 When you have damage to your property, you expect that your insurance company will pay your insurance claim and cover the damage. There are times when a dispute arises because your insurance company feels they only owe a certain amount to repair your damaged property and you feel they owe a different amount. This happens more than you realize and there are dispute resolutions options available to you in your insurance policy.
Most policies provide the option for either Mediation or Appraisal. When the appraisal provision is included in the policy, it will read something like the following (they differ from policy to policy, but you will get the gist): Mediation Or Appraisal. If you and we : “Fail to agree on the amount of loss, either party may demand an appraisal of the loss. If you or we demand appraisal of the loss, the demand for appraisal must be in writing and shall include an estimate of the amount of any dispute that results from the covered cause of loss. The estimate shall include a description of each item of damaged property in dispute as a result of the covered loss, along with the extent of damage and the estimated amount to repair or replace each item. In this event, each party will choose a competent and impartial appraiser within 20 days after receiving a written request from the other. The two appraisers will choose an umpire … The only additional cost to you and the insurance company through this process is bearing the cost of the umpire equally if one should need to be retained. Although the two appraisers will agree to the selection of the umpire, the umpire is not needed unless the two appraisers are unable to resolve the dispute. At that time, the umpire will be called in to assist. The appraisal process is sometimes the path of least resistance when trying to resolve an insurance claim. In addition to being licensed public insurance adjusters, we are also Certified Property Insurance Appraisers and Umpires (CPAU) and are members of the Insurance Appraisal & Umpire Association and the Windstorm Insurance Network. We have resolved many insurance claim disputes over the years, both as appraisers and umpires throughout the state of Florida. If you have any questions, you can reach us here or call 561-288-6434.
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Insurance Policy Misconceptions Part 3 – My claim is at policy limit – Is the mold still covered?7/21/2020  In a prior blog, Don’t Shop Price, Shop Coverage, I discussed the importance of insurance coverage for your property. It is really important to make sure you have enough coverage for the limits in your policy. Here's why ...
A potential client had water damage to his condominium that came from the unit above. Everything from the ceiling to the floors had to be replaced and there were obvious signs of mold. Upon reviewing his insurance policy, I found he only had a policy limit for Coverage A – Dwelling of $10,000.00. This amount also includes the dry out the mitigation company performed to dry his property. He was concerned about the presence of mold which the declarations page of his insurance policy stated he had $10,000.00 mold coverage. In this example, the mold coverage is inclusive when you have reached your Coverage A – Dwelling policy limit, it is not an additional coverage under the policy. After explaining the policy to him, he was understandably concerned with the lack of coverage and said he will make sure he changes his policy. His exact words were, “I never realized I needed more!” Most individuals do not look at their coverage limits, and if they do, they think they have enough. My explanation on how to view your coverage and determine if you are adequately covered is simple. Imagine a catastrophic loss occurring, such as a fire, and it destroyed your property. Would the coverage limit you currently have be enough to cover the rebuild of your property? I know that many of you think this will never happen to you, but it certainly can, and you need to be properly insured so you do not have to come out of pocket for repairs. For additional information or answers to any questions you have, please contact us here or call 561-288-6434.  The Wedontsee Insurance Company has inspected the damage to your property and you are told that they will review the claim and get back to you. You receive a letter informing you “our adjuster’s estimate to repair your damaged property is below the amount of your deductible so therefore, we are unable to issue a payment at this time”. You think to yourself, “great, my claim has been denied and I don’t have enough money to repair the damage. What am I going to do?” Not so fast! First of all, your claim has not been denied and I will explain.
The letter you received reads something like this: Damage to Coverage A: $1,567.24 Deductible Applied: $2,500.00 Net Claim Amount: $ - 932.76 In the sometimes confusing and head scratching language of insurance speak, the insurance company has actually made a payment on the claim. They feel that they owe $1,567.24 to repair the property and have afforded coverage for your claim. But because the deductible amount is greater than the payment amount, they cannot issue a payment. This is a far cry from getting your claim denied. Here is where a public insurance adjuster can come to the rescue (enter stage left). Often times when asked to review these types of claims, we find that the insurance company has under paid for a variety of reasons. The Wedontsee Insurance Company and either overlooked damages, missed damages that could be hidden from view or they misapplied coverage. We have been very successful in re-opening these claims and getting our clients the proper claim settlements they need to repair their property. Yankees all-star catcher Yogi Berra is famous for saying “it ain’t over till it’s over”. At Reliant Insurance Adjusters we say “it ain’t over till we say so!” For additional information, a FREE claim review or answers to any of your questions please contact us here or call 561-288-6434.  The other day I was on the phone with a potential client discussing a water damage claim when the subject of her deductible came up. She explained that the reason she was hesitant to file a claim with her insurance company was that she could not afford to pay the deductible. You know the old saying, “if I had a dollar for every time….” It seems that at least once a week I have this conversation with a policy holder. In actuality, no one really “pays” the deductible. The reason it’s called a deductible is that it is deducted from any payout that an insurance company makes on your insurance claim.
For example, let’s say that Swamp Grass Property & Casualty is going to pay $10,000 you for water damage to your property and the deductible in your policy is $2,500. That amount will be deducted from the $10,000 and you will receive a check for $7,500. Let’s look at another scenario involving a hurricane deductible which is much higher than the regular or “all other perils” deductible example above. These deductibles are usually 2% to 5% of Coverage A. Coverage A is the amount that your building is insured for and this information can be found on the Declarations page of your homeowners insurance policy. Let’s say that Coverage A is $350,000 and your hurricane deductible is 2%. That means your friends at Swamp Grass Property & Casualty will deduct $7,000 from any payment issued if you have hurricane damage to your property (ouch!). I hope this clears up any confusion regarding deductibles. Don’t miss next week’s blog “Insurance Policy Misconceptions Part 2” where we will discuss under deductible insurance claim payments. If you have any questions, please contact us here or call 561-288-6434 and we will be happy to assist you. |
AuthorKaren Schiffmiller Archives
January 2023
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