Tag Archives: insurance settlement

Missouri Insurance Claims and Politicians Don’t Mix Well

April 13, 2026 By in Property Insurance Tags: , , , , , 3 Comments
map of missouri

The Great State of Missouri

 

There is a disconnect between legislative promises and regulatory reality in Missouri property insurance claims. Here, what THEY don’t know can hurt YOU.

In the world of property insurance, the language we use to set consumer expectations matters. Currently, Missouri’s proposed Senate Bill 1543 is attempting to change, among other things, how consumers interact with public adjusters. There are some good provisions in this bill, but a close look at the bill’s mandated language reveals a massive gap between what legislators are promising and what state regulators can actually deliver.

The Legislative Promise: “Free Help”

Missouri SB 1543 proposes that public adjusters must include a very specific, bold-text disclaimer in their contracts. It requires them to tell the consumer: “YOU DON’T HAVE TO HIRE A PUBLIC ADJUSTER TO FILE A CLAIM WITH YOUR INSURANCE COMPANY… IF YOU NEED HELP WITH YOUR CLAIM, THE MISSOURI DEPARTMENT OF COMMERCE AND INSURANCE WILL HELP YOU FOR FREE”.

It is true that a policyholder does not have to hire a public adjuster to assist with their insurance claim, just as a taxpayer does not need to hire a tax preparer or CPA to prepare their taxes.  Particularly, when the firetruck is still at your home spraying water on the fire and a public adjuster or solicitor is there trying to get you to sign a contract for representation before you have had a chance to consider your entire situation (yes, unfortunately, this happens), this warning is certainly valid and useful. I enthusiastically endorse it. However, when you have already filed a claim and are seeking help with it, is the Missouri Department of Commerce and Insurance able to represent you in the same way I can for free? 

In the context of the bill, which tightly regulates who is allowed to “negotiate” a claim—defined as discussing or exchanging offers with an insurance company to reach a settlement amount—this mandatory disclaimer strongly implies that the Department of Insurance will step in and act as a free alternative to a hired public adjuster.

The Regulatory Reality: “No Authority to Determine Loss”

However, if we look at the actual letters sent by the Missouri Department of Commerce and Insurance when consumers today request this “free help,” a completely different reality emerges.

When responding to consumer complaints regarding property claim disputes, the Department explicitly clarifies the strict limits of its power. A standard response from a Department complaint investigator plainly states: “I do not have the authority to determine the amount or extent of loss you have incurred”.

Instead of negotiating the dollar value of the damage or debating the scope of repairs with the insurance company, the Department outlines a strictly regulatory role:

  • Finding out the current status of the claim file.
  • Evaluating how the insurance company is handling the situation.
  • Assisting in claim resolution if possible, primarily by ensuring “the company is compliant with Missouri insurance laws”.
  • Cannot address property claim denials or partial denials.
  • Cannot establish the facts regarding any other disagreement between you and another party.

How much “help” can they really provide without determining or negotiating the amount of the loss, the scope of the damage, or the merits of the claim they are presumably helping with for free when the claim has been denied or underpaid?

The Danger of Overpromising

The difference between these two documents is staggering. The proposed contract language suggests to consumers that they can forgo professional representation because the state will step in and “help” them resolve their claim for free. Yet, when the state actually arrives, they legally cannot evaluate the damage, determine the cost of the loss, or negotiate the financial settlement.

If an insurance company relies on an engineer to deny structural damage or limit a roof replacement, the Department of Insurance does not have the authority to argue the engineering merits or negotiate a higher payout on the consumer’s behalf. They merely check to see if the insurer followed the statutory timelines and processes. When they have finished helping you for “free” and informed you that the insurer who has denied or underpaid your claim has violated none of the particular rules they govern, is not the insurer who denied or underpaid your claim even more solid in their partial or full denial of your claim? What can you do at that point other than sue?

Conclusion

For property owners facing devastating losses, clarity is essential. Suggesting that a regulatory body can replace the active negotiation and valuation services of a public adjuster is not just misleading; it leaves the consumer fundamentally unprotected during the most critical phase of their claim.

In short, while the state will offer its regulatory review for free, they will not—and legally cannot—act as a free public adjuster to negotiate the financial value or factual merits of either a residential or company’s commercial insurance claim.

