We represent personal or commercial policyholders who have experienced the damage and devastation of this catastrophic storm. If you haven’t filed your claim yet, don’t wait. If you have filed a claim and your claim gets denied or underpaid, call us for help or submit your information for a free case review.
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Policyholders are often faced with complicated issues and complex decisions after they suffer a property loss from a hurricane. These decisions and issues can arise while filing a claim with your insurance company. The claim information that is presented can be crucial and the strategy used can be paramount in your settlement.
Here are some frequently asked questions posed by policyholders involved in the hurricane insurance claims process:
I have a loss. Where do I start?
Get the insurance policy. It may be multiple policies such as flood, wind and all-risk peril policies. But the insurance policy provides the framework for determining how much is going to be paid, by whom, and what you need to do to get paid.
What is the next step and what if I cannot find the policies?
The second step is to report the loss to the insurance companies involved. You must report the loss promptly even if you are unsure if the damage will exceed the deductible. Most of the time, you will report the loss to your agent with a phone call but some policies also require a written notification or call to the special claims reporting department.
Ask and write your agent for a copy of the policy if you do not have one and get the name of your insurance company, your policy number, and telephone number for the company.
What will they ask me and what should I tell them when I report the loss?
They will want to know what caused the loss, when it happened and a general description of what is damaged. If you are unsure of whether the cause of the loss is covered, we would recommend you call an attorney first. Hurricane and fire claims generally are easily covered and should pose no problem. However, some agents mistakenly tell their customers that a cause of loss is excluded because the agent does not understand the policy language or the policyholder fails to give an accurate description of how the loss occurred.
After I report the loss, what else should I do while waiting for an adjuster?
Protect the property from further damage. You have an obligation to take reasonable steps to minimize, or mitigate, the loss after it happens. Most policies will reimburse you for those costs. For example, getting a tarp on a roof following a hurricane to protect the structure and contents from further damage is a type of mitigation.
What if my agent is slow to send my policy?
After major hurricanes, agents are deluged with requests for policies. They often do not have enough copies to send or are so backed up that weeks go by before a copy is sent. So, it is important to get the name of your insurance company, the policy number, the limits of coverage, and call your insurance company asking for an adjuster to come out as soon as possible. Also, ask the insurance company for a “certified” copy of the policy. At the very least, ask your agent for a copy of your policy “Declarations Page.”
What are insurance policy Declarations Pages?
These are the unique portions of the policy that indicate the name of the insurance company that insures you, the insurance policy number issued, how much you are insured for, the deductibles chosen, and what standard forms are issued, including the endorsement forms. The Declaration Page is very important and you must at least get this even if the rest of the policy is provided later.
How do I find out how much coverage I have?
The Declaration Page lists the basic policy limits for each coverage and the basic deductible -But do not stop there. Additional coverages and extensions within the policy may also exist. For example, many people purchase “Guaranteed Replacement Coverage.” This extension of additional coverage is usually found in the policy forms, or as an endorsement. You must read the policy to find out the various additional coverages you have. These are quite valuable and are often overlooked.
What information must I provide to my insurance company when I make a claim?
After taking steps to prevent further damage, most of the duties include documenting and presenting the damages and claim amounts. We suggest that you photograph and videotape the damaged property, obtain estimates for repair or replacement, itemize the personal property damage and most of all, keep receipts for everything you spend for repair, replacement, protection of property, and other expenses incurred or caused by the storm.
What is a Proof of Loss?
Virtually every standard insurance policy has mention of providing a Proof of Loss. It is the formal submission of your claimed amount. We suggest you obtain from your insurance company the form it wants you to use. Once a Proof of Loss is submitted, the insurance company usually must respond to it within 30 days. Many times insurance companies do not require a Proof of Loss to be submitted. Ask the adjuster if they will pay without submitting a Proof of Loss. Flood Insurance ALWAYS requires a Proof of Loss completely and timely filled out even if the adjuster says otherwise.
