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Thursday, December 19, 2013

Public Adjuster in Mesa, Arizona – No claim is to small.

The Farmers Insurance  adjuster said, “why did your customers hire a public adjuster for such a small claim?” I replied, “Because the scope of repairs that was written by you was not sufficient to cover the damage sustained”. The Farmer’s company adjuster had indicated by his scope, that outside the flooring, there was only $1,250.00 worth of damage. My customer, after the deduction of his deductible, held in his hand a check for $250.00. Not sure what to do, he had searched on the internet for a public adjuster in Mesa, Arizona and had come across our web listing and gave us a call. This was indeed a small claim, but when properly adjusted, settled out at over $17,000.00.  The increase in cost was not an inflation on our part, but only a complete and accurate itemization of the damages caused by the sudden and accidental broken plumbing system pipe.
The Farmers adjuster had also included in his scope the cost of the flooring, a laminate wood floor, at the price indicated by the pricing and evaluation service called ITEL, despite the fact that the insured had in his possession a sample of the flooring for the adjuster’s inspection as well as the original purchase receipts.  The costs were significantly different, with the purchase receipts being much larger than what ITEL had reported.
Only after our customer engaged our services as a public adjuster, and our presentation to the Farmers company adjuster the complete and accurate scope of repairs for the claim, did the claim get the fair look that it deserved. I am not sure what the reason company adjusters and independent adjusters choose to not include all the factors and components of a claim in their scopes for repair.  Maybe they are overloaded by their workload? Maybe they don’t have the proper experience necessary to make these determinations? Maybe time is an element to be investigated, as it takes much longer to write a complete and accurate scope of repairs.  Whatever the reason, if insurance company representatives would write complete and accurate scopes of work the first time they visit the claim site, the need forpublic adjusters would be greatly diminished.
For some crazy reason, I don’t foresee this being anything that will magically change in the near future. That being said, I invite all insurance company adjusters who are annoyed by the insured’s hiring of a public adjuster, even for small claims, to treat their insured’s better by writing a complete and accurate scope the first time, especially on small claims.  Owners of real property and other interested parties will not stand by any longer and fight alone for what their policies should pay for their damages. They will continue to hire public adjusters, as in this instance, and many will see the value of their claim increase to what it should have been from the beginning.  As in this case from 5K to over 17k.
At Hudson Douglas Public Adjusters, no claim is to small for our evaluation. We offer a free claim evaluation to anyone who asks. We recommend that you hire a public adjuster even before you call your insurance company. But if you did not and you have a check In your hand that you feel will not adequately cover the costs of the repairs necessary, give us a call we can help!

Tuesday, December 10, 2013

Who is the Adjuster at Your Door?

