Dealing with a Property Insurance Claim…One step at a time.

PUBLIC AWARENESS: PART 1

 

 

HELP: My Home has been damaged or destroyed…what should I do? What should my first steps be?

SOME FREQUENTLY ASKED QUESTIONS REGARDING A HOMEOWNERS INSURANCE CLAIM

First, …we hope that all in your home are physically ok. Second, …take a deep breath and know that you have help.

It may seem overwhelming;  Dealing with a loss like what you have experienced is a traumatic event. So, take a deep breath; now take some more.

Now let’s walk through the process;

 

If your property was insured, your first step starts with your insurance policy. It will outline the process, your coverage, and your rights.  This doesn’t mean that it will be easy to understand or a straightforward process. Insurance is a business and an insurance claim is, in essence, a business negotiation.

Fire Damage

 

The issue for most homeowners is that they are not experts in insurance. Unless you are in the insurance, legal or construction business, you might be – you probably are – at a disadvantage. And insurance companies will try to make the most of the gap in your knowledge versus theirs.

Some good news: you have rights and there are laws and rules that protect you. Insurance is a business that is highly regulated, and you can get help in negotiating with your insurance company.  It is your right.

We can help you understand the process and your rights and help ensure that you recover everything you are entitled to under the terms of the insurance policy that you have paid for.

Step One: The Policy Declarations

The starting point is your policy’s declaration page (GET PICTURE OF ONE.) Grab a copy of your policy.  Don’t have one?  Request one from your insurance agent or the insurance company directly.

The “Dec” page will break your policy into the categories of coverage:  for your “dwelling;” for “other structures (a shed, detached garage, etc.); personal property; living expenses, etc. There may be more. The “Dec” pages outline what the coverage is that you have paid to insure.

[UP’s “Simplified Guide to Your Homeowners Policy” will help you understand what’s inside your policy.

Step Two: Understanding Your Policy

When you have the policy in your hands, read it over.  Ask yourself these questions:

  • Do I fully understand my policy?
  • Do I know what I am entitled to receive or to ask for?
  • Do I feel comfortable working directly with the insurance company representative (the “adjuster”) to
  • Do I want someone representing me?

 

The reimbursements that your policy covers may be spelled out in the document, but they are not always straightforward. There are calculations that need to be made for various provisions: replacement value, landscaping, inspections, hauling, and debris removal, and many other items.

 

The most common issues that homeowners face include:

  • Being underinsured (Not having enough coverage)
  • Confusion over what the policy covers and what it doesn’T
  • There are A TON of items that may be covered that may not be obvious to you, and complicated formulas to determine what you are rightly entitled to.
  • Differences of opinion over the value of loss and the scope of the work needed to repair the damage
  • Unfair or “lowball” estimates and offers by the insurance company
  • Delays in processing your claim
  • An insurance company adjuster who is difficult to work with

    Property Damage

    Mold Damage in White Plains

 

Step Three:  Getting Help

 

If you feel you need assistance – and you are not alone in feeling that way – you have two options:

  1. Contacting the State Insurance Department to request assistance, or
  2. Hiring a reputable and experienced Public Adjuster.

 

Repairing/replacing your home can be a long and complicated process.  It can wear you out – at a time when most people are still recovering from the trauma of the event. It is not uncommon to take 18-24 months to repair or rebuild/replace your home and possessions after a large loss.

Remember, for most of us, our home is your biggest asset. An insurance company is going to act in its own best interest, and that may mean interpreting the policy provisions in their favor – not yours. And remember an insurance company adjuster works for the insurance company, not you.

 

This is not meant to scare you or make you distrustful.  Most insurance companies and their teams are wonderful to work with and go the extra mile for their policyholders.  But not all do, and not all the time. As the saying goes: “Trust but verify.”

You paid good money for insurance benefits and good claim service. Do your best to settle your claim directly with your adjuster/insurer by following United Policyholder‘s tips. Try getting help from elected officials, Case Managers, and government agencies. You may be unsure of what to do next.   Or are not certain you can trust what you are being told by your insurance company.  Maybe you are just running out of steam because it has taken so long to put the pieces back together.  All three are common feelings folks have. If that sounds like you, hire professional help.

 

A reputable builder/construction pro, a policyholder attorney or a reputable public adjuster are all good options. But do your research and be knowledgeable in this area, too.

