Month: September 2017

HARVEY TWIA DEADLINE EXTENSION

HOT OFF THE PRESS- HARVEY TWIA DEADLINE EXTENSION:

Many (including our office, our followers,our local representative, etc.) have been working to get TDI to extend its deadlines sooner rather than later for Harvey claims and just yesterday afternoon the Texas Department of Insurance published Bulletin #B-0033-17. They have officially extended the deadline to dispute your TWIA claim based on reasons that we have been trying to express loud and clear. I have included the link to the bulletin here below. Further below is the link to the Commissioner’s Order along with a portion of the language in the Order.

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http://www.tdi.texas.gov/bulletins/2017/b-0033-17.html

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Below is the section of the order that addresses the reasons why the deadline was extended. We don’t believe 120 days will be long enough for a catastrophe of this size, but it’s a start.

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http://www.tdi.texas.gov/orders/documents/20175226.pdf

2017-5226

Commissioner’s Order- IN PART**

  1. Under 28 TAC §5.4222, good cause exists to extend the deadline for TWIA claimants to demand appraisal for claims arising from Hurricane Harvey. Good cause exists based on
  • the number of claims TWIA has received arising from Hurricane Harvey, and
  • the reasonable anticipation of
  •  a shortage of qualified contractors in the affected areas that could promptly bid out work for the damage TWIA accepts,
  • fluctuation in prices for labor and materials in the affected areas, and
  • the potential that claimants will not reasonably be able to dispute

TWIA’s payment determinations within the time required by

Insurance Code §2210.574.

  1. The deadline for a claimant to demand appraisal for disputes about the amount of loss TWIA will pay on claims arising from Hurricane Harvey should be extended 60 additional days. With the additional 60 days, a typical claimant will have a total of 120 days to demand appraisal after the date the claimant receives TWIA’s required written notice accepting coverage in full or in part.

TEXAS WINDSTORM INSURANCE ASSOCIATION (TWIA) CLAIM DISPUTES

Good morning folks, if you have an insurance policy with TWIA, right about now or in the near future you will be getting a letter with one of the two following headings or a variation of the two combined:

  1. “Notice of Claim Acceptance”
  2. “Notice of Claim Denial”

These two letters are dramatically different in nature but they will both go on to explain when your claim was received, the claim issues you noted and note specifically other observed damages. The letter likely includes  documents which detail what to do if and when you make repairs, legal notices, what to do if you disagree with the payment amount, frequently asked questions about appraisal and an appraisal request form.  On the page titled “If you disagree with the payment amount”, there will be a bold underlined phrase stating: “All disputes concerning the payment amount for an accepted claim under your insurance policy must be resolved through the appraisal process”.   A little further down you will likely see a statement that says: “Please be aware that if you do not request appraisal within the time period above, you waive your right to contest TWIA’s determination of the payment amount.”

History behind the changes: What I am about to share with you will have you fighting mad and it should.  A couple years ago the Texas legislature passed a bill providing a massive number of protections and special conditions for TWIA.  So that you will fully understand the gravity of the protections that were given to the insurers I will explain.   Once you receive the letter above from TWIA, you only have 60 days from the date of that letter to demand appraisal.  If you disagree, as an insured, you are now forced to use the appraisal process and you are forced to pay for it out of pocket.  In a nutshell, appraisal is a process that is used to resolve disputes related to claims’ amounts, whereby you hire an appraiser, the insurer hires an appraiser and the two appraisers either agree on a third party umpire who decides the differences or have an umpire appointed by a local court if the two appraisers can’t agree on the umpire.  Appraisal is normally a very good option for resolving disputed claims, however, it is limited under TWIA policies.   Appraisal in most standard policies provides that both parties have the right to petition the court for an umpire appointment if the two appraisers cannot agree on an umpire.  However, if you have a TWIA policy, end up in appraisal and the two appraisers have to get an umpire assigned, the umpire is picked by the Texas Department of Insurance from an “approved umpire list”.  Here is the bad news about the “approved umpire list”.  If you work under the direction of insurers day in and day out you can be included on the list.  However, no one who is working for an insured as a public adjuster at the time of TWIA approved umpire list renewal is approved. The bottom line is that the TDI approved umpire list is apparently full of folks who represent insurer’s every day, but anyone who may happen to represent an insured at the time of their license renewal is refused admission to the list.

