Many hail damage claims events have engulfed the United States this past year. This has caused an increase in the amount of hail damage claims that have been reported to insurance companies. However, the increase in hail damage claims reported is not just from the claim events themselves, but rather unethical contractors as well.

You may recall an article I authored, “Insurance Appraisal And The Insured’s Integrity“, explaining an appraisal I was involved with where the insured was claiming things that occurred during Hurricane Irene that were just not possible. Well, be careful of your contractor’s integrity as well. CBS News recently ran a story where contractor’s where purposely damaging roofs after a large hail storm.

Below is video from the broadcast about Hail Damage Claims fraud:

Unfortunately,  this is not the first or last time such fraud has taken place. In the video above you will notice the contractor “spinning” his hands in a circular motion on the roof shingles. In the story below a contractor was found to be directing his sales team to purposely damage roofs using a process known in the industry as “dime spinning”.

Hail Damage Claims From Dime Spinning.

Now, please understand, not all contractor’s that are out educating homeowner’s that they may have valid hail damage claims are fraudulent. If you are skeptical about a contractor visiting your home, get their business card and advise them that you’d like them to inspect your roof with your insurance company adjuster present. If you are physically able, you can inspect the roof with the contractor.

As always, if you have a covered loss, the insurance company should pay, if you do not, then they should not pay! As in my last article mentioned above, “It’s bad enough suffering a loss, and for many people having to battle with their adjuster for a fair settlement. Please, do not compromise your integrity by making false statements about your claim in an effort to profit from a loss. It’s illegal, your entire claim can be denied due to fraud, and your family will be left without you for the next few holiday seasons while you’re serving your prison sentence. Insurance Appraisal is in the policy for the benefit of both parties, to resolve claim disputes using a less costly and less time consuming process…don’t abuse it!”

Find out more if you have a hail damage claims dispute.

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March 2011 a tornado wreaked havoc in Westmoreland County, Pennsylvania (PA). The tornado first touched down in Sewickley Township. Now, almost 7 months after the tornado ripped through the area, Jamie & Denny Cerilli have been notified by their insurance company, Allstate, that their tornado claim dispute will need to be settled via the insurance appraisal clause within their homeowners policy.

Allstate and the Cerilli’s could not come to an agreement on the amount of the damages caused by the tornado. Allstate has offered the Cerilli’s just about half of what local contractors have been quoting to do the repairs for. Allstate issued a written demand for the tornado claim dispute to be settled through the appraisal provision in the policy just this month of October 2011. The appraisal clause of the policy states:

Appraisal. In case the insured and this Company shall fail to agree as to the actual cash value or the amount of loss, then, on the written demand of either, each shall select a competent and disinterested appraiser and notify the other of the appraiser selected within twenty days of such demand. The appraisers shall first select a competent and dis interested umpire; and failing for fifteen days to agree upon such umpire, then, on request of the insured or this Company, such umpire shall be selected by a judge of a court of record in the state in which the property covered is located. The appraisers shall then appraise the loss, stating separately actual cash value and loss to each item; and, failing to agree, shall submit their differences, only, to the umpire. An award in writing, so itemized, of any two when filed with this Company shall determine the amount of actual cash value and loss. Each appraiser shall be paid by the party selecting him and the expenses of appraisal and umpire shall be paid by the parties equally.

The Cerilli’s have chosen Joe Brennan, of Insurance Claims Group, Inc. as their competent and disinterested appraiser. We are happy to represent the Cerilli’s with their tornado claim dispute and claim damage issues. This appraisal process has just begun. We will keep you posted on the outcome of the appraisal.

In the mean time, below is a news story posted by the local Channel 4 Action News (WTAE) with an interview and video of the damages suffered by the Cerilli family from the tornado.

SEWICKLEY TOWNSHIP, Pa. — More than four months after a tornado damaged homes in Westmoreland County, one family is still struggling with its insurance company to sort out the damage.

Jaime Cerilli said she’s most concerned about her Sewickley Township home’s foundation because water poured into their basement. “This was our finished game room. This was the main area where my kids played. This did not look like this,” she told Channel 4 Action News.

