What You Need to Know About Insurance Claims Processes
In a case of a physical loss to covered property, the insurance policy requires you to submit a Proof of Loss within 60 days after the loss or upon their request. They will pledge to have no duty to provide coverage under policy if the failure to comply with the following duties is not met.
In a case of a physical loss to covered property, the insurance policy requires you must notify the insurance company within 180 days of your loss and show intent to repair or replace your property in order to recover any depreciable amounts or funds owed.
We must read the policy to see what your policy states. However, many policies will allow whatever expense or time frame within reason to the lesser of the two time frames:
- Actual Cash Value or (ACV): A dollar value placed on the damaged property equal to the replacement cost less depreciation. Actual cash value is derived by fixing a new price for the same or similar item and deducting for wear and tear and obsolescence.
- Additional Living Expenses: Any additional expenses incurred for food, lodging, transportation, and other daily needs, resulting from an insurance loss.
- Adjuster and/or Claims Representative: Employee of an insurance company who negotiates settlement on behalf of the insurance company.
- Agent: One who sells a policy of insurance on behalf of the insurance company.
- Appraisal: If we fail to agree on the amount of loss, either one can demand that the amount of the loss be set by appraisal. If either makes a written demand for appraisal, each shall select a competent, independent appraiser. Each shall notify the other of the appraiser’s identity within 20 days of receipt of the written demand. The two appraisers shall then select a competent, impartial umpire. If the two appraisers are unable to agree upon an umpire within 15 days, we can ask a judge of a court of record in the state where the residence is located to select an umpire. The appraisers shall then set the amount of the loss. If the appraisers fail to agree within a reasonable time, they shall submit their differences to the umpire. A written agreement signed by any two of these three shall set the amount of the loss.
- Arson: The malicious burning of a dwelling house or outhouse of another man, which by the common law is a felony; the malicious and voluntary firing of a building. This is a common issue we deal with in our field as public adjusters. If you are innocent and have concerns regarding any accusations or concerns this may become one, Disaster Adjusting is with you each step of the way. Keep in mind this is a very difficult crime to convict someone of, especially if you’re innocent.
- Attorney Assistance: Working along with your attorney as a consultant to assist them in maximizing your settlement and provide them with the experience in insurance property claims and items they may not be aware of. Historically, it has been proven that together we are a valuable asset.
- Bankruptcy: Is a legal status of an insolvent person or an organization, that is, one that cannot repay the debts owed to creditors. In most jurisdictions, bankruptcy is imposed by court order, often initiated by the debtor. With the growing number of unemployment and shortage of jobs, this has become a very common issue we face during the settlement of a loss. We will work with you or your attorney to come up with a solution to this issue.
- Business Interruption Insurance: (also known as business income insurance) Covers the loss of income that a business suffers after a disaster while its facility is being rebuilt. A property insurance policy only covers the physical damage to the business, while the additional coverage allotted by the business interruption policy covers the profits that would have been earned. This extra policy provision is applicable to all types of businesses, as it is designed to put a business in the same financial position it would have been in if no loss had occurred. However, this is not always the case when you suffer a loss. Keep in mind your adjuster is out to settle the loss for the minimum amount of expense. This process is very difficult and takes a lot of research. You can have up to 18 different coverages in a commercial policy with each one needing to be addressed separately in order to obtain your actual expense loss and burdens accrued from having a disaster occur. Disaster Adjusting has navigated many business owners through this process.
- Claim Denial: Homeowners buy insurance because it gives them peace of mind. The moment they sign their policy they think they aren’t financially liable for any damages to their home. This helps them sleep easier at night, at least until they actually have to file a claim. Your insurance company doesn’t want to pay claims for damages to your property any more than you do. They routinely deny claims to people who have been victimized. This is where the services of Disaster Adjusting have been able to recover the loss and prove coverage for many of our customers.
- Co-Insurance Penalty: Reduction in the amount that the insured receives from the insurer, after having incurred a property loss because the insurer failed to carry the amount of coverage required by the Co-Insurance Clause. Disaster Adjusting has had to contend with this issue on many occasions and has found different ways to obtain a fair settlement when you are faced with this problem.
- Divorce: We can assist you by working with your divorce attorney on property issues relating to your insurance loss. Many times getting a mortgage payoff amount if this is applicable or helping you obtain information from other sources necessary in order to settle your loss.
