Insurance Claim Presentation

Following the loss, after the insurance company adjusters are contacted, in a complex loss situation, a claim should be presented. This presentation can be made by the property managers and/or condominium associations themselves, with the assistance of a public adjuster, or with the assistance of an attorney. In this regard, the importance of competent, professional legal counsel cannot be overemphasized. Many states prohibited property managers from negotiating the insurance loss because it constitutes the practice of law or public adjusting.

  1. Tips for Adequate Claim Presentation

    Public adjusters are individuals typically licensed by the state, although some states may not necessarily license public adjusters. They often charge a percentage of any recovery, and are available to assist the property owner in making an insurance claim. Although public adjusters are able to estimate and scope the loss, they are usually not able to interpret insurance policy provisions on behalf of the policyholder. Insurance coverage attorneys, such as the Perry & Neblett P.A., are also available to assist with claim presentation to the insurance company, as well as with coverage disputes.  Certain concepts should be kept in mind when presenting an insurance claim. For example:

    1. Do not sign a Release if you feel you are not receiving enough to properly fix the damages. Property insurance policies do not require that a release be signed.
    2. Do not allow insurance company adjusters to write claims or based on normal repair circumstances, and not take into account the increased costs of materials and labor in a catastrophe climate.
    3. Do not allow the insurance company adjuster to make the policy a “self-serve” policy by telling you what to do to determine the loss or damage, rather than promptly making a complete inventory and estimate of damages. Showing first field adjuster to fully document the loss is a critical step to the easy flow of insurance benefits because it avoids duplicative requests.
    4. Do not allow an adjuster to write up to only 45% of the property’s value in order to escape new building code requirements, which are potentially triggered at damages exceeding 50%.
    5. Obtain your own independent quotes for fixing the damage to the property.
    6. Call, confirm, and follow-up in writing with everything told to you by the insurance company adjuster.
    7. Keep receipts for every thing repaired and replaced, as well as all other costs associated with the repair process.

  2. Proof of Loss Forms

    In addition, insurance policies need to be reviewed with respect to the requirements for a “proof of loss” form to be submitted. Typically, windstorm and property insurance policies either require that a proof be proactively submitted by the insured, or that a proof be submitted within a certain number of days after it is requested by the insurer. In some cases, the insured will be granted an extension to file a proof of loss under a windstorm policy. With National Flood Insurance policies, the proof of loss requirement of the policy is sixty (60) days following the loss, unless a formal written waiver is given by FEMA. A verbal waiver or a waiver by an adjuster will not suffice to circumvent the sixty-day proof of loss requirement. The failure to properly and completely fill out a flood proof of loss, or the failure to timely submit the proof of loss, will result in the failure to recover any flood benefits under a Federal Flood Insurance policy.

  3. Preventing Breach of Contract and Fraud Claims

    Insurance policies also contain conditions requiring an insured to submit to an examination under oath, if requested by the insurer, and to allow inspection of books, records and documents in the possession of, or maintained by the insured. These requirements cannot be taken lightly, and must be completely complied with, so that there is no argument that the insured has breached the policy conditions. A breach of policy conditions by the insured can be used as grounds for the insurer to deny coverage for a claim. The unintentional actions of an insured can sometimes be seen as an unlawful attempt to defraud the insurance company. For example, throwing away debris before the insurance company can inspect it may lead an insurance adjuster to suspect that a policyholder was trying to destroy evidence which may indicate that he damage was not as bad as claimed. The property manager may have assumed that getting rid of the damaged property was the safe and efficient thing to do unaware that the policy requires the damaged property to be held for inspection.

  4. Be Aware of Applicable Statutes of Limitation

    If a dispute arises between the insured and the insurer, the particular state’s statute of limitations for filing a lawsuit must be recognized and complied with, with respect to a windstorm or property insurance policy. When it comes to National Flood Insurance, a one-year statute of limitations exists, and any litigation between the insured and the insurer must be filed in Federal Court.