Cerilli said the water damage also extended to the garage and that the roof and ceiling also collapsed. Cerilli said contractors told her the foundation damage is too serious to repair. “All the contractors say this house needs to be leveled,” she said. “This was not an issue we caused. This was not a pre-existing issue. This was a direct result of the tornado.” Allstate has offered the Cerillis less than half the total amount the house is insured for.

An Allstate representative told Channel 4Action News, “We really are in business to make people whole again after a catastrophic loss like this. We will do whatever is in our power, within the boundaries of their policy, to make that happen.” “If they can find us a contractor that will come and do this and fix this place up, we’ll do it, and they just won’t, and it’s consumed our entire life,” said Cerilli.

Allstate is paying for the Cerillis to live in a rental house but the family is not sure how much longer they’ll be able to stay there. “Our sons say, ‘Mommy, when are we going home?’ We don’t know when we’re going home,” Cerilli said. The Cerillis have also filed a complaint with the Pennsylvania Insurance Department.

Original Story: http://www.wtae.com/weather/28838905/detail.html#ixzz1ac5MNUyy

Tornado Claim Dispute

If you need assistance with a Tornado Claim Dispute, feel free to contact Joe Brennan at 919-669-9111, or visit our Tornado Claims page.

Tornado Claim Dispute

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The NC Department of Insurance gives Hurricane Irene information and claim help for you to stay away from potential fraud and also to process claim issues after the hurricane strikes.

Hurricane Irene Claim Help:  NC state inspectors warn that many policyholders will unknowingly be unaware of the following hardships:

Claim Help Blunders

Many of these tips might appear like basic no-brainers, nonetheless, basic issues are easy to overlook in the mist of a catastrophe. Educating oneself along with being aware of misleading practices can help you save thousands in costly mistakes.

Claim Help

(C) Joe Brennan is President and owner/operator of Insurance Claims Group, Inc., a national independent adjusting, appraisal, and umpiring firm. We will answer your claim problems for FREE – Ph: 919-669-9111 . Secure FREE insurance advice, by visiting Hurricane Claim Help or Property Insurance Claims.

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Earthquake Damage?

A Parks Police helicopter inspects for earthquake damage to the Washington Monument shortly after an earthquake struck Washington, DC August 23, 2011. One of the strongest earthquakes to strike the US east coast in decades rattled offices Tuesday in downtown Washington and caused panicked evacuations from skyscrapers as far away as New York. The Pentagon, the US Capitol and Union Station in the nation’s capital were all evacuated after the 5.9-magnitude quake, which was shallow with its epicenter only 0.6 miles (one kilometer) underground.

The big question on most peoples minds from VA here in the next few days when earthquake damages begin to show will be,

“Does my Policy Cover Earthquake Damage?”

Well…probably not.  The vast majority of policies for home and business insurance written in Virginia (and the East Coast has a whole) do not cover damages caused by earthquakes.  A small percentage of policies include it automatically, and an even smaller percentage of policyholders have specifically requested earthquake coverage.

If you just felt your home or business shaking, and you don’t know if you have earthquake coverage, it’s a good idea to call your agent.  Praise God that no serious injuries have been reported thus far.  However, residents and workers should move about with caution, as loose windows, masonry, tree limbs, etc. can unexpectedly fall from high elevations causing injury.

The associated press reports:

WASHINGTON — A 5.9 magnitude earthquake centered northwest of Richmond, Va., shook much of Washington, D.C., and was felt as far north as Rhode Island, New York City and Martha’s Vineyard, Mass., where President Barack Obama is vacationing.

The U.S. Geological Survey said the earthquake was half a mile deep. Shaking was felt at the White House and all over the East Coast, as far south as Chapel Hill, N.C. Parts of the Pentagon, White House and Capitol were evacuated. There were no immediate reports of injuries.

It was centered near Louisa, Va., which is northwest of Richmond and south of Washington.