Here are examples from our recent experience:

 

  • An insurer offered reimbursements based on its “computer model” that did not come close to matching what qualified local contractors estimated the work would cost.
  • An insurance company refused to factor in a contractor’s overhead and profit in its reimbursement, despite a provision in the policy that allowed it.
  • Insurance companies often send inexperienced adjusters to claims which leads to incomplete estimates or low valuations.

 

In each of these situations, the policyholder turned to an outside professional to get the insurance company to play by the rules and pay all that the homeowner was entitled to. You can push back…you do have the ability to challenge what you are told and what you are offered.

 

Step Four: Hiring Help

 

Many folks need someone to help them through the process of understanding what they are entitled to and recovering that full amount. They turn to a public adjuster – an independent professional without ties to the insurance company. Public adjusters charge for their services, with most reputable public adjusters charging between 7% and 10% of what they recover after they are retained.

 

If you need someone to help you exercise your legal rights, consider hiring a plaintiff-side insurance attorney on a contingent fee basis who will advance litigation costs if a settlement cannot be reached and a lawsuit becomes necessary.

 

In all instances, please protect yourself: make sure you check references carefully and hire only an experienced and reputable professional who represents policyholders, not insurance companies.

We’d be happy to help you through the process.  It only takes a call or a click to reach us for a free, confidential consultation.

Frozen pipes and water damage

February 12, 2016 by  
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Freezing cold weather can cause frozen pipes, resulting in leaks.

Your Obligations

Most insurance policies will pay for water damage caused by frozen pipes as well as pipe repair and the cost to tear out and replace necessary elements to access the pipes. But there are also many requirements to be covered for such loss. If the building is vacant, unoccupied or under construction an insured is required to do their best to maintain heat in the building or to completely drain the plumbing. Automatic oil delivery is one way to demonstrate that you are doing your best to maintain heat with an oil furnace.  It is necessary to have regular service of any heating system. Having a service contract can fulfill a portion of your obligation. If the plumbing is to be drained, be sure to have it done professionally so you can prove it. If you must undertake it yourself, use a compressor to blow air through the lines after draining to eliminate low spots where water can accumulate.   Shut off all toilets, flushed and anti-freeze put in both the tank and the bowl. Pour antifreeze into all other drains.

Thawing Pipes

Sometimes the best efforts will not stop plumbing from freezing. Pipes that are next to exterior walls are more susceptible to freezing. Buildings with poor insulation stand a greater chance that the interior might be warm, but a basement pipe may freeze. Often a frozen pipe will not leak until it actually thaws, as the frozen ice is a block to the water escaping. Sometimes pipes can freeze without damage. In such cases you can thaw the pipe with a hair dryer. But avoid heat guns and torches which commonly cause fires when attempting to thaw pipes. You might also warm the pipe with an electric blanket, or towels soaked with hot water.

Avoidance

Some things you can do to avoid frozen plumbing (especially if it has occurred previously):  Keep cabinet doors under sinks open so that the room air can heat the space. Or open faucets just slightly to create a drip. Just like running streams do not usually freeze, the water moving in pipes may prevent the line from freezing. If there are pipe runs in an unheated or poorly heated basement, you can insulate them, but that is not always effective. It is more effective to be sure there is insulation in the basement, especially if there is any open framing on an exterior wall. There is often space between the top of a masonry foundation and the floor above it, and the exterior walls of that space need to be insulated.

Cleanup

If all else fails you may still have water damage from frozen plumbing, heating, air conditioning, or appliance. Immediately notify your insurance company and hire a mitigation company to come to pump out water and to dry the premises. Take plenty of photos to demonstrate the damage as it occurred. Do NOT throw damaged items away, as an insurance company has the right to inspect them before payment. Feel free to call us if you need advice or assistance with your claim.

For more information about water damage see Water and Mold.

Bob D’Amore among recipients of Governor’s plaque

May 4, 2015 by  
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Bob D’Amore, president of the New York Public Adjusters Association, Ron Papa, past president, and Jonathan Wilkofsky, general counsel, were each recently honored with a plaque in recognition of their assistance in establishing a new law.  This law broadens the rights of consumers expanding the appraisal provision found in all property policies.  Governor Cuomo and Secretary Mulrow signed the plaques.  Each also contained a pen used by the Governor to sign the law. Prior to this law, only the value of a loss was appraisable.  Consumers can now be assured that not only can they demand a non-litigating solution to an unresolved difference in the value of their claim but also the extent of damage.

See also Court Ruling Affirms That Scope Of Loss Is Appraisable

For more information on the appraisal process, see Alternate Resolution.

