Staying up-to-date with the ever-evolving state insurance market is paramount for homeowners in Florida. Anyone insured through Citizens Property Insurance Corporation should be aware of a critical development that requires immediate attention: the introduction of a mandatory flood insurance requirement. This measure aims to provide additional protection against flood-related damages but may impact some homeowners ability to afford coverage.
Discover the hidden clauses in your insurance policy that could limit your rights. Our latest blog post shines a light on the anti-public adjuster endorsement. Learn how these endorsements work, their implications, and how we can help. Don't let complex language stand in the way of your protection. Read more about your rights and how to ensure you're fully covered.
It's in our nature to help people in any way we can, and as the track of Hurricane Sally continued to shift east before making landfall, our public adjusters made preparations to respond in Pensacola if the need should arise.
Several hotel reservations were made throughout the area in case power was knocked out or damage was widespread like we saw in the aftermath of Hurricane Michael in Panama City in 2018.
As it turned out, the storm made landfall just about right on the Florida-Georgia line. Our public adjusters immediately mobilized and went to help.
Hurricane Sally made landfall as a Category 2 storm and took its sweet time passing through. Although the winds weren't incredible like the ones from Hurricane Michael, the length of time it spent in the area allowed those winds to do some damages. The whole area saw downed trees and many areas were without power for quite some time. Our public adjusters have also observed missing shingles and damaged roofs, as well as damage caused by projectiles.
Closer to the coast and along the water, there was significant damage caused by storm surge and flooding, causing many businesses along the beach, in downtown, and in Perdido Key to have to shut down for repairs.
VIP Adjusting's public adjusters remain ready, willing, and able to assist homeowners who have sustained damage from the storm with making sure they're fairly paid by their insurance company. That’s our job; to be a check on your insurance company and make sure they’re looking out for you instead of their own interests.
We know there's a big military presence in and around Pensacola and that many service members are insured by USAA. Just because an insurance company insures service members and their families does not mean they are perfect, and we are happy to provide a free claim review to anyone who has received an undisputed payment, and we're also happy to provide references from Panama City whose USAA claims we helped them with.
In addition to homeowners, our public adjusters have experience with commercial building and construction that is invaluable for evaluating commercial insurance claims, and we've handled a number of business interruption claims from multiple storms.
Unfortunately, as much as we'd like to help all storm victims, Alabama prohibits public adjusting, and although there's significant damage across the Florida border, our services will be offered for Florida residents only.
If you or a loved one have a home or business that's sustained damage in the Pensacola area, VIP Adjusting's public adjusters are happy to provide a free claim evaluation and consultation. Please call today, or contact us, and we'll be more than willing to discuss.
It's no secret. Insurance companies hate paying claims, and it's no different throughout Florida when a home or commercial building is damaged by a sudden and accidental event.
If the damage is so significant that the home may be a total loss, or a federal, state or local building code or regulation requires the property be rebuilt, it's no longer a time to nitpick the amount of the loss.
In the experience of our public adjusters, insurance companies often ignore this law when this type of damage occurs, and it's more important than ever to have someone in your corner looking out for you.
What is the Valued Policy Law? Fla. Stat. 627.702 says that "in the event of the total loss of any building, structure, mobile home..or manufactured building...in the absence of fraudulent or criminal fault on the part of the insured or on acting [on their] behalf, the insurer's liability under the policy for such total loss, if caused by a covered peril, shall be in the amount of money for which such property was so insured as specified in the policy and for which a premium has been charged and paid."
What does that mean? Well, it means the if you're in Florida and you have property insurance and the property is a total loss because of a peril covered by the insurance policy, then the insurance company is supposed to pay you the policy limit listed on the insurance policy's declaration page.
Florida's Valued Policy Law dates back to 1899 and in short is a way to fix the price of a total loss so that an insurance company isn't withholding 90% of the insurance proceeds for months and months (or force a homeowner into litigation) to say the property was either overinsured or underinsured.
It's worth noting that the Valued Policy Law does not apply when there's blanket coverage when two or more buildings are insured under a singular combined limit of insurance, but our public adjusters can check your policy for you and verify this.
Florida's Valued Policy Law doesn't specifically define the term "total loss" and that’s part of the reason insurance companies largely ignore it. Luckily, Florida's courts have defined the term and it can either have to do with the types and amount of damage to the home or building, the feasibility of repair, the application of laws, codes, and ordinances to the repairs, or all three.
When evaluating the damages, the courts have created an "identity test" and a "restoration test" to evaluate whether a total loss exists under the VPL. For application of codes and ordinances, the courts have defined total loss under the "constructive total loss" test.
The "identity test" to determine if a structure is a total loss says that if the damage to the structure is so severe that it has lost its identity and character as a building, even though a portion of the building's components remain and could be utilized for some useful purpose, then the property is a total loss.
This is a debatable test and can justify a dispute between your public adjuster and the insurance company. The property doesn't need to be a pile of rubble, but if the damages are so significant that the building isn't recognizable as the same building, even if parts of it are usable, then the identity test may apply.
When looking at the before and after images of a home damaged by Hurricane Michael to the right, the insurance company tried to argue that because the home was still the same basic shape, it didn’t meet the criteria of the identity test.