Obama and many of the nation’s leaders were out of town on August vacation when the quake struck at 1:51 p.m. EDT. The shaking was felt on the Martha’s Vineyard golf course as Obama was just starting a round.

The East Coast gets earthquakes, but usually smaller ones and is less prepared than California or Alaska for shaking.

At Reagan National Airport outside Washington, ceiling tiles fell during a few seconds of shaking. Authorities announced it was an earthquake and all flights were put on hold.

At the Pentagon in northern Virginia, a low rumbling built and built to the point that the building was shaking. People ran into the corridors of the government’s biggest building and as the shaking continued there were shouts of “Evacuate! Evacuate!”

Earthquake Damage Possible In Other States

In New York, the 26-story federal courthouse in lower Manhattan began swaying and hundreds of people were seen leaving the building. Court officers weren’t letting people back in.

The quake came a day after an earthquake in Colorado toppled groceries off shelves and caused minor earthquake damage to homes in the southern part of the state and in northern New Mexico. No injuries were reported as aftershocks continued Tuesday.

In Charleston, W.Va., hundreds of workers left the state Capitol building and employees at other downtown office buildings were asked to leave temporarily.

“The whole building shook,” said Jennifer Bundy, a spokeswoman for the state Supreme Court. “You could feel two different shakes. Everybody just kind of came out on their own.”

In Ohio, where office buildings swayed in Columbus and Cincinnati and the press box at the Cleveland Indians’ Progressive Field shook. At least one building near the Statehouse was evacuated in downtown Columbus.

In downtown Baltimore, the quake sent office workers into the streets, where lamp posts swayed slightly as they called family and friends to check in.

Social media site Twitter lit up with reports of the earthquake from people using the site up and down the U.S. eastern seaboard.

“People pouring out of buildings and onto the sidewalks and Into Farragut Park in downtown DC…,” tweeted Republican strategist Kevin Madden.

“Did you feel earthquake in NY? It started in Richmond VA!” tweeted Arianna Huffington, president and editor-in-chief of the Huffington Post Media Group.

Missouri Sen. Claire McCaskill tweeted that her staff in Washington was in an “emergency location. Hope everyone is ok.”

John Gurlach, air traffic controller at the Morgantown Municipal Airport was in a 40-foot-tall tower when the earth trembled.

“There were two of us looking at each other saying, ‘What’s that?’” he said, even as a commuter plane was landing. “It was noticeably shaking. It felt like a B-52 unloading.”

Immediately, the phone rang from the nearest airport in Clarksburg, and a computer began spitting out green strips of paper — alerts from other airports in New York and Washington issuing ground stops “due to earthquake.” No major earthquake damage reported.

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Tornado Damage Claims

As if suffering from a devastating tornado and tornado damage claims isn’t bad enough, an additional catastrophe can be dealing with the short falls of your insurance company. During a television interview even an insurance company adjuster advised that much of the tornado damage claims caused by windstorms and tornadic activities are often overlooked. Policyholders should educate themselves and seek tornado damage claims assistance regarding the diverse damages to be on the lookout for. Not to mention how to detect subtle damages which will be very costly and can show up many months or years after the high winds from the tornado are long gone.

Unfortunate policyholders who have found themselves in the vicinity of a tornado that cause tornado damage claims agree that most of the damage is not that  difficult to see. Even though most people will agree to such facts about tornado damage claims, many insurance companies and engineers often will miss unseen or hidden damages, because they fail to closely inspect your property for associated damages.

A thorough wind damage inspection by an insurance claim consultant or independent insurance appraiser is suggested. Far too many people take their insurance adjusters opinion, without obtaining the opinion of another professional. Why do policyholders continue to allow such a thing to happen? Most believe that the insurance company is there to support them after they suffer from tornado damage claims. However, you are at the mercy of the adjuster that visits your home, as well as the file reviewer at the insurance company. Are they structure experts? Not likely! Protect yourself and your investment by knowing these worthwhile  tornado damage claims inspection tips.

