- An Impasse
We are often called in when an insurance claim has reached an impasse. If you have reached this stage in your claim, there are a couple of things you should keep in mind:
No carrier can unilaterally declare an insurance claim settled by simply sending you a check.
That doesn’t mean that they won’t try to bully you into signing releases or waivers.
We were called in on a year-old claim that an insurance carrier deemed “concluded.” They had brought in their experts and tried to get the insured to sign off on a deeply unfair and poorly investigated claim. They were pressuring the policyholder to settle for what they were given, which would have meant that the policyholder would have to pay out of their own pocket to finish the repairs. The carrier ignored repeated requests by the policyholder to reconsider their position.
We got involved and conducted an independent investigation. We discovered that the carrier had acted so badly and in such bad faith that we contacted the district claims manager and resubmitted documentation, which we carefully and thoroughly prepared for the policyholder.
We also assisted the insured in preparing official complaints to the state and moved up the corporate ladder to file additional complaints with regional management.
The Result: A win for the policyholder. We got the claim paid fairly and the adjuster was disciplined by the state Insurance Department.
- Document Review
We were contacted by a broker whose insured was having a difficult time responding to all of the documentation demands from the carrier’s adjuster. We were asked to review the claim and let the policy holder know how to best comply. While reviewing the loss we discovered that the building consultant hired by the carrier to produce a valuation of the loss was not using any customary method or estimating program to provide the value of the damaged property. The insured tried in vain to have another estimator assigned. We felt invoking the appraisal clause within the policy was the solution to resolving the differences in value.
The Result: Acting as the policyholder’s appraisers, we reviewed the differences with the other appraiser and we clearly saw the issues and awarded the corrected value of the loss. No umpire was required to intervene on this particular appraisal.
Sometimes a simple document review requested by the broker can break the log jam and expedite the conclusion of a claim.
- The Storm Drain
The carrier was claiming the damage came from an underground storm drain that had overflowed during heavy rain. Pointing to a weather report and an exclusion in the policy, they were going to deny the claim.
We were called in to investigate and discovered key questions were not asked, or simply ignored. The discharge actually came from the plumbing system itself, not a storm drain. The carrier then tried to cap the coverage to a sewer back up and an endorsement in the policy with much lower limits.
Through careful investigation and proper documentation we went on to prove the discharge came from the plumbing system on premises and that full policy limits should apply, not a sewage back with smaller limits on coverage.
The Result: Our documentation was irrefutable. They paid the full value of the claim.
- A “Fair Claims” Investigation
We are experts in fair claims practices, and we can maximize the funds needed to restore you client’s property, or simply make sure that things covered in the policy for repair or replacement are properly and promptly paid.
We had a contractor contact us after he was called out to do an inspection on behalf of the carrier. He was told the would wait and see the cost before they afforded any coverage. This is an illegal, but often-used tactic by carriers.
We contacted the carrier and discussed our “fair claims” investigation and produced our carefully prepared documentation. The carrier agreed to send a representative to discuss the value of the loss.
The Result: The contractor’s estimate was accepted, and they were able to concentrate on completing the repairs and restoring the property and left the carrier to us.
The CBS News program 60 Minutes aired a segment which documented the lengths to which some carriers will go to avoid paying claims. Watch it here.