Satellite image of a home in Panama City prior to Hurricane Michael in October 2018
The same home via drone after Hurricane Michael had caused damage, knocking down several exterior walls
The "restoration test" is also subjective to some extent and is open for debate, but it is more clearly defined that a structure is a total loss if a reasonably prudent owner would not use the remains of the structure after the loss as a basis for restoring the building to its pre-loss condition.
This can mean a couple of different things, and your public adjuster can assist with these evaluations and make these arguments to your insurance company. It could mean that it costs more to repair the home than to demolish and rebuild, or it could mean that some components or structural elements of the property are questionable to include in repairs. This often happens either after a fire, where structural components were exposed to intense heat, or in the aftermath of a hurricane where huge wind forces or flood waters affected the building, but these aren't the only situations.
In addition to the damage pictured to the home above, the missing roof, the knocked down exterior walls, the cracked and leaning remaining exterior walls, and the water and mold in every building material “inside” what used to be the home, the wind also applied so much force to the hot water heater that it broke several copper plumbing lines inside the poured slab which would require significant trenching of the slab to repair.
A "constructive total loss" is the most definitive way to apply the Valued Policy Law. Under the "constructive total loss" test a building is a total loss when it is damaged by a covered peril and an ordinance or regulation prevents repair.
The most common occurrence and application of this test is related to elevation requirements, either locally, or through FEMA's regulations regarding the National Flood Insurance Program.
Many areas of Florida, in response to a rise in sea level, are requiring homes be built at certain elevations. If a building pre-dated this regulation, once significant repairs are required because of a covered loss, the building department may require the home to be rebuilt at a higher elevation. This would be a constructive total loss. This is common in the Florida Keys, but also happens on throughout Florida for beachfront homes or properties on barrier islands, such as Jensen Beach.
More common than a local building requirement is the regulations from FEMA and the NFIP where, in order to be eligible for flood insurance, a home must be a certain amount above the areas Base Flood Elevation. Our public adjusters see these types of claims in the aftermath of hurricanes all the time. If a home sustains "substantial damage" exceeding 50% of the property's appraised value, then the property is required to be brought in compliance with the current regulations as the the base flood elevation.
Substantial Damage Determination from a local building department
In addition to a hurricane, the constructive total loss test may come into play relatively easily for a mobile or manufactured home that is appraised at a relatively low value and might have a significantly lower policy limit.
There's a lot to evaluate to determine whether damage to your home constitutes a total loss justifying the payment of your insurance policy's limits. Our public adjusters have been through these situations many times and can explain the process as it applies to your specific situation, and present information to your insurance company on your behalf. If you think your home may have sustained enough damage to constitute a total loss, call or contact VIP Adjusting's public adjusters today for a free claim review.
You might also be interested in:
Hurricane and windstorm claims
More reasons you should hire a public adjuster
If your home is a total loss, the homeowners insurance deductible should be absorbed
Over the past decade, Florida residents have seen a lot of changes to insurance policies and a lot of roof leaks that caused damage, both because roofs have aged, and because of a number of storms.
In the early 2010's many insurance companies got tired of repeated claims for damage caused by roof leaks and started to change their policies, but not all insurance companies followed suit. If you've had a roof leak, whether or not there is coverage is highly dependent on what your policy says.
VIP Adjusting's public adjusters will gladly provide a free policy review, but in the meantime, let's discuss a little more.
We've discussed this a few times, but the most common homeowners insurance policy is a form HO-3, often referred to as an "all risk" policy. This just means that the base homeowners insurance policy covers all "direct physical loss" or all "sudden and accidental loss" to the home and then excludes coverage from there.
If you have the broadest of insurance this standard Florida homeowners insurance policy, chances are a roof leak is covered, but unless the roof is first damaged by a covered loss, will likely not be replaced by the insurance company.
Hurricane Andrew hit south Florida in 1992. Hurricanes Charley, Frances, and Jeanne affected the Treasure Coast in 2004 with Frances and Jeanne making landfall in almost the exact same locations of Hutchinson Island, Sewall's Point, Stewart and Port St Lucie. 2005 saw Hurricanes Katrina make a Florida Landfall and then Wlima making landfall, both affecting the Treasure Coast as well.
Needless to say, this was a tough stretch for Florida roofs and St Lucie homeowners, and at the same time, in the 2008 to 2011 range roofs all across the state started to fail both from old age and as a result of the delayed appearance of damage from the 2004 and 2005 hurricanes.
At the time, nearly all homeowners insurance policies covered roof leaks under an exclusion for wear and tear, aging, lack of maintenance, etc, that said even though the roof failure for these reasons was not covered, the "ensuing water damage" was covered.
With the statute of limitations expiring on the 2004 and 2005 storms, and in the middle of a historic run without a Florida landfall by a hurricane, the insurance companies were seeing homeowners making a claim for a roof leak, holding the money, making another claim for another roof leak, holding the money, and repeating until they had enough money from the multiple claims to fully replace the roof that wasn't covered by the insurance policy.
Understandably unhappy with this practice, insurance companies sought to put limiting language in the insurance policies that would prevent this claims practice by homeowners.
One insurance company produced new policy language that was added as a "Florida Change" to its HO-3 insurance policies that read the insurance company does not cover loss for rain that enters the dwelling unless the exterior of the building is first damaged by a covered peril. That means no claims for roof leaks for old roofs. No claims for damage caused by water from leaking window seals. No water entering the property from outside unless the building is damaged.