Tornado Damage Claims Tips:

Plumbing: Windstorms will rack or shake a home or building. Policyholders should open all faucets in kitchens and baths, then open and inspect all cabinets to check the plumbing lines for leaks. Continue by flushing all toilets, run showers and fill all bathtubs with water. Investigate the ceilings below these areas for water marks .

Roofing/Siding: Sometimes an insurance damage claim that’s a result of high winds may not have appeared to damage the roof from the ground. However, it’s a good idea to have a professional inspect the roof for cracks, gouges or tears that affect the roof tabs from flying debris. Tornadoes or high wind activity will also rip, tear, and crack many types of siding. Such affects on the siding and roof can often allow water entry.

Windows & Gutters: Wind activity and flying debris will often damage window glass, rip screening, crack shutters, and detach or dent gutters.

Brick & Foundations: Inspect masonry for splits and separation. Property damage by tornadoes or windstorms can also cause displacement and uplift to footings and foundations. View the perimeter of all crawlspaces. Severe structural damages can occasionally remain unseen.

Interior: Extreme storms can cause splitting to the corners of walls. Such stress cracking can also be seen around doors and window openings. It’s a good idea to check for shifting of flooring and the movement of walls using a level. In the following weeks and months it’s also highly recommended to look out for water stains and mold on walls and ceilings. Such stains could indicate missed roof damage .

Insurance companies and many engineering firms have even been sued for their failure to recognize these types of property damage claims  after excessive wind activity and tornadoes.

CNN reports State Farm Penalized in Suit Over Tornado Damage Claims :

State Farm acted “recklessly” and “with malice” in handling insurance claims from dozens of families whose homes were damaged when a wave of tornadoes, including the strongest in recorded history, swept through Oklahoma in 1999, a jury has decided. The verdict…delivered millions to the lead plaintiffs… The jury in the District Court of Grady County, Oklahoma, awarded Donald and Bridget Watkins almost $13 million in total damages for their part in the class action suit against the nation’s largest insurer….

We are all well aware that windstorms involving a tornado will result in damaging winds. Even tornadoes that do not actually “touch-down” will often cause severe pressure on residential and commercial structures. Extreme winds will often push and pull on the buildings causing fasteners and building parts to become damaged.

Above all, as stated, call an insurance loss consultant or independent insurance appraiser to inspect your home or building and be sure your family is safe. Feel free to call Insurance Claims Group, Inc. at 919-669-9111 to obtain FREE Insurance Advice… especially if you suspect that you are not be treated fairly for the tornado damage claims insurance coverage you have paid for. Tornado Damage Claim Assistance is available for anyone who has, or knows anyone who has suffered from tornado damage claims.

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Even worse, numerous property owners may find themselves within a dispute with their insurer. Most phone and ask us if there is any approach to challenge their home owners insurance claim with their insurance company adjuster. Yes, you can contest home owners insurance claims against your insurance company. Not all claims arrive at an agreed price. You will find there’s a provision named Appraisal in many property insurance policies that enable both parties of the policy to reconcile their issues by using a less costly, less time consuming, course of action without the need to settle the dispute in a court of law.

For starters, a brief summary of the insurance appraisal provision. The disagreement can be concerning injury to your house or your personal possessions (couches or chairs, garments, etc.). Let’s say that a home owner experiences a substantial fire to their residence or property. The insurance firm sends a claims adjuster to your house that determines the damage to be $225,000. However, you’ve got a local, dependable general contractor who furnished an estimate to correct the damages for $325,000.

At this time a dispute concerning the expenses to repair your home has begun and some sort of settlement on the repairs or replacement costs cannot be reached. Both the property owner or the insurance company possess the right, per the appraisal clause in the insurance policy, to demand an appraisal concerning the damages. After either party has requested an appraisal, both parties will need to find and retain the services of an independent insurance appraiser. Home owners insurance claim disputes that are to be decided utilizing the insurance appraisal process is what we do.

