisor WYO Companies FEMA

155 ADJUSTER AUDIT ISSUES

156 AUDIT ISSUES 1. Incorrect Estimate/Worksheet Calculation Estimates are line by line, room by room using unit costs Depreciation to both building/contents line by line Rooms should be described and identified Typically overhead /profit is not applied-at least three trades Include only building items on the building estimate/worksheet Qualifications for R/C clearly documented

157 AUDIT ISSUES 2. Insufficient Damage documentation Invoices may be needed to adequately support a commercial inventory Salvor or CPA Photographs should adequately document the claimed damages also undamaged elements/contents

158 AUDIT ISSUES 3. Payment Processing Errors The adjuster should make all payment recommendations clear Other claim documents including the estimate/worksheet, final report, and Proof of Loss should support the recommendations

159 AUDIT ISSUES 4. Covered loss exceeded the value of certain items Care is taken when Special Limits are claimed Loss Avoidance Measures should be supported with invoices Property removed to Safety claims should be supported with invoices

160 AUDIT ISSUES 5 Case Loss Reserving The reserving system mandates that reports be timely and reflect true reserves Stat reserves by WYO The NFIP Preliminary Report should refine the case loss reserve amount FEMA Bulletin W December 22, 2008 Updated FEMA Bulletin W December 17, 2010 FEMA Bulletin W February 4, 2010

161 Adjusting Issues Technical Bulletins for WYO: W Claims Payments on Enclosures at or above the BFE W Flood Insurance Claims Guide W Flood Insurance Claims Guidance (Elevated Building Slabs) W Waiver of the Two-Year Limit for ICC W Elevation Wind/Water Investigative Tips

162 Adjusting Issues, continued Technical Bulletins for WYO: W Claims Guidance Detached Garages W NFIP Adjuster Fee Schedule W Claims Guidance-Hurricane Gustav and Ike W / W / W NFIP Case Loss Reserving Procedures

163 Adjusting Issues, continued Technical Bulletins for WYO: W Formal Appeals Process Issuance of Denial Letter W Wind Vs Water Adjusting Process W Oil in Flood Water

164 Adjusting Issues, continued Contents Manipulation Personal Property Coverage purchased Room by room lump sum not allowed in estimates Invoice/receipt needed if recommended Removal/storage not included

165 Adjusting Issues, continued Repair vs. Replacement Repetitive Losses Reserves Water Depth

166 Adjusting Issues, continued Water Depth Water Depth Equals (+) 2 7

167 Remediation Issues Prior to signing with remediation contractor Consult with the flood adjuster or flood insurer

168 Adjusting Issues, continued Heating, Ventilation, Air Conditioning (HVAC)

169 Adjusting Issues, continued Elevators

170 Adjusting Issues, continued Foundation elements Slab under elevated building Direct physical loss by or from flood All earth movement is excluded Litigation Use experts -Engineers, FEMA, WYO company staff Review with insured their duties after a loss Use current documentation -Adjuster Claims Manual -Standard Flood Insurance Policy Commercial claims Business inventory generally means the hiring of a CPA

171 Adjusting Issues, continued Duties after a loss Duties of the Adjuster Investigate Evaluate Explain coverage to insured Report Litigation support Duties of the Insurer Process claim FIRA requirements Policy reformation Approve or deny claim Options after loss Duties of the Policyholder Give prompt written notice of loss Mitigate the loss Cooperate with the adjuster (see the policy forms for complete list)

172 Adjusting Issues, continued Foundations/Slabs

173 Adjusting Issues, continued Foundations/Slabs FEMA Bulletin W November 19, 2004

174 Adjusting Issues, continued Foundation / Basement Look inside the house for: 1) Cracks in drywall on walls and ceiling 2) Doors that stick 3) Gaps between walls and ceilings 4) Nails that are coming out of the drywall 5) Windows that are not square or are sticking 6) Floors that are cracked or not level 7) Gaps between walls and floors

175 Adjusting Issues, continued Pre-existing Damages Look outside the house for: Cracks in the masonry Gaps between bricks, doors and windows Bricks leaning away from garage doors Gaps between fireplace and house Sagging roof line Paint, caulking, vegetation in cracks

176 Basement Adjusting Flood Losses

177 Basement, continued Adjusting Flood Losses The definition of basement is: any area of the building having it s floor sub-grade (below ground level) on all sides.

178 Basement, continued Adjusting Flood Losses Do basement coverage restrictions apply in each of these structures?

179 Basements REMEMBER!!!

180 There is Restricted Coverage in all Basements

181 PORCH DEFINETION 1. porch, structure, construction usage: a structure attached to the exterior of a building often forming a covered entrance

182 Elevated Buildings

183 Elevated Buildings, continued

184 Elevated Buildings, continued

185 Elevated Buildings, continued The Elevation Certificate Base Flood Elevation (BFE) Top of Bottom Floor Top of Next Higher Floor Highest Adjacent Grade (HAG) Lowest Adjacent Grade (LAG)

186 Elevated Buildings, continued The Elevation Certificate

187 Elevated Buildings, continued The Elevation Certificate Building Photographs

188 Elevated Buildings, continued The Elevation Certificate - Building Diagrams Diagrams 1A,1B,2

189 Elevated Buildings, continued The Elevation Certificate - Building Diagrams Diagrams 3,4,5,6

190 Elevated Buildings, continued The Elevation Certificate - Building Diagrams Diagrams 7,8,9

191 Is it Wind or Water? Wind/Water Investigative Tips W-08008

192 Is it Wind or Water?, continued Tornado damage Building construction Wind resistance Take photos debris tiedowns connectors Was it elevated? Ask neighbors

193 Is it Wind or Water?, continued

194 Is it Wind or Water?, continued

195 Is it Wind or Water?, continued

196 REVIEW!!!!!!!

197 FLOOD CRITIQUE You will receive an with a link to the evaluation for this workshop. Please take a few minutes to fill it out so that we can improve workshops for next year.

198 Did Not Get Notification???? To be added to our list SEND US AN adjusters@h2opartnersusa.com Subject line: Adjuster List

199 Where to get help! FEMA Flood Map Store

200 Resources Adjuster Claims Manual NFIP Flood Manual Community Status Book WYO Bulletins Preliminary Damage Assessment Adjuster Certification Application Current Effective Maps/Historical Maps

201 Resources Adjuster Certifications Mail: NFIP Bureau & Statistical Agent Certification Coordinator P.O. Box 310 Lanham, MD Fax:

202 Evaluations - Online All attendees will be receiving an with a link to a survey and feedback form. Please Take Time to complete and help us improve our training effort! THANKS

203