Steps to Filing an Insurance Claim

Posted on July 7th, 2010

The process of filing an insurance claim can be very confusing, especially during the first time you file a claim. We’ve done our best to layout a few essential steps in the Florida insurance claim process – read more steps in filing an insurance claim in Florida. These steps are very relevant to those in many areas around South Florida – this includes Boca Raton and West Palm Beach. The Boca Raton and West Palm Beach communities have been searching online for public adjusters in Boca Raton or public adjusters in West Palm Beach. Really the focus should be on a public adjuster that understands the South Florida communities and insurance claim process regardless of the location the resident is filing their claim. This is true for homeowners in the surrounding Dade and Broward areas. Hope the links and information is helpful to all of our readers.

Here’s a few useful links to keep handy and research for yourself:

Florida Department of Financial Services: www.fldfs.com

Florida Office of Insurance Regulation: www.floir.com

Florida Market Assistance Program (can help people find insurance companies): www.fmap.org

Consumer Federation of America: www.consumerfed.org

National Association of Insurance Commissioners (has a link to help people look up complaints/financial data on their insurer): www.naic.org

Insurance Information Institute: www.iii.org

These links and others can also be found on the Sun Sentinel website. They have a great story gallery on the Florida homeowner insurance crisis.  We’re excited about bringing these resources to our readership. It’s important that consumers / homeowners understand how to navigate the insurance claim process in Florida. We recommend that time be spent to learn about the insurance claim process before a disaster hits – it’s a lot easier and there’s time to get your questions answered.

Florida Insurance Claim Process:

STEP 1: PRE-LOSS PREPARATION

Ironically, the claims process begins long before the actual loss. In order to get properly and timely compensated in the event of an Insurance Claim, it is important to take the following precautionary steps: have a copy of your ENTIRE policy readily available, understand the types and amounts of coverage you have, film a video and take numerous pictures of the interior and exterior of your home and an inventory list of all of the items of personal property that you have in your home. Remember; keep this list, video and pictures outside of your home.

STEP 2: LOSS MITIGATION & DAMAGE CONTROL

One a loss occurs, whether it is water damage, fire, flooding, hurricane, vandalism or otherwise; you should make every effort to mitigate damages and salvage whatever you can. This includes, but is not limited to, using tarps, create ventilation, contact remediation companies and safeguarding your valuables.

STEP 3: CONTACT A PUBLIC ADJUSTER

Contact Your Public Adjuster to facilitate with the claims filing and handling processes. At some point, you will need to provide your adjuster with all of the above listed documentation so that the claim can be handled professionally and settled in a timely manner.

STEP 4: FILING THE CLAIM

Although it is always recommended to hire a Public Adjuster, many people do not. If a Public Adjuster is involved, it is strongly recommended that the Public Adjuster actually call in the claim information. The information you will be asked when filing the claim will include: Type of Loss, Date of Loss, Loss Location and questions regarding what you have done since the loss to mitigate damages. It is important not to provide too much detail or information in the form of an opinion as whatever you state can be used against you. There are many policy exclusions and limitations that Insured’s are not familiar with and your statements are checked against those exclusions and limitations so that the Insurance Company can deny or limit coverage.

STEP 5: THE PROPERTY INSPECTION

Typically, within 72 hours of the loss, the Insurance Company will send out an “independent adjuster” to evaluate the damages, assess coverage and make recommendations to the Insurance Company. The only thing “independent” about these adjusters is their title. They are hired by the Insurance Company to represent the interests of the Insurance Company – they are not there to advocate for you. This is primarily why you need a Public Adjuster – to represent your interests and advocate for you.