Insurance Claims Group, Inc. exceeds in their understanding of the appraisal process and is available to represent the facts of the dispute as your representative. To complete the duty as an impartial insurance appraiser successfully, not only should your appraiser be educated in the procedure, but one should also be qualified to evaluate the differences between the two parties. Our complex experience with construction, building repairs, building supplies, home owners insurance claim disputes, and the insurance appraisal process qualifies us as an dominant selection. We have in depth comprehension of Xactimate and MSB IntegriClaim. We are effective at looking through and comprehending the unit costs these kind of calculating applications present and work with the Appraisal Panel to ascertain a realistic amount of loss for your particular claim.

Obtain the home owners insurance claims advice you need by speaking with a professional. Learn the right steps to take and how to get what you paid for within your policy. Call (919)-669-9111 for a Free Consultation.

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So, here I go again… Most people believe that when they buy insurance, they will be taken care of when, and if, a tragedy occurs. It’s really quite simple.

1. We purchase insurance.
2. We have been paying for coverage for over X-amount of years.
3. When we have a claim the insurance company will be eager to help us and fulfill there part of the bargain.

Pretty simple… Right? If only it was that easy.

I just read an interesting article. The article was written by an insurance adjuster who specializes and trains other insurance industry adjusters on how to provide ”excellent customer service”. Basically, he is known as a customer service expert in the insurance industry. He stated that back in 2001, he was giving a speech about customer service to a group of claim representatives. After his speech, an insurance adjuster approached him and stated, “I disagree with everything you said, Mr. Van.”   I’ll let Mr. Van explain what happened next… (The block below is from the actual article.)

(Van) Puzzled, I asked, “Everything?”

(Adjuster) ”Yes; everything.”

(Van) So I asked him, “Like what?”

(Adjuster) ”You said we should be nice to customers, and show them respect?”

(Van) “You disagree with that?”

(Adjuster) ”Yes, and you said we should be patient with customers and show them you care about helping them.”

(Van) “You disagree with that?”

(Adjuster) ”YES!”

(Van) When I asked him why he would disagree with my point about being nice to customers, he said,

(Adjuster) ”Because you’re talking about the enemy.”

WOW! It’s hard to fathom that an insurance adjuster would think his customer’s are his enemy. Now, I’m not saying that “every” insurance company adjuster feels that you, the insurance company’s customer, is the enemy. However, many do feel that way. Who trains these people to think this way? This particular insurance adjuster has obviously not been trained correctly, and he actually is entitled to feel however he wants to. That being said, if an adjuster’s attitude deems the customer to be the enemy, then there is an overwhelming chance they are going to treat them as the enemy.

It is actually the insurance adjuster’s job to seek and find, any and all coverage that the policyholder is entitled to under the policy. Did you get that? (Go ahead, read it again… I’ll wait.) Yes, it’s the insurance adjuster’s  job to visit your property, find all the damages you have suffered, and pay for any and all costs associated with the damages incurred. Almost all people that I come in contact with, on a daily basis, do not feel that their adjuster has attempted to provide them that service.

Again, there are many excellent adjusters out there that are doing the job the way it’s supposed to be done. Unfortunately, such adjusters are few and far between. It’s your property, don’t let anyone treat you like the enemy after you have prepaid them to provide you with a service.

You’re not alone. If you feel your adjuster in not providing good customer service, ask them for their Supervisor’s contact information. Read your policy, ask questions, talk to someone with knowledge, and get answers.

Get your questions answered by an independent appraiser, at no cost, 919-669-9111.

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Many claims are entering into appraisal prematurely. For example; let’s say that a policyholder has suffered a fire damage claim. The insurance adjuster generates an estimate of repair for $100,000. The policyholder immediately disagrees with this number and advises, “There is no way my house can be rebuilt for that. It cost me more than that when I built it 10 years ago”!

Is this considered a dispute on the amount of loss? Should the policyholder invoke appraisal at this moment? Should the insurance company demand appraisal at this point? Unfortunately, many times, one of the parties has engaged appraisal at this point. However, technically it is premature and there is actually no dispute on the “amount of loss” as of this moment, just a disagreement.

