Here’s a story that might ring a bell with you.
A elderly couple return from a weekend getaway visiting their kids. When they walk in the door they discover that someone has broken into their home. The house is ransacked and so much is destroyed and missing. This couple begins the process of filing a claim. There are numerous objects that need to be replaced or repaired. They feel like the insurance company isn’t providing them a fair and acceptable amount to get them back to where they were before the burglary occurred while they go through the claim process. So, what’s next?
Customers and home insurers have disagreements about claim payments for a variety of reasons, ranging from fine wording buried in a policy to disagreements over the true cost of repairing your home.
If you believe things aren’t progressing as they should, here are a few suggestions to assist you to an agreement.
1. BE AWARE OF YOUR COVERAGE
Sometimes claim payment disputes arise from a lack of understanding of what is and is not covered by your homeowner’s policy.
Before you invest too much time and effort into something, check your homeowner’s insurance policy to determine if the damage you’re worried about is covered. Take a look at what your policy’s restrictions are. Knowing what you’re entitled to under your insurance will help you make a stronger case if you’re correct. For example, a large misconception is that jewelry or valuable items are covered under the homeowners policy. While many companies will give you a small limit around $2,000, in order to replace it for the full amount this should be insured on a Personal Articles policy.
2. GO OVER YOUR CLAIM AGAIN
If you’re not sure why the claim amount is smaller than you expected, speak with the adjuster. They may point to a policy exclusion or other specific language. If that’s the case, request that they point out the relevant passage.
Always keep a written record of everything. Adjusters are human beings, and they can make mistakes. Keep track of the dates, who you spoke with, and what you said in a journal. Send a follow-up email confirming what you heard if you received information over the phone or in person. Keeping a precise record not only helps you keep track of what’s been said, but it also helps you figure out what actions you’ve taken and what actions you haven’t taken.
If you still believe the insurance company’s position isn’t fair after getting clarity, prepare documentation that will assist you substantiate your case. For example, if your insurance company estimates that repairing your house will cost a specific amount, but you believe it will cost more, acquire a written quote from an independent contractor.
3. MAKE AN APPEAL
Start by drafting a letter to your claim’s adjuster if you still believe the settlement is unfair and need to file a dispute to a rejection or claim offer. Communication is important at times. Briefly explain your point of view, including any proof you’ve gathered to back it up, and ask the adjuster to investigate the claim.
Request a response within a specific time frame, such as 10 business days. If you’re emailing, send it certified read receipt or if you prefer mail send it certified mail at your post office to get a record of the precise day your letter is shipped and received.
Stay cool and polite, even if you’re enraged. While adjustors are required to do their jobs, we have seen situations where the customer service deteriorates because of disrespect.
4. REQUEST A RE-INSPECTION
If there’s a disagreement about the extent of the damage, request a second look from your adjustor. Bring any independent contractors or other professionals who have provided second opinions, such as a smoke-contamination investigator or a mould inspector, to meet with the adjuster to share their knowledge.
Bring everybody together. It may aid your case if other specialists can physically prove the issue to the adjustor and help everyone come to an agreement.
When it comes to arguments between policyholders and the insurance provider over property damage, appraisals are a common step. Both parties appoint an appraiser to act as their representative.
The two appraisers examine the damage to your home and personal property and attempt to reach an agreement on a reasonable compensation. Any deadlocks between the appraisers are broken by a neutral entity known as an umpire.
Are you curious if this clause exists in your policy? This is the type of policy language should be on the lookout for.
- “If you and we fail to agree on the amount of loss, either may demand an appraisal of the loss. Each party will choose a competent appraiser within 20 days after receiving a written request from the other. The two appraisers will choose an umpire. The appraisers will separately set the amount of loss. If the appraisers submit a written report of an agreement, the amount agreed upon will be the amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will set the amount of loss.”
The biggest downside to appraisal is that it determines only what was damaged and how much that damage amounts to, not whether your insurer actually has to pay that much. Appraisal won’t resolve disagreements over your coverage, the language in your policy or other issues holding up your claim, but it can help if there’s a disagreement on how much the insurance company is paying.
Mediation entails hiring a neutral third party, or mediator, to work one-on-one with you and the insurance company to reach an agreement that both parties can live with.
Unless your policy specifies otherwise, you and your insurer divide the cost of mediation. The mediator can be a court-appointed professional or a private professional chosen by both parties. You can also use a state-sponsored mediation program, which you can usually find on the website of your state’s insurance department.
Mediation is usually quick, but it’s nonbinding, so if you or your insurance doesn’t like the outcome, you or your insurer can pretend it never happened.
The following are some of the disadvantages: The insurance company’s rep likely will be trained for the process, while it will be brand new to you.
The last resort: lawsuit
Suing an insurance company can be a time-consuming and costly endeavor. Instead of filing a lawsuit, try to work with the insurance company rather than against it.
We frequently see policyholders who promptly seek legal counsel. The claims adjustor’s process is frequently disrupted because of this. Unless the lawyer allows the claims adjustor permission to speak to others, the claims adjustor can only communicate with the lawyer. This limits the policyholder’s ability to communicate and hinders their agent’s ability to assist them along the road.