“No” is Not Always the Final Answer With an Insurance Claim Denial

Steeple

A storm with 100 mph winds had damaged a steeple and allowed water to enter the church and cause significant damage. The church was insured and a claim was filed the following day.

The church’s insurance company denied their claim by improperly applying an exclusion in the policy that referred to “wind driven rain” and that precluded the church’s right to recover for the damage.

Their roofing contractor recommended that they contact me for assistance, which they did.

Although the insurance company’s adjuster and their engineer supported this exclusion and the denial of the claim, the facts that I brought to them after my investigation of the damage forced them to re-evaluate.

They eventually came to agree that the cause of the damage DID fall under the policy and  agreed to reverse their denial and issue a check to the church to cover their total loss.

“No” is not always the final answer with an insurance claim.

Copyright 2013 – James H. Bushart.

www.publicadjustermissouri.com

Considerations for Insurance Premiums

Insurance is based on the law of large numbers.  By combining a large number of common units, the insurers are able to make predictions of possible loss and are able to calculate their probable losses — and establish the rates for those losses and their operating expenses (which, depending upon the type of company, can include significant profits for the insurer’s stockholders).
Too often, the effects of losses on profits are managed at the claims level where insurers will routinely delay, deny or defend against the payment of claims.  (This is when the insurer will hire people like me.)
In my opinion, the amount of the premium for any insurance should be among the last considerations used by a consumer when considering an insurance company to hire.
When the premiums are significantly lower than the average premium among remaining insurers, one can be reasonably assured that the insurance company will be using other (and possibly less desirable) means to make the same or more profit than the company with the average premium rates.  Typically, one will find that such insurers are much more enthusiastic and prompt in their collection of premiums than their payment of claims at the time of loss.
Recently, I had some interesting results for a client whose home had been damaged by fire and needed extensive repair.  The insurance company had underpaid him by claiming a depreciation of more than 63% on the interior plaster walls that were in excellent condition prior to the fire, but were old.
After I reopened the claim, the insurer agreed to pay him an additional $11,438.00 that he had been originally entitled to and almost walked away from.
If there is a moral to this story, I think that it is to seek a reputable insurer with a fair rate in comparison to other insurers and not the lowest rate which is likely to find you struggling to be paid for your loss at a time you can least afford the hassle.


Copyright 2013 James H. Bushart

www.publicadjustermissouri.com

Missouri Home Owner’s Policy – Changes to Your Deductible

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

What is a Missouri Public Adjuster?

Mississippi River Scenic Byway in Missouri

Mississippi River Scenic Byway in Missouri (Photo credit: Doug Wallick)

By James H. Bushartwww.publicadjustermissouri.comAside from attorneys, public adjusters licensed by the Missouri Department of Insurance are the only type of claims adjuster that can legally represent the rights of an insured during a first party insurance claim process in the State of Missouri.

Upon notification of a claim for property loss or damage, the insurance company will send an adjuster employed by them or an “independent adjuster” contracted by them to investigate the claim.  These adjusters work for the insurance company and only represent the financial interests of the insurance company.  The Missouri Public Adjuster, on the other hand, levels the playing field by representing only the interests of the insured policy holder who has suffered the loss or damage to a business or home located in Missouri.

The Missouri Public Adjuster’s main responsibilities are to:

  • Evaluate existing insurance policies in order to determine what coverage may be applicable to a claim
  • Research, detail, and substantiate damage to buildings and contents and any additional expenses
  • Evaluate business interruption losses and extra expense claims for businesses
  • Determine values for settling covered damages
  • Prepare, document and support the claim on behalf of the insured
  • Negotiate a settlement with the insurance company on behalf of an insured
  • Re-open a claim and negotiate for more money if a discrepancy is found after the claim has been settled

For more information about the Missouri Public Adjuster or to request a free, no obligation consultation regarding a particular claim, contact me by writing jbushart@publicadjustermissouri.com or call me at 314-803-2167.

Copyright 2013 James H. Bushart

Property Depreciation – Age Should NOT Be The Only Factor

By James H. Bushart

www.publicadjustermissouri.com

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 age of the property is often used as the primary determining factor when depreciating or subtracting from the replacement costs of an item of property that is 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 true in every circumstance. Age alone should not cause an object to lose a large percentage of its value and if the object 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. Plaster on the wall that was lost to fire was depreciated by more than 65% even though it was fully intact and functional prior to the fire and the insured home owner 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 rates of depreciation can be mistakenly applied.  One recent case highlighted certain items as being subject to excessive depreciation due to what the adjuster determined to be advanced age when, in fact, the same insurance company had actually paid for their replacement less than a year prior when vandals had damaged the home.

Property owners should know and understand that an object’s amount of depreciation is identical to the amount of how much better, or more valuable, a new object is compared to the older object. This is what is actually being determined. Age is not always an appropriate measure of this and arbitrary deductions from replacement values that are simply based on age should be challenged by the insured. 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 a depreciation of 67% on the interior walls based totally upon their age.  After reopening the claim and further discussion with me,  they issued him an additional check for $11,438.00.]

www.publicadjustermissouri.com

Copyright 2013 James H.Bushart

How Many Will Walk Away From Their Own Money?

My client’s legitimate claim with his insurance company for property damage had been denied and so he contacted me.
After my first contact with them, the insurance company offered a very small amount of money which they had calculated from their adjuster’s database (commonly used by adjusters throughout the United States) and that was less than his deductible — for which they would still pay nothing.
Following a few more contacts from me, I received this email from the insurance company:
  “Mr. Bushart, after doing some additional research on patio cover pricing, I feel that the pricing that you provided is more in line with what the insured had than what is on our data base. As such, we will use your figures for settling on the patio cover.
  How would you like the check issued and where would you like it delivered?”
How many other insured home and business owners will simply walk away from a denied or underpaid claim and leave money that is rightfully theirs laying on the table?