For a dispute to be prime for an appraisal, there must be a dispute between the parties as to the “amount”, not just an “opinion” of the amount. In other words, the carrier actually has an amount on paper of what they have estimated for the damages. Where the policyholder has no actual estimate or reason to show why they disagree – just an opinion that the insurance company is incorrect. Both parties should have produced an estimate in writing for the “amount of the loss”. At this point they would both have  a professional opinion of the loss. The policyholder by way of a contractor’s estimate and the insurance company by way of an adjuster’s estimate.

Now, let’s step back for a minute. Let’s say the insurance company produced an estimate in writing for $100,000 and the insured produced a contractor’s estimate in writing for $175,000. There is now a difference in the estimates of $75,000. Can either party now determine that they have a disagreement on the “amount of loss” and demand appraisal? Not so fast!

The insurance company needs a reasonable time and chance to respond, review, and determine their position with respect to the increase and differences between the estimates. Once the insurance company responds, it is then that it will appear if there is significant disagreement over the “amount of loss” to warrant invoking appraisal. See, both the policyholder and the insurance company are entitled to reasonable time to consider and review the other parties values and the time to respond with either an offer of settlement or an explanation as to why they believe the “amount of loss” is more or less then what the other party submitted. If each party is provided with a reasonable time to respond the dispute could be settled without a need to demand appraisal.

The opinions and differences should be reviewed and discussed between the parties. Both sides should exhaust all efforts to come together and reach an agreed “amount of loss”. This saves both time and money for both parties, especially the insured whose pockets are not as deep as the insurance company. If the dispute still remains tens-of-thousands of dollars off and a mutual agreement cannot be reached to settle the claim, now you have a true impasse that is seasoned for a resolution to be resolved using the appraisal process.

A Kentucky court (Continental Ins. Co. v. Vallandingham & Gentry) ruled; “There must be an honest attempt made by the insured and insurer to meet on the question of loss and damage before the appraisal should take place. The initial disagreement between the parties without some effort to resolve that disagreement is generally not sufficient to make the case ripe for appraisal.”

In closing; it can be summarized that the policyholder has an obligation to present their claim, the insurance company has a duty to investigate the damages in good faith and reply, providing their value of the loss. These differences should be discussed in an attempt to reach a mutual agreement and settlement. If either party disagrees and is not wiling to move any further toward a settlement, the matter is primed to be resolved via the insurance appraisal process.

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Most people would believe that the insurance companies are not providing the coverage they offerer in the policy. In some instances this may be true. However, what happens when the insured is trying to claim damages that just did not happen? What happens when the insured is committing fraud or is making false statements in an effort to collect insurance proceeds in excess of what they deserve. Yes, it can go both ways.

I was named an independent appraiser by Pacific Specialty Insurance for a Hurricane Ike claim dispute in Houston, TX. A joint inspection was setup between the other appraiser and myself. The insured accompanied us during the appraisal inspection. The appraiser for the insured was selected by the insured’s attorney and had visited the loss prior to our joint inspection. When we met at the loss the insured’s appraiser supplied his appraisal and amount of loss for $54,000+.

During our inspection the insured followed us around the property pointing out damages and explaining to both appraisers what had happened. As usual I took photos of all the damages pointed out by the insured, scoped the loss by measuring the roof, elevations, rooms, as well as taking notes on all the insured was advising that had happened. I tried to be pleasant and professional while listening to the insured make false statement after false statement. The events that the insured was claiming had happened were not even possible. It was that moment that I realized why Pacific Specialty had invoked the appraisal process on such a small claim.

We began on the exterior because the insured, his attorney, and appraiser had included replacement of all the siding on the home. They included replacement for the front elevation from storm damage and they included the other three elevations as the profile of the vertical cedar siding was no-longer manufactured.

The storm came from the south. The front of the home faced south. The insured claimed that the siding on his home was ripped from the front elevation by Hurricane Ike’s strong winds. He advised that almost half the pieces of vertical cedar siding was tossed into the road and across the street. With the wind pounding on the front of the home it’s more likely that the siding would be tossed around the sides of the home or to the rear. However, with hurricanes having circular winds and sometimes tornadic activity within them - it is possible.