Almost every insurance company in Florida followed suit. The language varies from policy to policy. Some insurance policies say the roof or walls must be damaged by wind or hail. Sometimes they say the exterior needs to be damaged by a covered peril. It's important to review your policy with your insurance agent or a public adjuster because this language could get you in trouble if you'd had damage.
If you were lucky enough to have one of the insurance companies that didn't adopt this language, then you might have coverage for a regular roof leak due to a general failure of the roof, old age, wear and tear, lack of maintenance, or poor installation. We can count the number of Florida insurance companies on one hand that still issue these policies, though, and we still check the policies every time to make sure they haven't started with the exclusionary language.
VIP Adjusting's public adjusters are happy to go through your policy and provide a free review at any time.
Outside of having one of the good insurance policies, a roof leak would typically only be covered if your roof is damaged by a windstorm, hail, a fallen tree or tree branch, or, believe it or not, sometimes we see roofs damaged by stray bullets from people firing guns into the air on New Year's Eve or Fourth of July.
If you've found yourself on the wrong end of a roof leak, with damage to your property from rain entering the property, call or contact VIP Adjusting's public adjusters today for a free claim review.
You might also be interested in:
Hurricane Irma made landfall in Cudjoe Key, Florida and then proceeded to run south to north while its huge wind field was causing damage across the entire state. Hurricane force winds were nearly the width of the entire state while tropical storm force winds extended hundreds of miles further.
The deadline for filing a new or supplemental claim for that damage is three years from the date of the storm, and at this point you’d almost certainly need the help of an experienced public adjuster. Here’s what you need to know:
Fla. Stat. 627.70132 says that insureds have three years after the storm first made landfall to make new, supplemental, or reopened claims for property damage. This means that if you have damage, you need to let the insurance company know by September 9th, 2020, or else you’ll be forever barred from making that claim.
This statute, though, is not the statute of limitations for storm claims. If your claim has been reported prior to September 9th, 2020, Fla. Stat. 95.11 provides you five years from the date of loss to file a lawsuit for breach of the insurance contract. Because of the first statute, though, it’s basically a two-step process, where the insurance company needs to be first notified, and that deadline is fast approaching.
Your insurance policy requires you to provide the insurance company with “prompt notice” following discovery of damage. If your insurance company can’t figure out what happened that caused the damage because you were slow to act, it can jeopardize coverage for your claim entirely.
Many insurance companies will say “Late Notice” while pointing a finger at you, simply referring to the time that has passed in order to set up a potential defense, even though that’s only half the story.
Often times, damage caused by a hurricane can be latent, or hidden from view, justifying the delays in reporting. After all, you can’t report damages you didn’t see and didn’t know existed. If the damages are consistent with wind damage and there have been no other storms, a forensic engineer can evaluate whether or not the damages you’ve discovered are likely to have been caused by hurricane Irma with a degree of certainty.
With the deadline to report claims approaching, if you don’t believe you had damage from the storm, and your roof hasn’t recently sprung a leak, it can still be to your advantage to put eyes on the roofs surface. If you' haven’t been on the roof in years, it might be time to take a look, or if that’s not in your wheelhouse, have a professional take a look for you. You can have a roofer or handyman, or you can call the public adjusters at VIP Adjusting to check it for you.
Any roof that isn’t brand new could have some wear or broken tiles from being exposed to the elements (and Florida sun) for years. A couple of chipped tiles or broken corners isn’t usually indicative of windstorm damage. Many broken tiles or tiles that are loose can be a sign that your roof suffered damage from our last hurricane.
Ridge caps may be loose, or a uplift test can tell is tiles are no longer properly attached to roofs, or significant signs of cracking and breaks could indicate damage from hurricane Irma. If you have a shingle roof, significant granule loss could have resulted from the storm, and in the time since, the asphalt shingles will have baked in the sun and become incredibly brittle.
In any event, time is running out. If you think your roof has been compromised, VIP Adjusting’s public adjusters would be happy to schedule a free inspection anywhere from the Treasure Coast to the Space Coast.
If your roof leaks two weeks from now and you discover storm damages, it may already be too late!
You might also be interested in:
More about property damage claims from windstorm or hurricane
Almost all insurance policies contain deductibles, and your homeowners insurance or commercial property insurance policies are no different, but the application of those deductibles can be confusing.
VIP Adjusting’s public adjusters have come across countless situations where even the people working for the insurance company can make mistakes and misapply the deductible.
A deductible can be looked at in any number of different ways for your homeowners insurance or other property insurance, but essentially, it’s the insured’s responsibility to participate in the claim. It can be considered a type of co-insurance, but ultimately, it just means the insured is responsible for participating in at least an amount equal to the deductible.
Homeowners insurance policies in Florida usually carry a deductible of either $500, $1,000, $2,500, $5,000 or in the case of a hurricane, the deductible would likely be a percentage of the policy limit. The hurricane deductible is usually significantly higher than the “all other perils” deductible.
Before the time comes to make a claim, or there’s even damage to a property, an insured homeowner should be aware of their deductible and make an effort to have at least this amount in an emergency savings account.
One of the purposes of a deductible is so that if there is a covered loss to a home, but it isn’t really anything major (the example we usually use is a small hole being knocked in the wall), the insured isn’t calling their insurance company every couple weeks just because they have rambunctious kids. That financial obligation for the homeowner in the event of a claim for property damage also should encourage the homeowner to be more responsible too, since they have some skin in the game, so to speak.