At this inspection, the adjuster will ask many questions, look at the damage, take measurements and photographs and write up some notes to include in his estimate. DO NOT assume that just because he is doing these things the claim will be paid. Usually, the adjuster has no authority and is simply there to gather facts and information for the Insurance Company so that they can determine coverage. Normally, they use this information to claim some exclusion such as long term damage or wear and tear. Be very careful what you do and say with this independent adjuster.

more steps - Florida insurance claim process

Tags: filing insurance claim
Filed under How to File a Claim |

One Response to “Steps to Filing an Insurance Claim”

1. Contents Claims Says:
   July 30th, 2010 at 7:50 pm

   Rami,

   I wanted to comment on your post. By the way great blog…

   As an personal property appraiser, when evoked under the appraisal clause, I often see that the last step of an insurance claim is to “demand appraisal”. Of course this may only be the minority, I feel that the discussion of the appraisal clause would fit in good here.

   Business owners and home owners often encounter issues when submitting a claim to their insurance company. Even when represented by a public adjuster or an attorney, it is common for there to be some type dispute between the value of the claim.

   Virtually all property insurance policy contracts include an appraisal clause which may be invoked if there is a dispute between the policy holder and the insurance company regarding a coverage determination, the claim handling process, or most commonly, the settlement amount.

   Often, after an insured makes a claim under their policy, the insurance company will offer a dollar amount to allow the policy holder to “become whole”. Unfortunately, the insured may find that this “calculated” amount is insufficient, or even worse, may only realize this after the replacement/repair process has started.

   Contents Claims

   With in the capacity of personal property claims, there is often several thousand unique items subject to damages. Especially with Residential Homeowner claims, the magnitude of scope is enormous, and the time required to document and appraise each line item is often overwhelming. This basic fact increases the chance of dispute ten-fold, as a dispute can be on any of the thousand claimed items. This, coupled with the lack of professional personal property experts available on the open market, often results in the homeowner’s own documentation verses the carrier’s internal loss prevention methods. Common sense can predict the difficulties that a policy holder will face when submitting a claim to a well versed and experienced insurance adjuster working to protect the interests of his or her employer.
   Enter, the Appraisal Provision:

   The above captioned quote is much like any standard appraisal clause found in an insurance policy. It is also something overlooked by the policy holder, during an impasse or dispute. When a policyholder is offered a substandard settlement offer, they often do not understand their rights under the policy contract, and may feel that they have no other choice then to accept the amount calculated by the Insurance Company. There may also be an intimidation factor, when an inexperienced policyholder is faced with disputing a corporate super power, such as the typical Insurance Carrier. Popular belief may only expose (two) distinct options; Accept the offer and move on, or further delay their life by hiring an attorney to bring suite. Obviously, this belief can counter act and disable their proactive and assertive role in accepting the true amount of loss, and nothing less.
   An Alternative Method

   In theory, appraisal is to be used to provide a simple, speedy, inexpensive, and fair method of determining the amount of loss only. Fire Ass’n vs. Ballard, 112 S.W.2d 532, 534 (Tex. Civ. App. – Waco 1938, no writ).
   When the insured is faced with a settlement offer that they may feel is far less then needed, and they find that the company adjuster is not willing to “re-adjust” the offer, they may invoke the appraisal clause. Upon invoking this clause, the many personalities involved with the claim are now removed, and a fresh, new batch of individuals are appointed to determine the amount of loss. The “me vs. the world” or the “David vs. Goliath” feeling is now removed, and the entire claim is now transferred to a 3-person panel. Now, the insured is represented by one appraiser, and the carrier is represented by one appraiser, who will independently evaluate the loss, and calculate the amount of loss.

   Quoting a Supreme Court’s opinion, “The purpose of the clause is to secure a fair and impartial tribunal to settle the difference submitted to them.”

   Although there is a clear difference between Appraisal and Arbitration, many of the basic fundamentals of the appraisal process can be rooted from the Uniform Arbitration Act. An example of this is as follows:
   Uniform Arbitration Act, §13-22-201 et seq., and in particular, §13-22-211 (2), which sets forth the standard for impartiality of an arbitrator, essentially as: An individual with any kind of material interest in the outcome of the Arbitration is not considered neutral.

   It is my opinion, that an adjuster that either contracts or is employed by the carrier shall not be considered a disinterested party, as it can be argued that they have a substantial relationship with the party, proven by an ongoing financial relationship with that party. It is also my opinion that the public adjuster, retained by the insured, may also be argued disinterested, as they are economically interested in the final amount issued to the insured. This, and all legal issues pertaining the appraisal should be discussed with an attorney.