The insured then claimed that he gathered the siding from the road, reinstalled it all back on to the front of the home, caulked it, and primed it prior to the adjuster arriving for inspection. Although unlikely – this too is “possible.”

During my inspection of the front elevation I took the following photos.

The first photo here shows a flood lamp unaffected by the strong winds. Again, the insured is claiming that the winds sucked close to half the siding on the front elevation off the building and into the street. Yet, the light fixture and glass globe were unharmed.

I took several photos of rotted siding on the front elevation as well. Keep in mind the insured stated that he gathered the siding from the yard, road, and the neighbor’s yard across the street. He then reinstalled the siding back onto the home, caulked and primed it. To do exactly that; the insured also gathered all the little chunks of “rotted” siding and put the puzzle pieces back in the exact locations from where they came from. (Yes, he was asked to point out sections that had been blown off.) Also, lets assume the wind did not affect this particular rotted area, (again there were multiple sections) then what we are lead to believe is that the wind was strong enough to rip the solid pieces of siding from the home… but not the rotted pieces? Hmmmm.

In addition to the siding showing areas of wood rot, there were three sets of shutters on the front elevation. As you can see from the photo, the shutters also had significant rot and decay.

I guess the insured was able to gather the rotted shutter pieces and puzzle them back together as well. Not to assume anything I asked the insured, “Did the shutters get ripped from the house as well?” He replied, “Only the small set around the upper right window.” Interesting comment by the insured, considering the smaller set of shutters had the least amount of visible wood rot.

I would have never thought that Hurricane Ike could be so selective to rip solid cedar siding from the building, but leave rotted shutters intact.

The inspection continued inside the home to the master bedroom on the second floor. As per the traditional appraisal inspection I took photos and asked questions. I was suddenly taken back by the things coming out of the insured’s mouth.

The insured claimed that the two windows in the master bedroom were blown in from the severe winds. Ok… that is surely possible. Next the insured explained to the two appraisers that rain water entered the windows and caused damage. Ok… from the photo we can see “some” water entry caused stains to the drywall sill and under the windows. So far, so good.

Next the insured explained that the water from the windows filled the room with 4″ of water! He stated that the water was at least 1″ over the 3″ base molding. Ok… although very unlikely from the amount of stains around the windows, I was trying to be open minded and thought to myself, “I guess it could happen.” The insured advised that a restoration company came out and sucked up all the water. So, I began asking questions.

Q: “When was the drywall and baseboards replaced?

A: “None of the drywall or baseboards have been replacement.”

Q: “I don’t see any damage on the drywall or baseboards. If the room was filled with 4″ of water don’t you think they would show signs of damage, staining, swelling, anything?”

A: “Well I painted the walls already.”

Q: “And, when was that done?

A: “About 3 weeks ago.”

It did not appear to me that the room had been freshly painted less than a month ago. So, I took this photo of the textured wall. The photo was to show the amount of dust clinging to the texture lumps on the wall surface. It’s practically impossible that this amount of dust would gather on the texture in 3 short weeks. (The dark gray spots are dust balls.)

When the insured answered my next question I was disappointed that he would compromise his integrity to such a great extent.

Q: “Can you show the damages to the rooms downstairs below the bedrooms?”

A: “Oh no, none of the water damaged any rooms downstairs.”

The insured did not even realize that it was impossible for so much water to fill a second story bedroom with up to 4″ of water and none of it to drain into the rooms below. I guess the carpet in the master bedroom was waterproof. I continued my inspection showing the rooms below the master bedroom did not incur any damages.

As usual I completed my appraisal estimate and prepared to present my amount of loss to the insured’s appraiser. My appraisal number for actual damages was $10,000+ more than the insurance company’s adjuster, but was also $30,000+ less than the other appraisers.

In less than 15 minutes of me explaining my position to the insured’s appraiser about the rotted siding and shutters, and also the 4″ of water that did not drain to the floors below, he agreed to sign an Appraisal Award form for the exact number of my proposed estimate – approximately $19,000 and change. He did not mention one more word bout his $54,000+ appraisal number.