The deductible can actually be applied or accounted for in a couple of different ways. The most common way the deductible is applied for a Florida property insurance claim is to subtract that number from the Coverage A (dwelling coverage) amount.
This method is usually most convenient for everyone involved because it’s usually the portion with the largest damage and makes the least impact on the homeowner. Instead of coming up with the deductible up front, the homeowner would then only have to figure out how to pay the amount at the end of repairs because they can use the insurance proceeds to pay the rest up front (assuming they’ve been paid fairly).
Subtracting the deductible from the Coverage A payment is also convenient because the mortgage company will be listed on this check and may be slow to process the insurance claim checks. If there are claims for additional living expenses, loss of use, or contents, those checks would come directly to the insured and could be deposited immediately to allow the homeowner to use these proceeds interchangeably with the dwelling payment, making the funds more liquid.
There are other less common ways to apply the deductible, though. Some insurance companies will apply the deductible to these other coverages. Unless your insurance policy specifies, it’s really up to the insured and insurer to agree on these things, and if there’s a dispute or confusion, a public adjuster would be able to assist you in this situation.
Another less common method of applying the deductible is for the insured to actually pay the deductible up front. This can mean you pay it to the insurance company (we think this is stupid because if they’re going to issue you a payment, you giving them money and them giving you back money is just the same as subtracting it from the total claim amount, but with more steps, even though we’ve seen it done this way anyways...), or the more common of this scenario is for you to pay your deductible to a contractor up front. This could mean, for example, if you have a water mitigation contractor perform drying services that cost $5,000, and you pay your $2,500 deductible to that contractor, the insurance company would only pay the remaining $2,500 of that bill, and your Coverage A Dwelling, contents, and additional living expenses/loss of use payments would all come without any further deduction.
Ok, ok, so technically, there is no such thing as “absorbing” the deductible. That’s more of a colloquial term for “applying the deductible to amounts in excess of the policy limits.” That more accurate description gives a hint into what needs to happen for the deductible to be “absorbed.” You have to have losses in excess of the policy limits.
That does NOT mean that your property has to be a total loss, though. Florida homeowners insurance policies have multiple coverages, including “other structures” which are usually limited to 10% of the Coverage A Dwelling limit, and include things like fences, sheds, and other similar structures. Coverage B limits are usually easily exceeded in the aftermath of a hurricane.
There are also coverages for additional living expenses (which sometimes have monthly limits you may exceed) and contents. Florida property insurance policies also contain a number of sub-limits for certain items. Mold usually has a $10,000 sub-limit that can be relatively easy to exceed. There are also sub-limits for landscaping damages, and trees which can be easily exceeded following a storm. These are the most common sub-limits but your policy certainly has a number of these types of special limits that your public adjuster can review and discuss with you.
Now, on to this concept of absorbing the deductible. If you have insured losses that exceed a policy limit, then you, as the insured, are not only covering the amount you’re required to cover to obtain coverage (also known as the deductible), but you’re actually contributing even more than you’re required because there are losses over the limit. For example, if you have a mold remediation as part of your claim that costs $20,000, the policy limit is $10,000, in order to complete it, you have to pay the other $10,000 which more than meets your $2,500 deductible.
If you’ve got this kind of out of pocket cost for insured losses, it would be improper and inequitable for your insurance company to then deduct an additional $2,500 from another coverage. Believe it or not, our public adjusters have written statements from desk adjusters at one company stating that despite this concept, their company policy is to incorrectly apply the deductible.
Another way to look at this concept is that if there wasn’t a way to absorb the deductible, then the insurance company would never actually have to pay the policy limits. If you have a home that costs $250,000 to rebuild and there was a total loss caused by fire, the insurance company would only have to pay $247,500. That may seem like a drop in the bucket in that example, but it’s not what the insuring agreement says (and Florida’s Valued Policy Law says the limits are to be paid, but that’s for another post).
It would cause a whole lot more problems if the insurance policy was for a mobile home or manufactured home and the policy limits were only $15,000. In the event of a total loss on that policy, the limits should be paid, just as any other policy, but improperly applying the deductible can leave the insured really hurting out of pocket.
That’s the important part of this concept. The insured’s participation out of pocket. It’s required to be at least the amount of the deductible, and once that threshold is met, the policy is supposed to pay the actual amount of the loss to restore the insured to pre-loss condition.
We know these concepts can be complicated and this just adds on to the list of why having a public adjuster in your corner can be invaluable. When the insurance company’s first priority is to its shareholders, it pays to have your own professional looking out for your best interests.
If you are a homeowner or business owner in Martin County, St. Lucie County, Indian River County, or Brevard County, from Hobe Sound to White City, to Indian River Shores, to Palm Bay and Melbourne, VIP Adjusting’s public adjusters are standing by to assist you with your property damage insurance claim needs. Call now or contact us for a free consultation.
The relationship between a landlord and tenant can range anywhere from very good, to a passive business relationship, to outright contentious. If a tenant doesn't respect the landlord's property, or a contentious relationship manifests itself physically and revenge turns into property damage, you might have grounds to make an insurance claim for that damage, and possibly even loss of use if the property is uninhabitable because of the damage and you’ve lost rental income.