What is a flood policy? How is it different from other policies, and are there different requirements that 1 must fulfill in making a flood claim?
A flood insurance policy is a separate policy that insures your property from rising waters. Depending on where you live, you may have been required to purchase this type of a policy if your home or business is located in a flood zone. Although many flood policies are issued by private insurance companies, flood insurance is a federal program administered by FEMA. Federal rules govern what coverages are available and how and when you must make a claim. Of utmost importance is the proof of loss requirement. An insured must submit a completed “proof of loss” on the proper form within 60 days of the loss in order to obtain insurance benefits. This requirement can only be waived by FEMA in writing. Your adjuster cannot necessarily give you the authority to submit the form after the 60 day passes.
What are flood and windstorm policies, and how are they different from All-Risk Policies?
Most insurance policies exclude flood damage. Accordingly, the federal government administers the National Flood Insurance Program to cover this risk of loss. The important thing to remember is that the technical requirements to report, document and timely file the flood insurance claim are absolute. You must submit your claim properly and timely, or risk not getting paid at all.
Some All-Risk policies exclude “wind” damage. Thus, policyholders must also get “wind” or “hurricane” coverage to pick up loss caused by this peril. These policies typically act just like regular All-Risk policies, but only cover damage caused by ”wind,” such as experienced during hurricanes and tropical storms.
How does a hurricane deductible work?
Florida law allows an insurance policy to contain a hurricane deductible written as a percentage. This percentage can be either a percentage of the policy limits, or a percentage of the loss. The more typical policy today contains a deductible as a percentage of the policy limit. This hurricane deductible kicks in when your property is damaged by a “named” storm. The question has arisen whether an insurance company can rely on multiple hurricane deductibles in a season where an insured has sustained damage from multiple storms. Unfortunately most polices are silent on this question.
What does the adjuster do, and how does my insurer decide if my claim is covered?
Other than payment, the insurance policy is silent about what the insurance company adjuster is supposed to do. Statutes, regulations and industry standards require the adjuster to promptly and fully determine the coverages applicable, evaluate the amount of the loss and pay the claims. The adjuster is supposed to fully advise the policy holder of all policy conditions and available benefits. The adjuster is supposed to treat the policyholder in the utmost of “good faith” and make sure the policyholder is provided good claims service after the loss occurs.
What is the difference between a public adjuster, a company adjuster and an independent adjuster?
A company adjuster is employed by your insurance company. An independent adjuster works for a company separate from the insurance company, but is hired by an insurance company to act as its adjuster. There is very little legal distinction between the two as it affects a policyholder. However, the practical effect is that an independent adjuster usually has to send reports to the insurer, and there is often more claim delay.
Public adjusters only represent policyholders. They should do the same things company and independent adjusters do, but they do it for the policyholder.
Should I hire a public adjuster and how do I go about choosing one?
Whether to hire a public adjuster is a personal decision. There would be no need to hire public adjusters or attorneys if insurance companies always did their job right. Unfortunately, that does not always happen.
Find and choose the best public adjuster you can. Experience, reputation, credentials, and references must be thoroughly investigated. Do not let a public adjuster pressure you into signing a contract until you are ready to so do. However, it has been our experience that the best public adjusters are worth their fee. Most will negotiate their fee. The more complex or valuable a claim, the more we would suggest you consider hiring a public adjuster or attorney.
My insurer is requesting an Examination Under Oath (“EUO”). Must I agree to give one?
Yes – Your insurance policy contains certain conditions you must comply with in order to receive payment for your claim. One of these conditions is the requirement to appear for an EUO, which is a sworn statement taken by a court reporter. At this EUO, your insurer will ask you questions about your claim, and may ask you to bring any documentation supporting that claim. You are entitled to bring an attorney to represent you at your EUO. This is a serious proceeding not commonly invoked.
How do I know if I’ve suffered a total loss to my property, entitling me to receive policy limits from my insurer?