So, it’s bad enough suffering a loss, and for many people having to battle with their adjuster for a fair settlement. Please, do not compromise your integrity by making false statements about your claim in an effort to profit from a loss. It’s illegal, your entire claim can be denied due to fraud, and your family will be left without you for the next few holiday seasons while you’re serving your prison sentence.

Insurance Appraisal is in the policy for the benefit of both parties. To resolve disputes using a less costly and less time consuming process…don’t abuse it!

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The following story was broadcast by WRAL News on May 7, 2008 – one year to the day they covered the original story about the fire itself. This story has personal affects on me as I was the independent appraiser for the insured in this case. 

WRAL News - The May 7, 2007, fire at 1884 Memorial Church Road, in Fremont, claimed the lives of Shannon Minshew and her 77-year-old, bed-ridden grandmother, Mayola Waddell.

Firefighters found Minshew’s body on top of Waddell. She had been trying to save her, investigators said. “It’s horrible we have to see it (the home) every day, whenever we go somewhere,” said Minshew’s daughter, Brandy Hall, who lives behind the charred home.

Other family members live next door and directly across the street. The entire family is fighting with Nationwide Insurance to get the house demolished.

Nationwide declined to comment on the matter Wednesday, but Minshew’s family says the insurance company has not determined how much it is willing to pay on the property.

The family says it doesn’t care about the money. They only want to have the charred remains of the home removed. “It’s hurting all of us even worse, and we’re getting tired of seeing it every day,” Minshew’s son, Tyler Hall, said. “It needs to be torn down.”  -  WRAL End  -

Terrible loss from this fire - not only the loss of the home, but also the loss of two loved ones suffered by this family. My prayers still go out to them today.

Funny is this comment by the family, “…the insurance company has not determined how much it is willing to pay…“. Willing to pay? How about the amount it actually costs to replace the damaged home – not a penny more, nor a penny less? See, this is the mentality of many insurance company representatives. (Notice how I said many and not all – some actually know the policy and how to execute it’s coverage. However, they are few and far between.) By stating to this insured that we have not calculated how much we are “willing” to pay, shows that they are not interested in paying what they owe, but rather how much they can save. How much can they offer to make the insured go away.

As I mentioned, I was the independent appraiser hired by the insured on this loss. They had a public adjuster who could not obtain a settlement on the claim. Nationwide invoked the Appraisal Clause on February 11 2010 and I was named as the appraiser for the homeowners on February 19, 2009 – more than nine (9) months after the date the fire occurred.

The building was insured for $125,300. Nationwide calculated that the home could be rebuilt for $103,700 ($21,600 less than it was covered for). Nationwide mailed the insured a check for $90,468.00 for “Actual Cash Value” after applying depreciation to their Replacement Cost number. (The rebuild at $103,700.)

The dispute on how much it would cost to replace the damaged home continued into the appraisal where the court was petitioned to select a “competent and disinterested” umpire.

Fortunately the claim was settled by myself and Nationwide’s appraiser within four (4) months and did not require the services of the umpire. The Appraisal Award ended up as follows:

• Policy Limit: $125,300
• Nationwide’s Offer:  RCV – $103,700  -  ACV – $90,468
• Appraisal Award:  RCV – $140,500  -  ACV – $140,200

In conclusion, the insurance appraisal process resulted in $36,800 more than what was offered by Nationwide Insurance for RCV and $49,732 more than Nationwide offered for ACV. The insured was also paid $14,900 more than there policy limit of $125,300.

Certainly we have had larger appraisals where the policyholder has obtained “hundreds of thousands” of dollars more than the insurance company had offered. However, most would agree that no one would want to eat $49,732 to line the pockets of their carrier. For this family, it was about two loved ones, Shannon Minshew and Mayola Waddell, not about the property or the money.

Anyway, I ran across the WRAL News story online while searching for something else. It reminded me that the loss of property can be replaced… However, loved ones cannot.

(In an effort to show both sides of the coin, my next post involving an insurance dispute will be about how some policyholders try to claim fraudulent damage on claims that enter into appraisal as well.)

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