An experienced local public adjuster can review your insurance policy and compare it to the specific situation you might find yourself in. VIP Adjusting's public adjusters are based in Port St Lucie, and handle property insurance claims throughout Florida's Treasure Coast, including claims for damage to rental properties.
Homeowners insurance for rental properties in Florida are relatively similar to homeowners insurance policies for owner occupied dwellings. They require disclosure of occupancy as a rental property, though you'll find the major difference in coverage for contents.
The dwelling/building coverages are almost identical. A standard homeowners insurance policy for an owner occupied dwelling is an HO-3 or "all risk" policy, which means the policy covers all direct physical loss, and then limits coverage from there. The corresponding policy for landlords insuring rental properties is a DP-3 policy, or "Dwelling Policy" form 3. It shares the language for the dwelling with an HO-3 and is also an all-risk policy.
A DP-3 policy for landlords may have limited, or no coverage for personal property or contents. This is important to discuss with your insurance agent in advance so that you aren't renting a furnished property without the proper coverage. Many landlord policies do cover landlord's furnishings. Again, this an issue you should check with your insurance agent or insurance broker on before you find yourself with property damage and having to make a claim.
There is also a less popular, and lesser quality policy for landlords, a DP-1 policy. It's cheaper and that gets some people to fall for the trap, because it really is an inferior policy that only covers a list of what are referred to as "named perils."
For purposes of the information in this post, we'll assume a landlord has the more common DP-3 all risk policy.
Insurance policies have specific exclusions for wear and tear and other age related factors, because homeowners insurance is meant to cover direct physical loss and accidental damage to property. Insurance is not meant to upgrade or remodel your home, or to take care of overdue maintenance. If the carpets are getting old, that's not something your insurance policy is meant to pay to replace.
Likewise, what's sometimes referred to as "hard living" is not covered by property insurance. Anything that would normally be considered something that would be covered by the security deposit (although the security deposit would also apply to items beyond this type of damage, including your deductible if you need to make a claim) is typically not covered by your insurance policy. Worn and stained cabinets wouldn't be covered by your insurance, or scuffs on tiles, excessive cleaning, worn paint or dirty walls. These types of things might be the tenant's responsibility, but likely not your insurance company.
We've handled a number of claims for damages caused by tenants to a landlord's rental property. The two most common scenarios for these are damages caused by parties or party related activities, and angry tenants who have had a dispute with the landlord or been evicted, and before leaving the property have attempted some kind of revenge.
Some of the damages we've seen related to the type from parties or partying would be sizable holes in walls, cigarette burns to carpets (and sometimes fire or smoke damage if that isn't noticed right away), broken tiles from dropped objects, and, believe it or not, we've seen damaged roofs, decks, and patios from shenanigans related to pool parties.
Sometimes the landlord tenant relationship can become incredibly vindictive and the tenant, in possession of the property may seek their metaphorical pound of flesh. Claims VIP Adjusting's public adjusters have handled from tenant damage have included smashed and broken tiles, stolen appliances, ripped screens and broken windows, holes in drywall and plaster, broken pipes (and related leaks), and damaged AC units are the most common. We've also seen a number of bullet holes.
We have also handled a large commercial tenant vandalism claim over space related to a supermarket where the former tenant, after obtaining a new location and in order to protect their own business from a competitor went through the building destroying fixtures and utility hook ups, flushed concrete down the building's toilets, stole the air conditioning units on the roof, and poked holes in the roofing membrane.
If a building has sustained significant enough damage that it's no longer habitable, your policy may cover lost income from the inability to rent (or in a commercial policy, business interruption coverage), but only if certain conditions are met and only for certain time periods. This is one of the reasons assistance from an experienced public adjuster can be the difference in your claim. Lost rental income can exceed the damages to the property and can quickly become the driving point of a claim, putting your investment in the property itself at risk.
If you've found yourself in a situation where your former tenant has caused damage to your rental property, call or contact VIP Adjusting today for a free claim review.
You might also be interested in:
More info about the background of VIP Adjusting’s public adjusters
VIP Adjusting obviously recommends that you hire an experienced public adjuster to assist you in pursuing your claim for damage to your home so that the process can be explained to you all along, but in the event you haven't done that, it's important to know who all of the people associated with your insurance claim are.
As complicated as the insurance claim process can be, it can easily become confusing who is who, and what each person can (and cannot) do for you.
We'll start with perhaps the most important person, the "desk adjuster." The insurance company's desk adjuster is the individual assigned to review your insurance claim in-house, including all the photographs, documents, measurements, estimates (both from the independent adjuster and your public adjuster or general contractor). This person usually has not been to the property and works in an office, exclusively reviewing claims.
The desk adjuster might also be referred to as the "inside adjuster" because they're the person at the insurance company who reviews the claim and makes a recommendation on whether to extend coverage for a claim, and how much to pay.
The desk adjuster often is in charge of editing (read: reducing) the estimate prepared by the independent adjuster according to internal adjusting standards.
The person assigned as the desk adjuster usually also has final authority to settle your claim in-full, subject to internal standards, of course. Sometimes separate authority is needed for claims over certain amounts.
The field adjuster is the individual who actually comes to your home and inspects the damages. This person may or may not be a direct employee of the insurance company, and their motives may not always be known.
