Isaias Damage? New DFS Action to Expedite Claims

August 21, 2020 by  
Filed under Blog

For anyone who has had damage from the recent tropical storm Isaias, the following press release should be interesting.

Governor Cuomo said, “With many families and small businesses already experiencing financial hardship from the pandemic, it is critical that New Yorkers impacted by the storm are able to easily submit claims and quickly receive a resolution.”

And remember, there is help available in negotiating your claim.

Click here for information about public adjusters.

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




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


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.

State Governments Are Stepping In

March 26, 2020 by  
Filed under Blog

State governments are beginning to consider legislation which overrides existing insurance policies to cover business loss due to the Coronavirus, aka COVID-19, shutdowns. See this post on the Merlin Law Group Policyholder Advocate Blog.  Public adjusters and other insurance professionals will need to be aware of what effect this will have on their business interruption claims.

Coronavirus Update: Are You Covered for Business Interruption? Is Your Boss?

March 23, 2020 by  
Filed under Blog, Uncategorized, Website

Progress Is Being Made to Clarify Coverage for Business Interruption for Coronavirus.


We started getting calls today from business owners asking if they were covered due to the shut down due to the Coronavirus. We, as usual, asked for the policy in order to check the language.

Additionally, we received a letter from our own insurance company that was mandated out of the New York Department of Financial Services requiring all companies writing commercial insurance to explain the coverage or lack thereof.

The New Jersey State Assembly is working on Bill A3844 which will require insurance companies to construe coverage to include Covid-19, or Coronavirus related closures. They will be considering contamination to be direct physical damage.

Our own coverage as mentioned earlier affords coverage for Civil Authority if due to action by said authority prevents access to our Main or Dependent Properties. Of course, there will be additional language to sort through and we need a topic for tomorrow.

Until then we transposed a copy of the New Jersey Assembly bill for you. Do not hesitate to contact us with any questions.


Text of New Jersey Assembly Bill A3844:

ASSEMBLY, No. 3844







Sponsored by:

Assemblyman  ROY FREIMAN

District 16 (Hunterdon, Mercer, Middlesex and Somerset)


District 6 (Burlington and Camden)


District 33 (Hudson)


Co-Sponsored by:

Assemblywomen Reynolds-Jackson, McKnight, Lopez, Assemblymen Wimberly, Mazzeo, Chiaravalloti, Assemblywoman Jasey, Assemblyman Mejia, Assemblywomen Jimenez, Swain and Assemblyman Zwicker






Concerns business interruption insurance during coronavirus disease 2019 state of emergency.



As introduced.


An Act concerning certain covered perils under business interruption insurance and supplementing Title 17 of the Revised Statutes.


Be It Enacted by the Senate and General Assembly of the State of New Jersey:


  1. a.  Notwithstanding the provisions of any other law, rule or regulation to the contrary, every policy of insurance insuring against loss or damage to property, which includes the loss of use and occupancy and business interruption in force in this State on the effective date of this act, shall be construed to include among the covered perils under that policy, coverage for business interruption due to global virus transmission or pandemic, as provided in the  Public Health Emergency and State of Emergency declared by the Governor in Executive Order 103 of 2020 concerning the coronavirus disease 2019 pandemic.
  2. The coverage required by this section shall indemnify the insured, subject to the limits under the policy, for any loss of business or business interruption for the duration of that declared State of Emergency.
  3. This section shall apply to policies issued to insureds with less than 100 eligible employees, in the State of New Jersey, and in force on the effective date of this act. “Eligible employee” means a full-time employee who works a normal work week of 25 or more hours.


  1. a.  An insurer which indemnifies an insured who has filed a claim pursuant to section 1 of this act may apply to the Commissioner of Banking and Insurance for relief and reimbursement by the commissioner from funds collected and made available for this purpose as provided in section 3 of this act.
  2. The commissioner shall establish procedures for the submission and qualification of claims by insurers which are eligible for reimbursement pursuant to this section.  The commissioner shall incorporate in these procedures such standards as are necessary to protect against the submission of fraudulent claims by insureds, and appropriate safeguards for insurers to employ in the review and payment of such claims.


  1. a.  In addition to the special purpose apportionment made pursuant to section 2 of P.L. 1995, c.156 (C.17:1C-20), the Commissioner of Banking and Insurance is authorized to impose upon, distribute among, and collect from the companies engaged in business pursuant to subtitle 3 of Title 17 of the Revised Statutes, such additional amounts as may be necessary to recover the  amounts paid to insurers pursuant to section 2 of this act.
  2. The additional special purpose apportionment authorized pursuant to subsection a. of this section shall be distributed in the proportion that the net written premiums received by each company subject to the apportionment authorized by this section for insurance written or renewed on risks in this State during the calendar year immediately preceding, bears to the sum total of all such net written premiums received by all companies writing that insurance or coverage within the State during that calendar year, as reported.  The commissioner shall adopt the same procedures and calculations as are provided in section 2 of P.L.1995, c.156 (C.17:1C-20) as appropriate to calculate the additional special purpose apportionment authorized by this section.
  3. For the purposes of this section, “net written premiums received” means gross direct premiums written, less return premiums thereon and dividends credited or paid to policyholders, as reported on the company’s annual financial statement.


  1. This act shall take effect immediately, shall be retroactive to March 9, 2020 and shall apply to insurance policies described in section 1 of this act and in force on that date.