The 60 days: You only have 60 days from the date of the letter above to take action.  If you demand appraisal, you are forced into an appraisal process that you have to pay for out of pocket that limits your rights and recovery.  If you don’t demand appraisal, or you simply miss paying attention to the 60 day time limit, you are done and your claim is finished.  According to TWIA, failure to meet this 60 day time frame will result in you losing all rights to contest your claim.   I have an actual client who received his letter, was unhappy, hired us, we notified the insurer and they dispatched an engineer who may not have a report for weeks.  Potentially, as this stands, TWIA can acknowledge your claim in a delayed fashion, your adjuster can state the he is three weeks behind before showing up (as ours did), the insurer can dispatch an engineer to re-evaluate your claim once you question it, they can correspond at their own speed thereby delaying your claim, 60 days can pass and you are out of luck.  Wow – I could not make this up if I tried!  Perhaps you should start calling your senator and state representative and urge them to extend the response periods under the TWIA policy in light of this declared catastrophe.  If not, this could become the second catastrophe from Harvey.  For more information on these claims issues visit our website at: www.publicinsuranceadjuster.net.  As always if you have questions about your rights or the time periods in YOUR specific claim, seek the advice of legal counsel. Make sure to watch for a Texas Department of Insurance bulletin regarding an extension of these time periods.

 

 

THE SWORN PROOF OF LOSS (POL)

THE SWORN PROOF OF LOSS (POL) —THE MOST IMPORTANT DOCUMENT YOU WILL SIGN WHEN FILING AN INSURANCE CLAIM:
My timing on providing this information was intentionally delayed until now because the time has arrived when you are bound to start seeing this document crop up. This one little document (the POL) can set the stage for everything that occurs on your claim going forward, it can cause a denial of your claim, it can destroy your claim if not filed or not filed on time and it can also be the root of all leverage you have to start the clock moving and to force your insurer into taking action. Whatever you do, file this form timely, file it accurately and don’t file it until you know the amount of loss you are claiming.

If any insurance adjuster asks you to sign one of these forms make sure you have confirmed that everything on the form is 100% accurate and this is especially the case on a flood claim. Some insurance adjusters will attempt to secure your signature on one of these forms even when you may not agree with the amount of loss by stating: “just sign this POL and you can always supplement later”. As the name implies, this is a sworn document and it may be used against you. Some insurance adjusters are not allowed to turn in their file and bill for their time until you have signed a proof of loss so there is an incentive for them to work with you to get it right.  As the title of my post implies this will be the most important document you will sign, so I will start by giving you the basic components of a proof of loss and then I will then outline time frame requirements of several types of POL forms based on the insurer.
POL documents typically have the following information on them:

  1. The date of loss.
  2. The type of loss (ie flood, wind, etc)
  3. The insurance policy number
  4. The insurance claim number
  5. The address of the loss
  6. The use of the property (ie dwelling, business etc)
  7. The mortgage company
  8. Coverage amounts at the time of loss
  9. Anyone having an interest in the loss
  10. A place for you to sign and sometimes a spot for a notary
  11. Finally, there will be some scary language at the bottom of many that warn you against defrauding insurance companies.

There is not one form that fits every situation and they vary widely depending on the policy and policy language. The flood claim POL is very different than a TWIA POL or and that is very different from a standard homeowners POL. In almost every case you will find the requirements of what has to be included on the POL within the language of the policy. You will also find within the policy language, the time frame within which you must file a POL. Unfortunately most POL language is buried in the middle of the policy in a benign looking paragraph. Because this is such a key component to a claim, our company has long petitioned folks in Austin to make insurer’s put this language on one of the first few pages of the policy in big bold print so you can’t miss it and I have often wondered if burying the language in the middle of the policy is intentional, the old saying “it’s in the fine print” …but that is a discussion for another day.

POL TIME FRAME REQUIREMENTS BY INSURER:

TWIA: Texas Windstorm historically had a requirement that you file your POL within 91 days of their notice of claim acknowledgement. When you filed your claim you should have received a letter confirming your claim. Typically you would have 91 days from the date of that confirmation to complete and file your POL. TWIA was granted this time frame by the legislature a while back and it is in no way sufficient in times of a catastrophe. However,  TWIA has now waived the POL requirement and removed this time frame from the policy.