When you have damage to your home or business, your first responsibility is to “mitigate” the damage, or to stop further damage to the best of your ability. This may mean that you mop up water, cover a damaged roof with a tarp, or board up a broken window or wall. It may also mean that you call a qualified emergency service company that exists in your area.
The next step is to report the claim to your insurance company.  Your call will most likely connect you with a call center, where a representative will take the information that you provide them, and file them with your claim. The details you provide during this short phone conversation are very important both to you as well as your insurance carrier. You will likely be wondering if you have coverage, and how the rest of the claims process will work. The answers to these questions will be decided by the information and details you give the insurance company.  The details that they receive are compared to a general knowledge bank to make the first determination whether they have a liability or not.  The words you use are important! Most insurance policies are written in plain but confusing language. Words like, mold, seepage, and long term, may be words that may not be interpreted properly by your insurance carrier, as these words trigger limiting language in your policy. Your lack of knowledge to the insurance process could cost you a denial from your carrier just because you described the loss wrong.
Once the claim has been reported an adjuster will usually be assigned to come and investigate the damages. Here is where it gets tricky.     Who is the adjuster at your front door?  There are several types of adjusters that can show up to investigate your claim. Depending on your insurance company’s claims handling practices, they fall into two categories… a company adjuster, and an independent adjuster. This seems fairly simple, but it is important that you know who you are dealing with and what qualifications and authority they bring with them.
The company adjuster will usually come with proper identification and maybe even a company car or logo on their shirt.
The independent adjuster is not an employee of the insurance company, but rather an independent third party contractor. They will usually show up and identify themselves as such and produce a business card, letting you know that they are there to investigate the claim for the insurance company.
These differences are subtle, but important.
In Arizona and other states, the company adjuster does not need to have a license to perform his duties because he falls under the authority of the insurance company’s license. The independent adjuster is a different story. They must have a license issued from the Arizona department of insurance and it must be current  for them to act in the capacity of an adjuster to evaluate your claim.  The information that these two types of adjusters relay to the insurance company should be the same, but as you will later find, the way the insurance companies use this information can greatly affect your claim.
The company adjuster’s “scope of repairs” is a document that the company will use to pay for damages sustained. It is a final document that usually does not receive review beyond a cursory review after the fact.  This review is more for the benefit of the insurance company than yours, as the reviewers are looking for methodology and company policy violations, rather than searching for missed details about your claim. Many company adjusters in an effort to provide better customer service actually cut you a check on the spot and try to get you to sign release papers closing out the claim.
The independent adjuster’s “scope of repairs”, is treated differently by the insurance company.  Their “scope” is turned into the insurance company, and becomes nothing more than a recommendation for the insurance company to evaluate. The independent adjuster does not have authority to adjust the claim, or settle the claim, just to provide their recommendation for repairs.
The actual adjuster for your claim (if an independent adjuster is used) is commonly referred to as a “desk adjuster” and will only see your claim through the eyes of the independent adjuster’s scope of repairs.  The desk adjuster, armed with the independent adjuster’s scope, will apply the policy language for coverage and make payment from there. It is not uncommon for the desk adjuster to remove items from the independent adjuster’s scope for various reasons. The most common is usually coverage issues, and others are usually methodologies for reconstruction, or simply because the desk adjuster feels that the claimed amount is in excess of what would be considered “normal” for that specified peril.
Just as you would ask a surgeon about his qualifications before he performed any surgical procedure on you, it is also important for you to know who the adjuster is at your front door, what his qualifications are and what authority he has.
Why is this so important?
Recently while on an Allstate claim, an adjuster showed up driving an Allstate car, wearing an Allstate logo t-shirt and spoke about policy coverage issues with authority. It was not until well into our discussion that it was revealed that he was not an Allstate adjuster at all, but an independent third party adjuster, sent out with an Allstate logo car and shirt.  Without us probing for his qualifications and authority he would have come and gone without us knowing that we had actually not dealt with an Allstate employee at all. When he was asked for a business card all he would provide was a phone number to Allstate’s claim department. When asked where his company’s offices were located, he informed us that they were located right inside Allstate’s office. While there may not be anything illegal about this, we felt deceived and lost trust for Allstate and this adjuster.
The knowledge required to traverse the claims process and understand the coverage afforded you in your insurance contract is vast.  At the beginning of this post, I made reference to the first thing you do once you have discovered damage to your property. An informed consumer will hire a licensed “public adjuster” at the beginning of any claim to help them navigate through these treacherous waters.
The public adjuster is the only adjuster who can represent you and your claim to the insurance company.  In Arizona and most other states, public adjusters must be licensed, and in some instances carry a bond for their performance.  Public adjusters understand the claims process and can help you recover from your loss with the full value of the claim.
So when the adjuster from the insurance company shows up at your front door, whether he be a company adjuster or a third party independent adjuster, have him be met on your side of the door by someone who has dealt professionally with insurance claims before. A licensed public adjuster.
Hudson Douglas Public Adjusters is a team of licensed public adjusters who can help you through the insurance claims process. We look forward to helping you out.

