In the wake of Hurricane Michael, some policyholders are starting to see a response from their insurance companies for their home and business losses. The extent and the magnitude of the damages that Hurricane Michael caused has been captured by some media outlets but down played by others. Many of those dealing directly with the destruction and the devastation are resilient and taking it one day at a time but had placed a sense of hope on the premium dollars they had spent paying for insurance coverage and have long awaited the insurance company’s response and action.
Here are some important reminders about this stage of the claim process
The 90 day statute for Florida claims
For Florida homeowners claims, the carriers are supposed to pay or deny the claim with 90 days.
Fla. Stat. § 627.70131(5)(a):
Within 90 days after the insurance carriers receive notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurance carriers shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurance carriers which reasonably prevent such payment.
Short-changed damages don’t have to be accepted
When the response comes from the insurance company with a scope of damages that is inadequate you have several options. However, your insurance company may not clearly explain those options to you.
Improper Denial letter
If the response comes from the insurance company in the form of a denial, you are not alone. The denial may be 100% wrong in light of the damage and the policy.
Protect yourself by knowing if a 120 or 180 day rule applies.
Some policies have provisions buried within that say you will only be paid replacement value if you notify the insurance company of your intent to replace within 120 or 180 days. Other policies will require that the actual repairs begin within this time frame in order to be paid anything more than actual cash value damages. You don’t want to lose your RCV coverage and if you are not sure whether your policy has this requirement you need to seek the assistances of an experienced public insurance adjuster or experienced counsel.
Be cautious about signing a check with release language.
Certain insurance companies put language on the back of the check that indicates a full and final payment of the claim. But the language may not be simple and clear, so get clarification before you sign off on those proceeds.
Under the Deductible Excuse
The common excuse letter and easy out of any insurance company is to allege your claim is under the deductible. Hurricane deductibles in Florida are often higher than for any other claim but the damages to your home or business also have to be accurately scoped and estimated based on your particular property and the coverage you purchased in your policy. Don’t assume that a deductible can block your payment. Even if the deductible was higher than you remembered. Sending a simple letter that the damages aren’t so bad is one of the “easy excuses” in the library of form denial letters.
Be aware if the check is really a premium refund
If you are sent a check, make sure it’s a claim payment and not a premium refund check. If a premium check is being sent back to you, the insurance company is trying to cancel the coverage. Do not accept or sign off on this check if you seek coverage.
Flood Proofs of Loss
There are special rules for proofs of loss for flood claims. Our prior blog posts have detailed the NFIP Proof of Loss Requirements for just about every catastrophic storm with a flood component since Chip Merlin started the blog.
Proofs of Loss for other policies
Homeowner, Businessowner, Commercial Residential, and Dwelling policies can all require an insured submit a signed and sworn document called a proof of loss too! A separate form as compared to your flood loss POL.
Carefully read each letter you receive from your insurance company to see if they are looking for a Sworn Statement in Proof of Loss is Required. This is often referred to as a proof of loss. Don’t just discard the blank form in the packet that looks long and complicated when you were hoping it was finally the check, but it’s just paperwork. https://www.propertyinsurancecoveragelaw.com/2011/12/articles/insurance/what-is-a-proof-of-loss-and-are-you-required-to-submit-one/
Note: There has been a slight resurgence in policy language that requires a proof of loss without a request, but just as a claim requirement. Certain insurance policies have a buried landmine requirement expect you to send in a proof of loss within a certain amount of time (usually 60 days!) without being asked. This requirement is buried deep within an insurance policy that you were not re-sent after the disaster. You need to verify what your policy requires. Allstate/ Castle Key and Olympus are two carriers who sometimes have this language, but others may have tweaked their wording too.
Your carrier may be wrong when they say you need to start work to be paid additional funds, this could be a misrepresentation of the policy
Insurance companies have been using a strategy to low-ball claims by paying a small amount of money after taking a large deductible in hopes that you are overwhelmed and frustrated enough that you don’t question the list of paid damages compared to your actual damages. This misleading information is often so far off base from the policy requirements, that we take a deep dive into this excuse in an upcoming blog post.
The supplemental claim excuse
If the letters says you need a contractor’s bid for the insurance company to release a supplemental payment, this could be a misrepresentation of the policy. The damages that qualified insurance adjuster would investigate as a trained insurance adjuster for that peril should be included in the estimate or scope of damage.
Certain carriers have taken a path towards avoiding and paying what they owe, by sending a very limited estimate of damages with a small check. Then, telling insureds they must set forth their supplements for more money but the damages by the carrier didn’t even get close to a complete evaluation of the original claim damages. A supplement should not be needed when the carrier misses an entire room of original damage, doesn’t inspect an attic, or only includes half the building blocks necessary to complete the repairs they know are needed because of the storm! These issues are original and not supplemental. What should be done is the carrier should get much more accurate in the initial inspections and not tell the insured to follow back up if there are more problems—as there are open and obvious problem that constitute original damages but are not properly included!
The carrier is ignoring the damages in plain sight (and may even have photos of the full damages from the field adjuster) and dodging proper payment. The carrier wants to shift the burden, so the policyholder has to push for their own proper adjustment and follow up for the damages. This misleading information is often so far off from the policy requirements for paying for the damages. We will take a deep dive into this excuse in an upcoming blog post.
If you have questions about how your carrier is responding to the claim there are many resources available at http://www.merlinlawgroup.com/, and our team of dedicated counsel is available to answer questions and explain how the process should be going with your insurance company. The bottom line is you should act quickly and ask questions when you have a concern about your insurance. Ignorance is not bliss and can cause you to lose some of your rights.