 

Ice dam and snow coverage explained

January 26, 2015 by  
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What Is An Ice Dam?

An ice dam forms when warm air from a house circulating under the roof melts snow on top.  A thick layer of snow traps air and acts like insulation.  This allows the surface of the roof to warm to the point that it melts the snow.  As the water flows down the roof it reaches the edge (overhang) which is colder than the rest of the roof because there is no heat under it.  The water then re-freezes at the edge of the roof.  More water coming down the roof flows over it, building up more and more ice.  Eventually this ice forms a dam which traps the liquid water on the uphill side of it.  Water then rises to the point that it flows under the shingles, entering the house and causing water damage.  The only way to stop this damage once it has begun is to remove the thick layer of ice, which is often extremely difficult.

In many snow belt areas,  homeowners can install electric warmers under the edge of the roof.  Metal edging is sometimes used to allow any ice build up to slide off the roof (the rough texture of roof shingles holds ice in place.)   Quick removal of snow from the lower section of a roof can usually minimize ice dams.  Be sure to drag the snow down the roof rather than trying to shovel upwards, as a shovel will often catch a roof shingle and tear it off!  Hardware stores and mail order houses often carry a special telescoping tool to remove roof snow; it looks something like a big rake without teeth.

Snow & Ice Coverage

Most business and homeowner policies cover weight of ice and snow that causes damage. Check the policy to be sure.  The following is a discussion of a common problem after large snowstorms.

The most common form of policy is the HO3 policy form.  Direct writing insurance companies like State Farm, Nationwide and Allstate use their own version of this common policy, usually called “deluxe”.  It covers all risks of physical loss to the dwelling and other structures on your property except those specifically excluded.  This policy covers ice dam water damage to building components only.  If you have an HO2 policy form or the less expensive direct write policy (often called “standard”), there is usually no coverage for ice dam claims.  Under most homeowner forms, contents (personal property) are not covered for water damage from snow or rain unless the exterior of the building is first damaged by the force of wind or there is a complete or partial collapse of the roof and water enters through such opening.  Carpet installed over finished flooring is usually considered contents, not a building component.  Of course drywall, plaster, paint, wallpaper, wood floors, electrical fixtures, etc. are considered building items.

See also How To Get Rid Of House Dams – This Old House.

For more damage that freezing temperatures can do, see Frozen pipes and water damage.

New Insurance Bill on Appraisal signed by Governor Cuomo

June 28, 2014 by  
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In the waning days of the spring session of the NY legislature, both the Assembly and Senate unanimously passed a bill that requires ALL insurers in NY not only to honor the formal appraisal clause found in every property policy, but also to include “the extent of damage” meaning the scope of the loss.  Appraisal will not decide issues of whether or not a loss is covered.  But it can be an inexpensive way to settle a disputed claim.  You can avoid hiring an attorney or waiting years for a court case to be heard.

For more information on the appraisal process, see Alternate Resolution.

See also Court Ruling Affirms That Scope Of Loss Is Appraisable

Liberty Mutual customers beware!

June 15, 2012 by  
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It has come to our attention that many, if not all, Liberty Mutual homeowner policies have a new endorsement that seriously limits your recovery for personal property. This endorsement supersedes any other language in the policy, even the “deluxe” policy. It limits potential recovery to a maximum of $2500 in total for loss of any of the following, whether or not they are part of a collection: trading cards, comic books, figurines, stamps, advertising materials, stuffed animals, dolls, sports and entertainment memorabilia, toys, games, militaria, and books. This means the limit applies to any combination of loss to these categories of property.

To our knowledge no other company has such restrictive coverage in their homeowner policies. Most families have much more at stake for these categories of property. We suggest that you examine your COMPLETE policy for this endorsement.  Or, if you only have the declarations page, look for “Amendatory Endorsement FMHO2810”. We highly recommend changing insurance companies if you find this endorsement applies to your policy and you have these items. Note that you can change companies even in the middle of a policy period.  You will receive a pro-rata refund for the unused time period of your current policy.

For more info see FMHO2810.

NY Standard Fire Policy (165 lines)

June 5, 2012 by  
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Although no company issues a NY Standard Fire Policy alone, NY law requires that all policies covering property for the peril of fire damage meet the minimum standards of the 165 Line Standard Policy.  If your company is licensed to write business in NY, they are required to follow this rule.  However, unlicensed companies (such as Lloyds of London) are not required to meet this standard.

You can view the Standard Policy here: NY Standard Fire Policy