Wednesday, November 27, 2013

Public Adjusting – Your Right to Representation

Recently, in a public adjusting conference, I listened to a man who was an insurance adjuster for a large carrier. He spoke about how he was encouraged to discourage people from using public adjusters. He stated that California law provides for a 3 day right of rescission in which a contract with a service provider (including a public adjuster) may be cancelled in some cases. He reported that he often would use the argument that people could just wait until after the insurance company had come out with their offer to decide whether or not to use a public adjuster. While on its face this may actually seem to be a reasonable plan, it definitely works to the advantage of the insurance company. Like any negotiation, and make no mistake, the insurance claim settlement process is a negotiation, a policyholder may definitely benefit from the services of their own insurance expert to assist them. When dealing with what is likely your largest asset (your home), you would always engage a realtor when buying or selling a home? Why would you not engage a professional when negotiating for the repair of this asset? Likewise, when it comes to legal matters they say “a man who represents himself has a fool for a client”. Most people know the difference between right and wrong, but still there are many intricacies in an insurance policy that most people are not familiar with. Again it makes sense that a policy holder would benefit from the experience of a public adjuster who has experience with the policy and the claims handling process. Not only does it make sense to have an expert working on your behalf, but the law ensures and protects a policyholder’s right to professional representation.
Right to Representation:
In your state there is most likely a law which states that if you have an insurance claim you can have a professional represent you in settling that claim with your insurance company. In the Arizona Revised Statues that law is ARS 20-321 which states that an adjuster is “any person who for compensation, fee or commission adjusts, investigates or negotiates settlement of claims arising under insurance contracts on behalf of either the insurer or the insured.”
The adjuster must be licensed in the particular state in which representation is offered. This is also required by state law and in Arizona is in section 20-321.01. Licensing of adjusters; qualifications; exemption
A. A person shall not act as or claim to be an adjuster unless the person is licensed under this article.
In short, a contractor or other person is directed by law not to negotiate an insurance settlement or even present themselves to do so without being properly licensed by the state. The policy holder may engage representation to assist in the settlement of an insurance claim provided that the individual who is engaged for that representation is licensed to do so.
Right to negotiate with the insurer:
Also included in many insurance policies the insurer has the duty to negotiate the claim with the policy holder or their designated representative. One example for a policy is the following under the section for LOSS PAYMENT:
I. Loss Payment
“We will adjust all loses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment.”
Simply stated, the insurance company does not have the right to come in and simply tell the policy holder what it will and won’t pay. The policy stated that all losses will be adjusted with the policyholder (or its legal representation). The online Miriam Webster’s Dictionary defines the word “adjust” as determining the amount to be paid under an insurance policy in settlement of a loss. A policy holder should remember that their damage claim is an actual claim on the assets of the insurance company and that the amount for which the insurance company needs to pay in order to indemnify the policy holder under the contract of insurance is to be worked out together with the policy holder and not unilaterally handed down from the insurance company without negotiation form the policy holder.
What is Representation by a public adjuster?
Representation by a public adjuster is legal representation, but only within the narrow confines of negotiating the settlement of an insurance claim. Public adjusters do not give legal advice. You must consult an attorney for legal advice. A public adjuster will however, get between and your insurance company and negotiate a settlement for your damages. This means that your public adjuster will speak to your insurance company and that you should direct all inquiries from you insurance company to the public adjuster. The insurance company may exercise its contractual right to schedule a recorded statement from the policy holder, but your public adjuster, in most cases, is allowed to be there with you.

Who Represents the Insurance Company?
Insurance companies employ adjusters whose job is to reach settlement in the case of damage under a policy. Many times an insurance company will also hire an independent adjuster who will work with a public adjuster or even a home owner in the field to adjust the claim, but this is only an investigative exercise on the part of the carrier. Independent adjusters frequently state this when they inform the claimant that they “have no authority to settle the claim” and that their recommendations will be passed on to the carrier. As evidence that the carrier makes the final decision as to what their offer will be to the policy holder, often the carrier (insurer) may alter the recommendations of the independent adjuster or instruct the independent adjuster to do so. This occurs even when the carrier’s in house adjuster has never even been to the location where the claim is located to gain firsthand knowledge or spoken with the policy holder or their public adjuster. When this occurs, the carrier is not negotiating in good faith as they are not adjusting the claim with the policy holder or their representatives, but are making isolated decisions for settlement on their own without direct input from the other interested party. A public adjuster should make every effort to make contact with the carrier in such cases, to argue for a fair settlement.


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