   Mechanics of the Appraisal Process

   Simply put, when the two appraisers are chosen by their respected parties, they usually make contact with each other, and complete all required documentation in order to start the process. Shortly after the initial contact, the two appraisers shall agree upon an Umpire. It is our opinion, that the two appraisers should have an Umpire in place, before any matters of the dispute are discussed. This aspect of the process, in our opinion, is one of the most important mechanics of the entire Appraisal. It shall be duly noted, that the selection of Umpire is essentially the agreement and election of the final authority in the matter of dispute. This sole individual, will have the capacity to make the final decision, after both appraisers formally present their findings and supporting documentation. If the two party appointed appraisers cannot agree on an Umpire, either party can petition the court of record to put an umpire in place.
   The Appraisal before the Appraisal
   It is of my practice and opinion, to assert and demand a truly disinterested and neutral individual to serve in the capacity of Umpire, per the language of the policies appraisal clause. Our independent research demonstrates that often, the carrier’s appraiser will recommend individuals who they have a healthy relationship or preexisting agreement with.

   Clearly, the aforementioned traits could very well cause an individual to be bias, or at least, subject to preexisting opinions and views resulting from many years of protecting the interests of the Carrier. In addition, it is our practice, to formally reject any attempt made by the carrier’s appraiser to elect a disinterested party to act in the capacity of Umpire. Any such attempt will provoke a strict warning of compliance, with regard to the terms and conditions of the clause. Once all parties understand the due process of the appraisal, a selection of a fair and disinterested Umpire will preclude all other issues and actions at hand, and be the priority. If the parties cannot agree on an Umpire, either side shall partition the local court of jurisdiction for the appointment of an Umpire. It should be noted, that an Umpire should be very well versed in the appraisal process, as they will execute full authority over the panel.
   Once the Umpire is in place, the (two) appraisers shall create a “protocol”, to guide the panel in evaluating the loss. An example of a protocol is as follows:

   Agreement on scope of loss
   Disputed items of scope noted
   Agreement of RCV of loss, on line by line basis
   Disputed values noted
   Agreement of ACV of loss, on line by line basis
   Disputed values noted
   Confirmation of “agreed” aspects of loss
   Confirmation of “open” or disputed aspects of loss
   All open/disputed issues to be forwarded to Umpire

   Per the protocol, each appraiser will begin the process of evaluating the loss, independently. All documentation, evidence and information available during the claim, pertaining to the loss shall be examined. Property subject to the dispute should be evaluated, witnesses and experts should be consulted, and formal presentation of Replacement Cost Value and Actual Cash Value should be determined. Often, costs associated with replacement or restoration of claimed items may not have been claimed by the insured; all costs should be evaluated and calculated during the appraiser’s evaluation. Claim documentation prepared by the policyholder should be researched and substantiated, due diligence should be conducted with regard to the accurate valuations and calculations.

   It is my opinion, that neither appraiser is required to evaluate the amount of loss in the presence of the other, per the court’s opinion.

   “Appraisers are generally expected to act on their own skill and knowledge. It has been held that they may reach individual conclusions….” Florida Farm Bureau Cas. Ins. Co. v. Sheaffer, 687 So.2d 1331.

   With this being said, if the two appraisers find it mutually beneficial to meet at the loss site, and discuss the matters at hand, it can of course be a productive approach to reaching an agreement. As every appraisal is different, and personalities, practices, opinions and methods can clash, crash or follow a smooth process, the procedure shall be strategically executed to allow the most efficient, accurate and fair resolution. When it is impossible for the two appraisers to agree on some or all aspects of the loss, they are to regress, and submit all findings to the Umpire for ultimate decision.

   It is our practice, research, support and substantiate all aspects of our findings, to allow all other parties to understand and confirm our calculations. During Appraisal, knowledge is indeed leverage.

   http://www.digital-claims.com

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