New Beginnings. How Claims Put Peoples Lives Back Together

Transcription

1 New Beginnings How Claims Put Peoples Lives Back Together

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3 What is the claims process? This is a common question as there are many people, companies, and steps involved. Common Questions from the Insured: Who are you? Are you FEMA? How/when do I begin repairs? Do you send someone out? Should I begin dry-out? What can I throw out?

4 We deliver on the promise that was made when the policy was sold We are often the ONLY connection a policyholder has with their flood carrier We have an uphill battle from the start The flood policy is not like a regular homeowners policy It is a government aid program with elements of insurance

5 Complicated : How Many Elements are in the Final Work Product CLOSING REPORT - ORDER OF REQUIRED REPORTS 1. Cover Letter if Signed Proof of Loss not attached 2. Invoice 3. Narrative Report 4. Signed Proof of Loss and when appropriate signed Replacement Cost Proof of Loss 5. Unsigned Proof of Loss and when appropriate unsigned Replacement Cost Proof of Loss 6. Final Report 7. Preliminary Report 8. Copy of ADJUSTER FCN card 9. RCBAP Calculations (when applicable) 10. Preliminary Damage Assessments Form (when applicable) 11. Cause of Loss Subrogation Form (when applicable) 12. Mobile Home Worksheet (when applicable) 13. Building Valuation (when applicable) 14. Building Diagram (when applicable) 15. Building Estimate (when applicable) 16. Contents Estimate (when applicable) 17. Supporting documentation 18. Non-Waiver (when applicable) 19. Photographs 20. Adjuster s scope notes 21. Open coverage verification sheet / assignment 22. Flood Questionnaire CWOP (CLOSED WITHOUT PAYMENT) - ORDER OF REQUIRED REPORTS 1. Invoice 2. Narrative Report 3. Final Report 4. Preliminary Report 5. RCBAP Calculations (when applicable) 6. Preliminary Damage Assessment Form (when applicable) 7. Copy of ADJUSTER FCN card 8. Mobile Home Worksheet (when applicable) 9. Building Valuation (when applicable) 10. Building Diagram (when applicable) 11. Building Estimate (when applicable) 12. Contents Estimate (when applicable) 13. Supporting documentation (when applicable) 14. Non-Waiver (when applicable) 15. Photographs 16. Adjuster s scope notes (when applicable) 17. Open coverage verification sheet / assignment 18. Flood Questionnaire (when applicable) ERRONEOUS ASSIGNMENT - ORDER OF REQUIRED REPORTS 1. Invoice 2. Narrative Report 3. Supporting Documentation (when applicable) 4. Open coverage verification sheet / assignment

6 Complicated : The Insured Must Sign a Proof of Loss and RC Proof of Loss if they have replacement cost.

7 Confusing Basements are confusing. Subgrade crawlspace is a basement. Sunken living room is a basement. Blinds are building items. Curtains are a contents item. Not allowed to pay for curtains if policyholder didn t purchase contents. Contents of freezers in basements are covered but not contents of refrigerator/freezer in the same basement. Policy doesn't pay for matching. Can t buy upper kitchen cabinets unless directly damaged by water.

8 What is Covered in a Basement? Here are the 17 Covered Building Items 1. Central air conditioners; 2. Cisterns and the water in them; 3. Drywall for walls and ceilings in a basement and the cost of labor to nail it, unfinished and unfloated and not taped, to the framing; 4. Electrical junction and circuit breaker boxes; 5. Electrical outlets and switches; 6. Elevators, dumbwaiters, and related equipment, except for related equipment installed below the base flood elevation after September 30, 1987; 7. Fuel tanks and the fuel in them; 8. Furnaces and hot water heaters; 9. Heat pumps; 10. Nonflammable insulation in a basement; 11. Pumps and tanks used in solar energy systems; 12. Stairways and staircases attached to the building, not separated from it by elevated walkways; 13. Sump pumps; 14. Water softeners and the chemicals in them, water filters, and faucets installed as an integral part of the plumbing system; 15. Well water tanks and pumps; 16. Required utility connections for any item in this list; and 17. Footings, foundations, posts, pilings, piers, or other foundation walls and anchorage systems required to support a building.