Insurance Claims for Hail Damage

By James H. Bushart

 

Hail damage to a roof is a common occurrence and damage is often and routinely repaired at the expense of insurance companies.

For some insurance adjusters delaying, denying and defending a claim is also routine and are the three main strategies used to promote the financial interests of the insurance carrier at the expense of the insured.

As a part of this strategy when delaying, denying or defending a claim filed for hail damage to a roof, many claims adjusters (after making their own inspection and declaring that there is no damage to the roof) will arrange to provide an insured homeowner with a “special service” by having an engineer evaluate the roof for damage, as well.

Evaluating the condition of a roof covering does not require an engineering background, but it does impress many people to see an engineer’s seal and signature under an observation. While making an effort to appear to be objective, and while still fully aware that future referrals and fees are at stake, the hired engineer will sometimes seek ways to confirm the initial finding made by the adjuster.

Here is one of the methods used to minimize observed hail damage to a roof while appearing to be objective and “scientific”.

In spite of the damage that is visible to the naked eye many engineer reports that have been used by insurance companies to deny claims that I have personally read will refer to an opinion that a “rate of acceleration” and “velocity” of the hail strikes were insufficient to cause “significant” damage to the roof coverings.

Sounds like some real indisputable engineering stuff, doesn’t it?  At least, it does until one considers the following:

1.  The storm has passed by the time the adjuster and engineer have examined the roof.

2.  “Terminal velocity”, or the maximum speed reached by a falling object, is measured by a mathematical formula that takes into account the size of the hailstone and the high winds and gusts that can accelerate the speed of the hailstone.

3.  The actual size of each hailstone that struck the roof … and the speed of the wind and gusts that drove the hailstone into the roof … cannot be determined by simply looking at the roof days, weeks, months or years after a storm.

4.  Remarks that appear in the engineer’s report that address the sufficiency of the “velocity” or “rate of acceleration” to cause damage is pure speculation.  The fact that it is being “speculated” by an engineer does not make it more than speculation.  It is not factual.

The physical evidence of hail damage will speak for itself.  Speculations as to velocity and acceleration that are provided from observations made days, weeks or months after the event are not factual and should not be allowed to be used to deny a claim in the presence of actual damage.

If you find references to “velocity” and/or “rate of acceleration” in any engineer’s report that supports your insurance company’s denial of your claim for roof damage caused by hail, request in writing that you be provided with the factors and formula(s) used to calculate these rates.  Also, ask for the source of the data used to determine the size of the hailstones and the speed of the wind and gusts that drove the hailstones into your roof.

For more information about how some insurance companies use engineer reports to routinely deny valid claims, click on the following link and read:  https://missouripublicadjuster.org/2017/03/09/fraudulent-engineer-reports-and-your-homeowners-insurance-claim/

 

 

Copyright 2012 James H. Bushart

Before You Renew Your Insurance Policy … Read This!

Two small teddy bears

Two small teddy bears (Photo credit: Wikipedia)

Some people will carry insurance with the same company for years without ever having the need to file a claim … and then only at their greatest time of need, following a serious property loss, find that their insurer is NOT the “safety net” that they had expected.

Low rates, teddy bears, lizards with British accents, good hands and good neighbors … they all mean very little when disaster strikes your home and you experience improper claim denials and delays that add to your burden and interfere with your recovery.

Before renewing your next policy, check out (by clicking HERE) your insurance company with the Missouri Department of Insurance to see how they have measured up where it really matters … customer satisfaction in processing their claims. 

 

Copyright 2012 James H. Bushart

Superstorm Sandy and Property Damage Insurance

As is often the case following such damaging events as the recent storms in the Northeastern section of the United States from yesterday, hundreds of thousands of home and business owners will awaken and begin to discover the realities of their insurance contracts … those conditions and exclusions that are written into their insurance polices that, like landmines, often impede their steps toward restoring that part of their lives that has to do with their property damage and loss.

Believe it or not, thousands of home owners with their houses under water brought in by the sea or overflowing river banks will only — today — discover that flooding is not a covered peril under their insurance policies.  With all or most of their personal property missing or destroyed, providing proof of their losses will appear to be impossible.

Because the burden is on the insured to “prove” his loss and most are not totally aware of their rights or the process of proving their insurance claims, many will accept lower settlements or denials that will unnecessarily add to the burdens that they already are forced to endure.

Some “storm chasing” public adjusters from all over the country will soon be descending upon the area to help people with their insurance claims to help home and business owners contend with the wave of adjusters sent by the insurance companies to protect their financial interests … and while many of them will actually be helpful, the shock and the awe of the recent disaster still hangs over its victims like a dark cloud and not all of their choices during this period will be, upon later reflection, “good” choices.

Prudent home and business owners throughout the country can benefit from this lesson and take the opportunity — today — to meet with a public adjuster close to their home.  Get to know him and discuss your insurance contracts with him.  Let him show you what they do and do not cover, what your immediate steps should be following a loss and how to protect yourself from actions that could nullify or reduce the amount of your claim.

Public adjusters do not work for insurance companies and can help you through the process of proving your claim  … even before it happens … so that you can concentrate on more important things that you will certainly face during a personal property disaster.

It is also important to note that, if you try to handle your claim on your own and are unsatisfied with the results, a local public adjuster can review your claim and reopen it to address a wrongful denial or underpayment.

Take the time, today, to find a local public adjuster who will be there for you when you need him the most.

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