The field adjuster is in charge of taking photographs, measurements, and preparing an estimate. As previously mentioned, the field adjuster's estimate may not be the amount of the payment, because it is subject to review and modification by the desk adjuster.
Field adjusters may say things at the property that bind the insurance company. Statements that they're accepting coverage or will pay for certain items are binding on the insurance company, as these individuals have what's referred to as "apparent authority" even if the insurance company tries to claim they have no authority. This is another reason having a public adjuster present at these inspections can be in your favor, and this may become a very contentious subject if the claim requires a lawsuit at a later date.
An independent adjuster is a field adjuster, but they usually aren't a direct employee of the insurance company. Independent adjusters have a certain license in Florida that allows them to work for insurance companies adjusting claims. They may work for themselves, or they may work for a third party adjusting company. They may only handle claims for one insurance company, or may work for several insurance companies.
Since the independent adjuster's financial interests aren't always known, it's not always possible to know how happy they want to keep your insurance company if they appreciate their paycheck. Yet another reason to have an experienced public adjuster in your corner looking out for your best interests and protecting the value of your claim.
Claim examiner is another name for the desk adjuster.
Ready for us to blow your mind though? Sometimes the people involved in your claim can have multiple roles and these words can be used interchangeably. Sometimes, the desk adjuster/claim examiner can be one in the same as the independent adjuster/field adjuster.
A third party administrator as it pertains to a homeowners insurance company in Florida is an outsourced claims handling operation. Some insurance companies don't have their own in-house claims departments. Certain Underwriters at Lloyd's of London is one such insurance company (technically, Lloyd's isn't an insurance company but a collection of underwriters, but that's another story). Since Lloyd's doesn't have their own claims department, you would report your claim to your agent, who would follow some procedure internal to whichever underwriter holds your insurance policy, and that underwriter would outsource the roles of the claim examiner/desk adjuster and independent adjuster/field adjuster to a third party claim company.
Other times, third party administrators are used by insurance companies who do have in-house claims staff, but who either have more claims than they can handle (like in the aftermath of a hurricane or other natural disaster), or may use a TPA when reviewing a dispute to try to reasonably resolve the claim.
This is a catch-all term and can refer to any one of the terms so far above. This term is often used by insurance companies who like to send out unsigned letters, usually insignificant, like acknowledging a claim, or acknowledging receipt of a communication related to a claim. Other insurance companies use this term as a cowardly way to send out boilerplate document requests, or to make a letter impossible to respond to.
This is another catch-all term and could be used like Claim Representative above, but is more often just a call center employee who can give you basic information about your claim but has no authority to discuss the merits of your claim.
These people are sometimes used to placate homeowners who call a lot to prevent them from wasting the time of people who actually move the claims forward, and other times these people are used to frustrate claimants and prevent them from speaking to the people who are handling the claim.
Sometimes insurance companies will use the term "manager" to make it seem like they are set up like other customer service industries. 99% of the time that is not the case.
You aren't calling AT&T or Comcast when you call your insurance company. You can't ask to speak to "the manager" when you don't like your payment or don't approve of the decisions, behavior, or professionalism of the desk adjuster/claims examiner, but this person usually doesn't have any authority to overrule the desk adjuster or claims examiner because that's the person in charge of your claim. If you speak to a "manager" you're just being strung along.
We put "manager" in quotation marks because there actually are managers but they're usually behind-the-curtain type folks whose approval is required for claims over certain values. You'll never speak to this person.
A litigation manager for an insurance company is the person assigned by the insurance company to represent them as their face if you have to sue to overturn a denied homeowners insurance claim or to challenge a dispute in scope or pricing for a claim. This person is usually very experienced in litigation and often knows what they're doing. Sometimes this person is even an attorney.
You might meet this person if you attend the deposition of the insurance company's corporate representative in connection with litigation, or if you attend a mediation or trial.
An appraiser is an individual, usually required to have some sort of competency, to represent an insured or insurer in the appraisal process to resolve a dispute over the amount of a homeowners insurance claim. An appraiser advocates for the party who assigned them, either homeowner or insurance company, but also works to try to reach an agreeable resolution for the claim.
An umpire is a third-party neutral in the appraisal process. This person is unbiased and if the insurance company and homeowner's appraisers can't reach a resolution on their own, he or she would be available to break the tie by either deciding in one of the two appraisers favor, or somewhere in between. An umpire is a bit like an arbitrator.
If you’ve found yourself handling your own claim with a rotating cast of characters and feel like you’ve been given the run around, call VIP Adjusting today to speak to one of our public adjusters for a free claim review and consultation.
A good landlord insurance policy is essential to the smooth running of a rental property. Although property owners tend to view the premiums as a necessary evil, it makes good business sense to have adequate landlord insurance.
It can save landlords from paying the penalties for many damaging events that can occur in a rental. However, when buying insurance, landlords should also endeavor to get the most coverage at the lowest premium.
They can do this by finding out what insurance claims property owners are most likely to make. And having known what these claims are, they should strive to avoid the risk of making similar claims.
What are the most common insurance claims that landlords make?
As with every business, owning rental property comes with a measure of risk. One of those risks is that tenants in a property may stop paying rents. This can happen if some adverse event makes the home uninhabitable and the tenants move out, as a result, or simply refuse to pay the rent. Examples of events that can create such a situation include storm, flood, fire or smoke. When a property becomes uninhabitable, the landlord's rental income stops, but their bills do not. This is why loss of rental income is the number one insurance claim that property owners make.
