The insurance industry has the best business model in the world. Imagine owning a company where:
Client pays up front
Insurance Company benefits from that up front payment
Loss occurs
– Policyholder expects to be paid for losses
– Insurance company hits the breaks
The policy purchased by the policyholder is know as a “Contract of Adhesion”. This means, that the contract (policy) is a standard form contract drafted by one party (the party with the stronger bargaining power – CARRIER) and signed by the weaker party (usually a consumer in need of goods or services – POLICYHOLDER), who must adhere to the contract and therefore does not have the power to negotiate or modify the terms of the contract. Being that the policyholder cannot negotiate the terms or make revisions to the policy, they must “adhere” to what it says word=for-word. Sounds unfortunate for the policyholder. However, the Carrier must adhere as well. This means anything that’s ambiguous or unclear goes to the default of the party who did not generate the contract (the POLICYHOLDER).
With that being said, and the fact that the insurance company (carrier) is the stronger party who has collected money from the policyholder, they have a duty to protect that policyholder and provide any and all available coverage to each client.
“The primary duty of the [insurance company] claim representative is to deliver the promise to pay. Therefore, the [insurance company] claim representative’s chief task is to seek and find coverage, not to seek and find coverage controversies or to deny or dispute claims.”
James J. Markham et al., The Claims Environment, 13 (1st ed. 1993).
Seek And Find All Available Coverage
If the insurance adjuster and the carrier’s responsibility is to seek and find all available coverage, then why does it seem that with many claims the carrier is trying to find fraudulent activity by the policyholder? Investigations, depositions, waiver of right forms, release of all claim forms, etc. Well, it must be all part of the “Delay, Deny, Defend” model followed by many of the carriers that was designed to increase their bottom line… but that’s another story. Not “all” carriers follow this model, however, most of the “Big Boys” do!
(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 questions FREE as part of our FREE Insurance Advice and Insurance Claim Consulting Services.
I advise people all the time that their insurance company is not “really” looking out for their best interest at all times. The truth is that your adjuster is “first” and primarily looking out for the interest of the insurance company, their employer! Most insurance industry articles and classroom content is designed to teach the adjusters “what to look out for”, as if the insureds are all liars first. It’s guilty first. Look for deception, then handle the claim. Here’s an article in an insurance industry magazine that shows such.
“As always”, all contents related articles in any industry magazine will be written by an executive of Enservio, and this follows suite. You’ll notice that in all of the four topics of the article it’s about what the carrier is doing wrong… (ways to “first” investigate if the insured is a liar). It’s a good article and sheds some light from the carrier side. Do policyholder’s make false claims and bad judgements, sure, however, in more instances than not the carrier’s inexperienced adjuster is incorrect, NOT THE INSURED! Why don’t these professionals write more articles teaching the adjusters how to assist the insured in recovering all they are entitled too? (hmmmm)
Holding my breath waiting for an article that teaches adjusters how to go the extra mile to assist the policyholder… exhale (enough of that).
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(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 questions FREE as part of our FREE Insurance Advice and Insurance Claim Consulting Services.
When your possessions are lost or ruined after a fire or your home is destroyed or partially damaged, you are probably a tad emotional. That doesn’t put you in the best position to negotiate with your insurance company after filing a claim. You need someone on your side with a clear head, someone who can help you get what is rightfully yours, which you have earned from paying your insurance premiums. Insurance companies, when left to their own devices, might not always give you what you deserve. Jeff Blyskal, senior editor at Consumer Reports, says you need to be tough when you work with your insurance agent and be ready for a fight. But, why fight as the underdog when you can have an expert fight for you in an insurance dispute?
The Appraisal Clause
All homeowner’s insurance policies are different, and each state has laws that vary. However, many insurance policies have an appraisal clause, which gives you the right to file an insurance claim dispute. This clause allows you to get a second opinion on how much your home and property are worth, says Greg Hawkins, Director of Consumer Services in the Office of the Insurance Commissioner. If you think you are being short-changed to the tune of $20,000 or more, often substantially more, the service of an independent appraiser who can offer claim help will likely pay for itself many times over.
The Insurance Discrepancy
Let’s say you received bids from several contractors who all say it’ll cost about $200,000 to repair your home from fire damage. Then, your insurance company contacts you and says it will cut you a check for $80,000 to cover the repairs. That would be the time for you to start a claim dispute.
The Claim Dispute
To file a claim dispute, you need to notify your insurance company of what you intend to do in writing, ideally through certified mail. When you file, tell your insurance company that you wish to use an independent appraiser to determine the damage to your property and possessions. Understand, however, that an independent appraiser that you hire will come up with a number based on the cost to repair and replace. You should not expect a fire to become a bonanza for you, but you should expect to be made whole again.
We’re Here to Help
Your home is probably your biggest investment. You need to hire someone who is an expert in appraising property damage and understands the insurance claim dispute process. The Insurance Claims Group, Inc. is an expert in this field. We have qualified appraisers who act on your behalf when you have an insurance dispute. Call us at 919-669-9111, or visit our website at InsuranceClaimsGroup.com when you need 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 questions FREE as part of our FREE Insurance Advice and Insurance Claim Consulting Services.