Legislators must ensure that the statutory notices they force upon professionals accurately reflect the actual powers of the state agencies they promote. If those lobbying for this bill to become law are successful, Missouri policyholders will need to know that the promise of “free” help in this contract language may not be true.

James H. Bushart, Licensed Missouri Public Adjuster
MO License #8207067 | SCLA | NAPIA
314-803-2167 | missouripublicadjuster.org

Missouri Home Owner’s Policy – Changes to Your Deductible

February 23, 2013 By in Home Owner Insurance Issues, Property Insurance Tags: , , , , , , , , , , , Leave a comment

Many insured Missouri home owners are caught off-guard, at the time they file a claim and can afford it the least, when they discover that their “deductible” has increased to several thousands of dollars.  (The policy’s “deductible” is a dollar amount that is automatically subtracted by the insurance company from any amount that is owed, per occurrence, to the insured as a result of damage or loss to the home.)

When many home owners first insured their homes, their policies originally had a $500.00 deductible that eventually changed to $1,000.  Now, with recent renewals, insurance companies have begun to assign a deductible amount that represents a percentage of the total value of the policy.  By this, if a home is insured for $300,000, a 1% deductible allows for each claim to carry a deductible amount of $3,000.  This means that a claim against the policy for a $7,000 to repair will result in a payment of $4,000.

A recent Missouri client was surprised and upset to learn that his deductible had increased from its original $1000 to over $5,000 when he filed what was his very first claim after decades of coverage.  While we were able to successfully negotiate an agreement with his insurer to waive this deductible amount for his claim, this was an exception to the rule that is not always available – as was the case of another client who discovered too late that she had a significant $2,300 amount to be deducted from her settlement of $6,400.

These increases in the deductible amounts are reported to the home owner at policy renewal on the “Declarations” page that is sent at the time of each renewal.  Unfortunately, many home owners will simply file this important page with their policies without reading and noting the change.

Take the time, today, to read your most recent declarations page to see if your deductible has changed.  It is possible to negotiate a lower deductible with your insurance company, in some cases, with a slight increase in your premium … but this must be done and in effect PRIOR to the date of any loss or damage.

Copyright 2013 James H. Bushart

Property Depreciation – Age Should NOT Be the Only Factor

February 1, 2013 By in Home Owner Insurance Issues, Property Insurance Tags: , , , , , , , , , , , , Leave a comment

By James H. Bushart

 

Most insurance policies will define the terms by which the insurer will calculate ACV (“actual cash value”) in determining how much to pay, and, usually, the factor of “age” is not one of those conditions. Still, the property’s age is often used as the primary determining factor when depreciating or subtracting from the replacement costs of an item of property being adjusted for settlement.

While it is true that an object’s age can correspond closely to its extent of physical wear and tear – it is not valid in every circumstance. Age alone should not cause an object to lose much of its value; if the thing is functionally sound, it should retain most of its value.

I have helped clients recover higher settlements from insurers who had initially calculated depreciation as high as 75% for perfectly working and maintained fireplaces that happened to be original to older homes. The plaster on the wall lost to the fire was depreciated by more than 65% even though it was fully intact and functional before the fire, and the insured homeowner was entitled to a higher adjusted settlement. Countless other items and systems in the home have been grossly over-depreciated – at a great expense to the insured – for no other reason than their age.

In some cases, the age of the item may be incorrectly calculated, and higher depreciation rates can be mistakenly applied.  One recent case highlighted certain things as being subject to excessive depreciation due to what the adjuster determined to be advanced age when, in fact, the same insurance company had paid for their replacement less than a year prior when vandals had damaged the home.

Property owners should know that an object’s depreciation amount is identical to how much better or more valuable a new thing is compared to the older object. This is what is being determined. Age is not always an appropriate measure of this, and the insured should challenge arbitrary deductions from replacement values based on age. The adjuster must carefully listen to the insured’s arguments and negotiate in good faith.

If you feel that your property was unfairly depreciated and that your insurance company’s offer of settlement is unreasonable and unfair, contact me (if you live in Missouri) or a public adjuster licensed to represent you in your state.

[Update – 3/12/13 –  My client had a home damaged by a fire that needed extensive repair, as mentioned above.  The insurance company underpaid him … claiming depreciation of 67% on the interior walls based on their age.  After reopening the claim and further discussion with me,  they issued him an additional check for $11,438.00.]

 

Copyright 2013 James H.Bushart