How to avoid it:
Most loss of rent claims come from events beyond a landlord's control. Property owners cannot do anything to prevent rainstorms or floods. What they can do, however, is limit the risk of man-made events which also lead to loss of rent, such as fire or smoke damage.
This results from damage due to the unintentional discharge of water. The common cause of the problem is faulty plumbing, poor plumbing maintenance, and tenants' negligent behavior. This problem is fairly common and very costly to fix. Water damage, if left undetected, can result in massive damage to a property.
How to avoid it:
The best way to solve water issues is to prevent them. The landlord should implement a regular schedule for thorough inspection of the home's plumbing. Tenants should be properly oriented on how to manage the plumbing. And the lease agreement should include clauses on the consequences of tenant-originated water damage.
This claim results when items in the home, or some parts of the structure, are unintentionally damaged by occupants. This could be a case of damage to wooden floors, torn furniture, ripped-up carpets, or a broken television set. Accidental damage poses a risk to a rental property because it makes it less attractive to potential tenants and reduces the home's resale value.
How to avoid it:
Landlords cannot completely eliminate the chance of this happening but they can reduce it significantly. One way they can do this is by using décor that is durable and less likely to get damaged.
When installing fittings and fixtures, owners should prioritize hardiness over other qualities. A thorough vetting of tenants will also help to eliminate renters who are prone to engage in activities that increase the chance of accidental damage, such as parties.
This is damage that is intentional. It includes things like large holes in the walls, kicked-in doors, cigarette holes in furniture or some other form of blatant acts. Most of the time, malicious damage is done by outsiders, such as, visitors to a tenant's apartment. It could also result from vandalism or burglary.
How to avoid it:
The best protection against malicious damage from criminal activity is to implement appropriate security measures. Installing window grills, burglar alarms, motion detectors, and bright lights around the perimeter can deter criminals.
Having sturdy locks on gates, doors and windows, as well as CCTV cameras on the premises will reduce incidences of malicious damage. And landlords should make it the tenant's responsibility to pay for damage caused by their visitors.
Storms and floods happen all the time. When they do, they often leave their mark on a property in the form of damage. In some areas, winter storms are the major problem, in others areas, the damage is caused by strong winds.
Floods can also be the cause of damage to a property. There is not much a property owner can do about these acts of nature, except to prepare for them and possibly reduce their negative impact on the property.
How to avoid it:
The part of a building most commonly damaged by storm is the roof. To protect against the probability of roof damage, gutters and downspouts should be maintained properly. Loose and missing shingles amplify the power of wind and water to damage a roof.
They should be repaired or replaced promptly. Raising air bricks around the property and keeping electrical sockets ground will help reduce flood damage. And when there is news of an impending storm, homeowners should take extra steps to protect the home.
There’s one insurance company in particular that does it on every single claim. The claim gets reported and an automated boilerplate letter gets sent with ten or more vague document requests without anything known about the claim or if the requests are even relevant.
Other insurance companies do it, too, but there’s on in particular. Ask our public adjusters and we’ll tell you who it is, but for now, we’ll tell you how it creates unnecessary delays and could prevent you from recovering altogether.
When you submit a residential or commercial insurance claim for property damage, it’s supposed to be a two way exchange of information. The claimant or insurance policyholder is supposed to provide information relevant to the insurance claim, which includes information on causation and damages, valuation, and sometimes, prior claim history.
Likewise, an insurance company is supposed to provide information to the insured and their public adjuster as well. The insurance company should share its valuation of the damages, and other information related to its investigation, like conclusions and engineer reports, and any other information related to the claim. After all, if the claim isn’t covered loss, a homeowner still needs to stop the problem and repair the damages to make sure the home remains livable and is safe for those who visit.
When this two-way exchange of information breaks down, it invariably favors the insurance company.
A claim for water damage might get a response from the insurance company that looks like this:
We are formally requesting that you provide the following:
1) A signed, sworn statement in proof of loss and detailed repair estimate pursuant to policy language highlighted below
2) Any Emergency Mitigation Invoice/Documents
3) Any Emergency Mitigation Dry out logs & Contract
4) Any Emergency Mitigation Color Photographs
5) Any and all plumbing receipts, invoices, reports, proposals, photographs related to the alleged loss
6) Any and all receipts for repairs completed or commenced by you relative to the damages you claim arose out of the loss
7) Copies of all receipts, contracts, estimates, invoices, reports, permits, or material purchase receipts for any and all repairs, remodeling, or renovations begun/completed in the last 5 years
8) A photo of the damaged property prior to any repairs/EMS
9) Any photos or video taken by the insured (or anyone else) at time of loss
10) Water Usage Records or water bills for the preceding two years
11) Electric bills for the preceding two years
12) Condo/Homeowner Association Incident Reports
13) Prior Claim Information and proof of repairs
14) Recorded Statement of the insured
All of these requests for documentation and other actions related to an insurance claim are often followed by a regurgitation of language and provisions from the insurance policy that may or may not say you actually have to provide any of that (that’s a whole other topic entirely, but the short answer is that it is usually limited to whether or not a request is “reasonable”).