Tornado Damage Claim Help : Although the US seen one of its quietest tornado seasons in almost 40 years, Sunday sparked the worst November in US history, with 81 tornado reports in Illinois, Missouri, Kentucky, Ohio and Indiana.
Illinois suffered the hardest blow, with a total of 43 tornadoes, followed by 23 in Indiana, 13 in Kentucky, 1 in Missouri and finally 1 in Ohio. This November 17, 2013 storm caused overwhelming loss and destruction. Our thoughts and prayers are out to those who have suffered damages and loss of life during such a difficult time. It’s heartbreaking.
When the dust settles the second catastrophe for these folks will be the aftermath and dealing with insurance repair issues.
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.
(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 questions FREE as part of our FREE Insurance Advice and Insurance Claim Consulting Services.
Moore, Oklahoma: Helping others, providing donations, and lending a helping hand is the American Way! Ask the victims of 9/11, Hurricanes Katrina and Andrew, Joplin, MO Tornado, and of course those still in need from Super Storm Sandy, how grateful they were to receive assistance, and pure human kindness from other human beings Worldwide… Read the rest of this entry »
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(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 questions FREE as part of our FREE Insurance Advice and Insurance Claim Consulting Services.
INSURANCE CLAIMS ARE DEDUCTIBLE: If you suffered a insurance loss to your property and have not been fully reimbursed by your insurance company, you can file Tax Form 4684 and deduct the loss from your taxes. And, yes, parts of your loss that is not covered by insurance is still deductible… whether you had insurance or not.
Under the law, a personal casualty loss is determined by taking the smaller of:
The cost or other basis of the property (reduced by any insurance reimbursement), or
The decline in fair market value of the property as measured immediately before and after the casualty (reduced by any insurance reimbursement) (This is the one most should use.)
The cost of repairs may, in certain cases, be used to measure the decline in fair market value, but it cannot be used by itself to determine the amount of the loss. When the cost of repairs is determined to be a fair measure of the decline in fair market value, then all you have to do is take the fair market value before the casualty and reduce it by the cost of repairs to arrive at the fair market value after the casualty.
Losses You Can Deduct: You can deduct losses of property from fire, storm, shipwreck, or other casualty, or theft (for example, larceny, embezzlement, and robbery). If your property is covered by insurance, you must file a timely insurance claim for reimbursement of your loss. Otherwise, you cannot deduct the loss as a casualty or theft loss. However, the part of the loss that is not covered by insurance is still deductible.
Related expenses: The related expenses you have due to a casualty or theft, such as expenses for the treatment of personal
injuries or for the rental of a car, are not deductible as casualty or theft losses.
Here is a link to the form. Speak with your accountant – And, if you already filed and missed this deduction, you can still amend your return. Good Luck – http://www.irs.gov/pub/irs-pdf/i4684.pdf
For Hurricane Sandy victims, NY State has directions on how to claim the loss on your state taxes as well (http://www.tax.ny.gov/pit/file/sandydeduction.htm). It’s not too late to file your property damage loss either – even if you have already completed your tax return. It can be amended, sometimes years after the loss took place.
(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 questions FREE as part of our FREE Insurance Advice and Insurance Claim Consulting Services.
For the last few years I’ve been consulting many of my clients of the practice used by “some” insurance companies called Delay, Deny, Defend. Below is actually the “second” report Anderson Cooper has done about this topic. Although the report is about auto claims… the same holds true for home insurance claims, business claims, etc.
There is also a book titled “Delay, Deny, Defend by Feinman, Jay M. which can be purchased here. The book and videos are real eye openers… no matter which side you’re on.
The other story by Anderson Cooper was reported on the TV show “360 with Anderson Cooper”. It was reported in two parts. See them both here:
Insurance Dispute Part Two
Insurance Dispute Resolution
As stated, these stories are about auto claims, however, insurance companies use this Delay, Deny, Defend game for home insurance claims, business claims, etc.
Yes, you can dispute low-ball insurance claim estimates with your insurance carrier or adjuster. Many insureds disagree with their insurance adjuster with larger insurance claims. A clause called Appraisal is within most insurance contracts that allows you to settle your insurance dispute with your insurance company using a less costly and less time consuming process than a law suit.
(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 questions FREE as part of our FREE Insurance Advice and Insurance Claim Consulting Services.
Hail season has prompted Rick Richards, writer for Consumer Insurance Guide, to write a story about hailstorms and hailstorm coverage. Joe Brennan of Insurance Claims Group was one of three he interviewed for the story.
(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 questions FREE as part of our FREE Insurance Advice and Insurance Claim Consulting Services.
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. Read the rest of this entry »
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(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 questions FREE as part of our FREE Insurance Advice and Insurance Claim Consulting Services.
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. Read the rest of this entry »
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(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 questions FREE as part of our FREE Insurance Advice and Insurance Claim Consulting Services.