Who are the people involved in your property insurance claim?
You may hear titles for a lot of people referenced in connection with your homeowners insurance claim in Florida. Who are they?
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.
Desk Adjuster
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.
Field Adjuster
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.
Independent Adjuster
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
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.
Third Party Administrator (TPA)
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.
Claim Representative
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.
Customer Service Representative
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.
"Manager"
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.
Litigation Manager
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.
Appraiser
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.
Umpire
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.
The mortgage problem (Part 2)
We’re back, and it’s time to get down to business with your mortgage company and your insurance check. We’re continuing from Part 1, where we left off discussing what happens when you get your insurance claim check.
Do you have Bank of America, or is your mortgage with another major national bank that has branches everywhere? Many times these banks will endorse checks under $10,000 at any branch, with no, or few, questions asked.
Chase will typically endorse checks in-branch under $20,000, but will follow up on the status of repairs to make sure they’ve been completed. If a significant period of time has gone by and you haven’t kept in touch with them, they may revoke this privilege in the future.
What if your claim is larger than $10-20,000? Surely your contractor will want to get paid something to get started. Then what?
It depends on how your claim was paid.
If your claim was paid fairly in one or two payments, or through a supplement, the payment typically came with a loss statement and corresponding estimate from the insurance company. Your mortgage company will likely request this to know what areas of the home was damaged, or what areas are/might be affected by repairs.
This is where things tend to vary. Some mortgage companies will make a down payment to a contractor on your behalf with required paperwork from the contractor. Others will want you to get the ball rolling and reimburse you.
We don’t want to skip steps in the explanation here, but this is where things are highly varied from company to company. Whatever they want to do next, we’ll consult with you, and/or your contractor and figure out the best way to respond.
Keep in mind, though, that the repairs you perform in YOUR house are up to your discretion. If you want to upgrade your home, you’re entitled to do so. If you want to only repaint the damaged room, despite continuous painting, or break up a continuous floor, that’s your choice.
The mortgage company’s inspection is less rigorous than the insurance company’s and they want to make sure no glaring or visible damage remains outstanding.
We DO want to be up front though, that if the repairs get carried away beyond the insurance claim or you’re doing upgrades, our fees are still owed, even if the insurance company disburses every dime of the insurance proceeds to the contractor. This is sometimes an outcome in this business.
Lastly, if you decide that you don’t want to deal with your mortgage company, there are services out there that will work for you to obtain the mortgage company’s endorsement and eliminate the headache. There are smaller fees associated with this, but many of our client’s have found this service to be priceless. We’ve found the moth success with, and highly recommend https://iink.biz/ if that’s a route you’re interested in.
If you find yourself stuck and these situations don’t apply to you, feel free to contact us, or call today for a free claim evaluation.
The problem with the "Elephant" in the room.
Under Fla. Stat. 627.70131 and 626.9541(1)(i)4. your insurance company has an obligation to pay or deny your claim within 90 days of receiving notice. So what do you do if your insurance company's specialty is delaying claims? What happens when the 90 days expires?
Honestly? Nothing.
Your adjuster can't hold the insurance company's representative upside down and shake them until change falls out of their pocket.
You can hire an attorney, but if they know what they're doing, they'll know that the same statute says violation of the "90 day provision" doesn't form the sole basis of a cause of action. You can't just file a lawsuit because things are slow. Your insurance policy doesn't say they have 90 days to pay and in order to file a lawsuit, the insurance company must have breached the contract.
The remedy for an insurer taking longer than 90 days is technically for them to pay interest on whatever payment they issue.
Many insurance companies sit on claims and wait for day 89 to send you a request for additional information, which legally buys them 30 days, and then they can keep kicking the can down the road every 29 days repeating this indefinitely.
So what are you supposed to do?
Hire someone who puts actual effort into your claim. You need to present your insurance company your damages and provide all reasonable documentation they request. Then, your representation, be it attorney or adjuster needs to document follow ups. Send letters and emails. Keep logs of phone calls.
If you've created a paper trail showing you've given the insurance company everything they need to make a decision, and they've repeatedly blown you off when you're putting in a reasonable effort to adjust and resolve your claim, and you still make it past 90 days, then you can hire an attorney who can file a lawsuit on the 91st day, with an entitlement to attorney's fees and costs that are in addition to your claim, and it will get your claim out of the hands of the department that don't have the time for your claim or are making the conscious decision to ignore it.
If you’ve made a claim for property damage with Universal Property Insurance Company in St Lucie County, give VIP Adjusting a call today at 772-600-4663 for a free claim review.
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