9 Sometimes the claims have issues that involve additional processes and/or issues that delay the claims process There is an underwriting issue (underwriting alert is submitted) Prior loss issues An engineer is required (engineer request is submitted) Policyholder will not sign the proof of loss Policyholder is out of the country, has unforeseen issues, can t access the property until water recedes, etc. that prevents the claims from being inspected in a timely fashion The claim was submitted after 60 days and needs a waiver Policyholder needs to sign a non-waiver Public adjuster involvement

10 When Zones Change: How it Affects the Insured Mapping affects coverage on claims post firm elevated buildings. Explanation is much more difficult when rezoned to SFHA, premiums go up yet the amount of covered damages decreases. Yet, house didn t move. Example: It was indicated that this loss was in an AE zone with restrictions applying. We were informed mapping changes placed property in an A zone. $2, AE Zone with restrictions the Gross Loss = $2, A Zone without restrictions the Gross Loss = $107,902.34

11 Adjusters wear many hats. How do those those skills put peoples lives back together?

12 Counselor The policyholder is going though one of the most traumatic experiences they will have in their lifetime. The adjuster is there to listen and empathize as they guide the affected families through the process to recovery

13 Athlete The adjuster needs to be physically fit enough to lift, climb, crouch into small spaces, in order to inspect the claim properly.

14 Contractor & Electrician The adjuster needs to understand basic construction and electrical wiring in order to properly inspect and prepare his/her estimate. The policyholder may also have questions about the items that are damaged and proper repair methods.

15 Architect The adjuster creates diagrams of each room with exact measurements and locations of windows (with correct window heights), doors, closets, etc. This also needs to match what is in the estimate. If they are putting 200 square feet of carpet in a room in the estimate, the diagram needs to show a 200 square foot room.

16 Photographer The adjuster needs to take clear photographs of anything and everything, even items not damaged in the flood. Knowing how to operate and take clear photos in the worst settings is a necessary skill. The adjuster tells his/her story through the use of good photographs. When done properly, photo documentation provides inside examiners a good idea of what occurred to the policyholder premises ensuring the policyholder receives every dime owed to them.

17 Mathematician Take a look at the room you are in right now. If it flooded how would you calculate all amounts and costs of materials that were damaged? How many square feet of flooring, baseboard, drywall, etc. Don t forget to deduct those door and window openings! Now that we have that down, what about depreciation? It is the adjuster s responsibility to recommend payment for every dime owed to the policyholder. No more and no less.

18 Legal Expert The adjuster not only needs to know what is and isn t covered under the policy but how those policy provisions apply to each policyholder and their property. The adjuster also needs to be able to explain to the policyholder their rights and duties and what remedies are available to them if they are not satisfied with the outcome.

19 Author Remember those photos taken by our photographer and that estimate the mathematician wrote? The estimate is probably 50+ pages long with just as many accompanying photos. Now our author steps in to pull these elements together to tell the story of the loss in a way that is clear and concise for the examiners, who haven t been there, to understand. His/her narrative report will describe the flooding event and resultant damage to people who haven t seen the loss or know anything about it, just what our author outlines supported by his/her photos, diagrams and estimate.

20 Salesperson Estimate and Proof of Loss Now that all the work to document, photograph, and carefully examine the reports is complete, it s time to present everything to the policyholder. Adjusters need to know how to present their estimate and proof of loss to the insured so they understand what it says and feel comfortable with the outcome of their claim. They need to know how to sell their estimate.

21 Rebuilding The policyholder now has the funds to complete repairs to their home and put their lives back together. While many people are fortunate to have the funds on their own to start repairs before this point, many do not. This is why it is so vital to be as efficient as we can in the process to make sure the funds reach the insured as soon as possible. This includes providing advance payments so work can begin even before our adjuster has completed his/her paperwork

22 When we do the job right, here s what happens: This is what an insured s home looked like during the adjuster s inspection

23 When we do the job right, here s what happens: After Repairs Have Been Made : I wanted to say thank you once again. We met when it was a very low point in our lives and I wanted you to see the finished project! By the grace of God, our home is finished. We wanted to share with you what you helped us to accomplish.