Sure, an insurance company is entitled to many of these things, but the reason that the vague requests are made in writing are twofold: first, it creates delays that favor the insurance company, and second, if you don’t respond to just one of these requests, they may try to claim later on (usually incorrectly) that if you file a lawsuit that you’ve prevented them from conducting their investigation and you shouldn’t be allowed to recover at all.
Each one of these requests is a potential landmine and it pays (pun definitely intended) to have an experienced public adjuster by your side when reviewing and responding to these requests.
The more an insurance company can drag out a claim, statistics show, the more money they save, either from the time that they hold on to your money, or that an insured will inevitably get frustrated and give up or take less.
These requests are designed to create just these types of delays that favor the insurance company.
Five years worth of documents related to home maintenance and repairs? Do you need to go back through old credit card statements for that thing you bought at Home Depot four and a half years ago? They seem to imply you should. You may not have those records in your possession or they may not even be stored online anymore and after you take the time to look and that one specific delay is over, the insurance company can later use that missing item to point the finger back at you and try to undercut your claim.
What about the utility bills? Do you even keep those? Are they stored online? If not, you might have to request them from the water company or municipality, or get power bills from Florida Power & Light (FPL). It might take 30-60 days to get copies, and every 30-60 day delay adds up in favor of your insurance company. Before you know it, your claim that was supposed to take 90 days has taken a year or more.
How about reports from a condominium association or homeowners association (HOA)? These may be helpful for your claim, but a lot of condominium associations and HOAs take a while to get you documents, or may even refuse to provide it as some type of work product, especially if the association is not professionally managed. This can put you in an indefinite holding pattern while you’re waiting for your claim to be paid. This is a tough situation to wait in while your home is damaged and you’re waiting to do repairs.
Insurance policies in Florida all have a vague provision that says no suit may be brought unless there has been full compliance with the policy. That means you can’t file a lawsuit, should the need arise because an insurance company is unreasonably delaying or hasn’t fairly paid for your claim, if you haven’t complied with the insurance policy. They may be in the wrong, but then again, technically, so are you.
As we mentioned before, a lot of those requests above are conditioned on whether or not the request is reasonable, and a lot of time the standard is whether you attempted to comply or substantially complied. For example, that Home Depot receipt from 4.5 years ago? If you at least tried to get it, but couldn’t obtain it, that doesn’t prevent you from filing a lawsuit.
The first item on the sample list above, however, the proof of loss, is almost always absolutely mandatory. Florida’s courts have routinely held that if a proof of loss is requested and you don’t provide one, your suit will be dismissed. Unfortunately for homeowners, a proof of loss can be complicated and usually requires a public adjuster or attorney to explain and assist in its completion. It’s worth noting that a general contractor cannot legally assist you in completing a proof of loss and an attempt to do so would be a felony by the contractor.
Yes! We did! Thanks for remembering. Florida’s legislature has written a series of requirements prescribing good faith claims handling procedures that insurance companies often ignore.
Fla. Stat. 626.9541(1)(i)3.h. Requires that an insurance company clearly explain the nature of requested information AND the reasons why such information is necessary. VIP Adjusting’s public adjusters often respond to these boilerplate requests with the good faith intent of fairly resolving an insurance claim and ask for this very simple request; that the insurance company explain why such information is necessary. It is almost uniformly ignored.
That response, however, protects an insured homeowner in the event they need to file a lawsuit.
Many of the items on that list may be duplicitous. If a pipe leaked and you have provided a photo of the damage pipe, video of the leak, and a repair invoice from a plumber (or better yet, saved and produced the damaged plumbing component that caused the leak), do you need to provide water bills for several years and condo/HOA incident reports? Maybe. If the insurance company thinks the leak was ongoing for an extended period of time, or if another party was responsible for the pipe and the insurance company can subrogate. Maybe not, though. It’s up to the insurance company to have that dialogue with you.
What about prior claim information? Again, maybe, maybe not. It depends on the insurance company’s intent and investigation. If you had a prior claim that was similar in the same location, they may want to know if you have overlapping damages and completed repairs to the prior reclaim so you aren’t double-dipping. If you’ve never had another claim, or a prior claim was on the opposite side of the house, the request may not be valid.
Often, VIP Adjusting’s public adjusters have noticed that the insurance company’s intent often isn’t on ultimately receiving the document requests, it’s usually just for the purpose of creating delays and trying to set you up for failure. (Reading between the lines, yes, we’re saying that many of these requests are made in bad faith)
A public adjuster can battle the insurance company’s tactics for you and do most of the heavy lifting, but some participation is required from an insured. We had a claim recently where our public adjusters prepared an estimate for the insured and provided it for approval with a sworn statement in proof of loss form, which requires a notarized signature of the insured. Despite repeated follow ups, the insured took more than seven months to get the document notarized, and even then wouldn’t provide any other documentation, validating the insurance companies tactics and rubber stamping the delays.
We understand all homeowners are different. Some people just aren’t good with paperwork, and some procrastinate. In these instances, this tactic from the insurance company is targeted directly at you because it allows them to justifiably delay and possibly prevent you from recovering altogether. If you’ve paid your insurance premium and you’ve suffered covered damage to your home, you should be fairly compensated for your claim.
If you’ve made a claim and received a document request like the one above, call the public adjusters at VIP Adjusting today for a free claim review. We’d be happy to go over the requests with you and come up with a strategy that puts the power back in your hands.