If your damages exceed 50% of the appraised value, pursuant to your county’s property appraiser’s office, you may be entitled to receive the policy limits for that insured property, and potentially additional monies for building ordinance or law coverages. If your structure is demolished, you normally have a “total loss” even if it can be rebuilt for less than the policy limits.
What is the difference between a Consumer Complaint and the filing of a Civil Remedy of Insurer Violation?
Both are filed with the Department of Financial Services. A consumer complaint may trigger an investigation of that insurer, but does not create a legal remedy for the policyholder. A civil remedy notice, on the other hand, is a document which must be submitted if the policyholder wishes to pursue a “bad faith” claim against the insurer. This Civil Remedy Notice is required by Florida Statutes if a legal remedy is to be pursued following a successful claim against the insurer. The statute, section 624.155, contains additional requirements that must be met in order to pursue such a claim. We recommend you hire an attorney if you plan to submit a civil remedy notice and suggest you do so if your insurance company is not being fair.
Can my insurance company withhold insurance monies from me because I have not agreed to settle out the entire insurance claim?
No. An insurance company may not withhold undisputed amounts, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage, in order to influence settlements under other portions of the insurance policy coverage. Insurance companies should pay as soon as they can, even for partial amounts.
Should my insurance company adjuster advise me of the insurance coverages available to me under my policy of insurance?
Yes. The insurance company should inform the insured of his/her rights under the policy. However, this does not always happen, in our experience.
Should my insurance company adjuster have the knowledge and training to adjust my loss?
An adjuster should not undertake the adjustment of any claim if the adjuster is not currently competent and knowledge able as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise. In catastrophe situations, adjusters are often overworked and do not have sufficient time, nor resources because of the volume of claims. Many “storm” adjusters are from out-of-state and are inexperienced.
May an insurance company deny my insurance claim without any investigation?
No. An insurance company may not deny an insured’s claim without conducting a complete and reasonable investigation based upon available information.
If my insurance company denies my insurance claim, what must it provide me when denying my insurance claim?
An insurance company must promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise.
May an insurance company adjuster suggest or infer to an insured that the hiring of a public adjuster or attorney would cause delay or denial of the insurance claim?
No. No insurer or insurance company agent or representative shall represent or imply to any insured that a public adjuster is unscrupulous or that engaging a public adjuster or attorney will delay or have other adverse effect on the settlement of a claim. However, many clients have indicated some adjusters suggest that a claimant refrain from seeking professional help.
What does Actual Cash Value (ACV) mean?
Many policies indicate that ACV is the amount of monies necessary to repair or replace the damaged or destroyed insured property less an amount for depreciation. There is no exact measure to determine this figure and Florida allows for various measures to help determine “Actual Cash Value.”
What does Replacement Cost Value (RCV) mean?
The amount of monies necessary to repair or replace the damaged or destroyed insured property with materials of like kind and quality, without deduction for depreciation.
What is a Certified Copy of my insurance policy and why should an Insured always request one from their insurance carrier when reporting a insurance claim?
A Certified Copy of the policy is a complete and true sworn copy of the insured’s policy, including all endorsements, riders, and Declarations Page, provided by the insurance company. The rights, obligations, and knowledge of all coverages may not be known to the insured without being able to reference the Certified Copy of the policy.
What is an Appraisal?
Most insurance polices contain an appraisal condition to resolve disputes regarding the amount of loss between the insured and insurance company. Generally, an appraisal condition provides for the insured and insurer to each to select an appraiser, and for those two to select a third person called an umpire with agreement by any two of the three being binding. Insurance companies should pay the undisputed amounts and only appraise the disputed amounts. Either party may demand appraisal.
If you feel like your hurricane insurance claim has been improperly handled, has not been properly paid or if your claim has been unfairly denied, you can call our team of experienced insurance lawyers. Merlin Law Group is The Policyholder’s Advocate®. For over three decades, we have dedicated ourselves to standing up against insurance companies and their corporate lawyers.