- Endorsements: An endorsement is a document provided by your insurance carrier that may provide additional coverage for specific items not covered by the original policy.
- Exclusion: Provisions in the policy which state certain circumstances that bar coverage.
- Estimate: A rough approximation of restoration costs having no promise to perform.
- Foreclosure: Is a specific legal process where a lender attempts to recover the balance of a loan from a borrower who has stopped making payments to the lender by forcing the sale of the asset used as the collateral for the loan. With the growing number of unemployment and shortage of jobs, this has become a very common issue we face during the settlement of a loss. We will work with you or your attorney to come up with a solution to this issue.
- Depreciation: A reduction of worth arising from age, use, or obsolescence. Depreciation is usually determined by calculating the difference between how long an item is in use against its life expectancy.
- Hidden Damages: Damages that are not discoverable under reasonable inspection.
- Independent Adjuster: A person or firm who holds himself or itself out for the employment of claims adjustment to more than one insurance company
- Investigation: This is the procedure an insurance representative (adjuster) is obligated to follow in order to create the claim file for the insurance company. Don’t be intimidated by the term “investigation.” The company is not investigating you (unless you have a history of fraudulent claims).
- Liability: Insurance protection that covers injuries to others
- Living Expense: If the dwelling becomes uninhabitable because of a loss covered in the policy, the insurance company should pay the costs of living.
- Loss of Use: Expenses incurred as a result of the homeowner’s loss of property. See additional: Living Expense.
- Low Ball: Term used within the insurance industry that indicates an estimate for completing repairs to property which was designed to deceive a customer with a lower price or amount of loss.
- Market Value: Research the selling price of comparable properties in your area. This is the market approach to valuation. Location is important in real estate, so only compare houses similar to yours in your neighborhood. Many insurance companies will use this tactic to minimize the settlement of your property. They also deduct the land from this value. The right to offsite replacement of your loss is one way to obtain your settlement. Disaster Adjusting will walk you through this process.
- Matching Issues: Your insurance company will generally only want to pay for the damages directly related to your loss. This is been an ongoing argument for Disaster Adjusting. We believe and take the stance that if your home is not matched (ex. siding), that you are not fully indemnified as your policy states they owe you. Your home is not of the same value prior to your loss. Disaster Adjusting will argue this issue every time. Even getting your home re-appraised to prove this.
- Mediation: A voluntary, legally non-binding method of resolving a dispute with the assistance of a neutral party.
- Mortgage Inspect: A representative of a mortgage holder who verifies work progress of restorations to an insured dwelling, in order to release some or all funds for payment.
- Policy Limits: Virtually all property coverage policies indicate a policy limit. Policy limits are normally the maximum that can be paid on the claim.
- Proof of Loss: A claimant’s formal statement to the insurer which is used to determine the insurer’s extent of liability.
- Proof of Loss Form: This is a form provided by either your agent or your claims adjuster. It is required to be submitted with your claim for damages. It is a document that asks you, the policyholder, to provide information concerning your loss.
- Release: The document usually required by the insurer to be executed by the claimant before the payment of a claim is made.
- Rental Property: An amount paid or collected as rent; a piece of property available for rent; the act of renting. We work with several property investors that have insurance-related losses if the insurance coverage on these properties is different than that of regular home policy. The issues that arise can vary from the problems with deprecation on the structure to the properties sustaining damages while being vacant. Disaster Adjusting has been able to navigate many of our clients through this process without any out of pocket expense by the property owner. Please see our References area for some of those names.
- Replacement Cost: Replacement cost generally means that the insurance carrier is responsible for the full cost of repair or replacement of the damaged property, without deducting for improvements or depreciation.
- Restoration Contractors: The most versatile of all types of contractors, the qualified restoration contractor is not only experienced in damage evaluation, the scope of repairs, and claims processing but in the actual restoration of your home and property.
- Scope of Damages: A contractor’s list of structural damages, combined with an explanation of the method of repair and their cost.
- Settlement Demand: The settlement demand is normally the amount of money you are requesting your insurance company to pay for the repair or replacement of your damage or loss. In property claims, this amount is based either on your cost to repair or on the estimate provided by your contractor.
- Subrogation: The transference of legal rights from the homeowner to the insurance company in order to recover from a third party.
- Supplemental: An addition to the original claim for newly discovered hidden damages.