FLOOD: The standard flood policy has a requirement that you submit your POL within 60 days from your date of loss. In plain language you have 60 days from the date you flooded. Unless NFIP (the National Flood Insurance Program) waives this time frame and extends this in writing, you must meet this deadline. If you blow this, you may be forever barred from recovering. However, I have some very good news for you. The NFIP has not only waived the requirement for a POL within 60 days, but you can now use it as a tool to petition for more funding if you don’t agree with the amount of loss allocated by your initial adjuster and you now have up 365 days from the date of loss to file this document. Additionally, FEMA has loosened the requirements concerning signing your adjuster’s initial report.
https://www.fema.gov/…/femas-national-flood-insurance-progr…

HOMEOWNERS: The POL requirements for time frames vary widely depending on the carrier. Review each policy on a case by case basis to determine what your policy may have. Generally, look for the portion of the policy that says “your duties after a loss” or the “loss payment” sections and you can usually find the POL requirements there. Again, these policies vary as to where this language is located.
The POL can be a complicated and potentially a game changing document when you have flood, wind or overlapping issues. If you have questions you can contact us at and we will do our best to answer them:
http://www.publicinsuranceadjuster.net/contact-us/

Unfortunately with our work load growing we may be slow to respond individually but we will do our best to get you the answers you need and I will continue to equip you with the knowledge I have gained from years past as a consultant to one of the largest insurers in the world and my current 20 years as a public adjuster. Disclaimer: At times the POL situation can meld into legal situations and we advise you to consult an attorney if there is any hint of this.

My upcoming posts will address what to do if you don’t agree with your adjusters assessment, what to be prepared for when the insurer sends out a “consultant” or engineer, what to do if your proof of loss is rejected, the subject of Co-Insurance and the topic of demanding appraisal, which you will probably see a lot of as this storm progresses. We will also be posting a comprehensive resources page for you.
Our extended family has place in PA and my wife and I have been bringing our kids there since they were young. The house was damaged and we are waiting in line to deal with our claim just like all of you.

 

WIND DRIVEN WATER DAMAGE—-IS IT COVERED?

This evening I will be taking the mystery out of one of the biggest issues you will be facing when it comes to water damage. Wind driven rain is probably the single biggest contributor to damage in a hurricane other than the storm surge itself. This topic is one of most hotly contested issues of all time when it comes to insurance coverage and I can assure you that once I am finished you will be equipped to take on this issue. It should be obvious that if you have a gaping hole in your roof or walls after a hurricane you can expect to be covered for interior water damage. However, what if you have water damage to the interior, but you can find no permanent holes in your structure? This is where is where it gets interesting. Most policies require an opening to be created in the structure for wind driven rain to be covered, however most policies don’t specify that the hole in the structure has to be permanent. Let that sink in for a moment. During a hurricane, incredible wind pressures are exerted upon a structure that create “openings” that would not normally exist outside of the hurricane event. What I mean by this is items such as windows, doors and other locations can be distorted by pressures that exceed the design ratings of these items thereby causing them to distort in shape and create temporary openings. Whats the bottom line— openings in the structure are not always permanent and not always gaping holes. Sometimes they are temporary and unless your policy specifies that the openings must be permanent, you should be entitled to coverage for damage caused by the temporary openings just like you are covered for the permanent openings. If you are insured with TWIA and have a “320” endorsement, it does not matter whether the openings are temporary or permanent- you are covered! The moral of the story is to always ask your agent for wind driven rain coverage. In many cases, this coverage is worth more than the wind coverage itself.

Port A Happenings Post 2017

IN AN ONGOING SERIES OF HARVEY INFORMATION YOU REALLY NEED TO KNOW ABOUT THIS: I need to share what is happening with windstorm claims along the coast. While I was in Port A, an older gentleman showed up at our neighbors house wearing a lanyard and ID badge that said Crawford Adjusting and Farmers Insurance on the label on the ID card. He approached me because he was confused as to the correct address he needed and I assisted in informing him that he was looking for our next door neighbors home. A conversation ensued, he told me he was an insurance adjuster and after a few minutes he figured out that I knew way too many terms so he asked what I did for a living. When I told him I was a public adjuster he did the usual slight recoil in posture, but then proceeded to tell me that he was interested in becoming a public adjuster and switching sides because he was tired of the dishonesty within the insurance companies. He continued and told me that he was not there to adjust the claim and provide a check for the insured to start repairs, but only there to document the damage to report to the insurer and that another adjuster was coming later. Unsolicited, he continued telling me that his information was being gathered to be used to “screw the insured down the road” as the claim ages and further that while he did not like his job but that was what he was assigned to do and it was common knowledge among his adjusting group. I am quoting him and not paraphrasing so forgive my language. Just so it’s clear, this first claims adjuster was not sent out to adjust and pay the insured, but to document damage to be used against the insured down the road. I don’t know if this is criminal, but it’s certainly egregious and disgusting. While people are living in shelters, at least one insurer is putting the gathering of data ahead of adjusting claims. As a public adjuster the insurance industry often labels me as the dishonest guy who is responsible for taking advantage of people and driving up rates. If the discussion of taking advantage of people is in play, some insurance companies might need to take a look in the mirror. If you are a policy holder you need to be alert.