This bill provides a mechanism by which certain businesses that suffer losses due to interruption as a result of the coronavirus disease 2019 pandemic may recover those losses from their insurer if they had a policy of business interruption insurance in force on March 9, 2020, the date on which the Governor declared a Public Health Emergency and State of Emergency in Executive Order 103.  The bill would apply to businesses covered by such a policy with less than 100 eligible employees in the State of New Jersey.  “Eligible employee” is defined as a full-time employee who works a normal work week of 25 or more hours

The bill provides that every policy of insurance insuring against loss or damage to property, which includes the loss of use and occupancy and business interruption, in force on the date of the Executive Order, shall be construed to include among the covered perils under that policy coverage for business interruption due to global virus transmission or pandemic, as provided in the Governor’s  Executive Order.  The coverage provided would be subject to the limits under the policy and would indemnify the insured for losses incurred during the State of Emergency.

The bill then provides that an insurer which indemnifies an insured who has filed a claim pursuant to its provisions may apply to the Commissioner of Banking and Insurance for relief and reimbursement from funds collected and made available for this purpose as provided in the bill, pursuant to an additional special purpose assessment under the general scheme already established by law to recover the general expenses of the Department of Banking and Insurance as the regulator of the insurance industry in this State.  The commissioner shall establish procedures for the submission and qualification of claims by insurers which are eligible for reimbursement, incorporating such standards as are necessary to protect against the submission of fraudulent claims by insureds, and appropriate safeguards for insurers to employ in the review and payment of such claims.

Finally, the bill authorizes the commissioner to impose upon, distribute among, and collect from insurance companies, other than life and health insurance companies, the additional amounts as may be necessary to recover the amounts paid pursuant to the bill.  The additional special purpose apportionment authorized by the bill shall be distributed according to essentially the same procedures and calculations as are provided currently for the existing special purpose apportionment.

Industry sources have indicated that global virus transmission and pandemic are generally excluded from the list of covered perils under the existing standard business interruption insurance policy. The Insurance Services Office, ISO, has developed a rider to provide an insured with the option of purchasing such coverage, but to date, no states have yet approved the form.  This bill, then, is intended to hold harmless a certain portion of the business sector, which had the foresight to purchase business interruption insurance, for losses sustained as a result of the current health emergency, but for which no such coverage is currently offered.

Calling for Reinforcements on Business Interruption Claims

March 22, 2020 by  
Filed under Uncategorized

Employing  Experts Adjusting and in an Insurance Appraisal.

Public Adjusters and Business Interruption Claims

Does your Insurance Policy Cover Coronavirus Closing


As a Public Adjuster hired by the policyholder to assist in preparing and substantiating an insurance claim, all Public Adjusters have had the following experience. The Insurance Company is sending in XYZ experts to evaluate the damaged property. Quite a few of you reading this just had several names pop into your head.

With all the talk of potential Caronavirus and Business Interruption insurance claims, it’s time to take stock of our skills as well as our limitations. How many of us have the experience to adjust or be the Named Appraiser on a business interruption claim?

Gather Your Experts Now for Business Interruption Claims

Most of us are highly competent with building damage, loss of use, and personal property. The documentation requirements are going to be a handful. The interpretation of those documents will require you to call in the cavalry. Line up your experts now. The insurance companies will be deploying an army of Forensic accountants, Certified Public Accountants, Tax Attorneys, and maybe a few former IRS agents. Public Adjusters and Appraisers better have them, too, along with your Industrial Hygienists and decontamination experts.

All of us in the world of policyholder advocacy should not be handling claims we are not qualified to handle. Have your bullpen stocked, have your battleships on standby. Insurance companies will be digging deep and asking questions that most Public Adjusters and Appraisers should

Can you file a claim for business interruption?

Do you have the resources available to guide your clients through a Business Interruption Claim?

not or could not answer.

Bring yourself up to date on all commercial insurance forms, exclusion, endorsements. Keep up to date on any changes in the law.

Business Interruption Claims and Insurance Appraisal

On the Appraisal front, you can assume that a Business Interruption claim that has come to you for Appraisal will have both sets of documentation that has caused the disagreement in the amount of loss, which has moved the claim into the insurance appraisal process.

In a contentious appraisal, it may be best to have the umpire bring in neutral experts to dissect the conflicting findings. As an Appraiser, you may be an expert in the Appraisal Process, and an expert in accounting, taxes, or business administration may need to help you put together your appraisal finding.

As the named Appraiser substantiating the amount of loss for a business interruption claim, you will be called upon to present the financial damage the Insured has sustained concisely and accurately. Many livelihoods could be riding on our skills and decision in the coming year, on both sides of the policy.

Be Aware Of New Carrier Defense Strategy

March 16, 2020 by  
Filed under Uncategorized

This is a must read.
Estimators make sure you have supporting documentation. Engineering reports, historical data, proof of prior payment or scope approval.
Don’t throw spaghetti against the wall to see what sticks.

Expect carriers to start looking for detailed Appraisal Awards for nullified line items.

Click for full article.


Storm Damage, What Now?

March 7, 2020 by  
Filed under Website

It all starts when you have an insurance loss. The first thing you should do is contact your insurance company and get a claim started. This is usually done through your agent, but most companies have a claim page on their website as well.

Depending on the type of loss, you may have some work to do at the house. One of your main responsibilities, written into your policy, is to reduce or eliminate the possibility of further damage, to the best of your ability. For example, if you have water damage, you should call a water damage mitigation company. They will take steps to clean up any standing water and prevent mold growth. Click here for more about the mitigation process. Or if you have structural damage, you should call a contractor to stabilize the area and cover any exposed areas with a tarp.

Click here for more information on the claim process.

Frozen pipes and water damage

February 12, 2016 by  
Filed under Uncategorized

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.


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.


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  
Filed under Uncategorized

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  
Filed under Uncategorized

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.

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