Appraisal Umpire May Be A Policyholders Only Chance To Resolve An Insurance Claim Dispute
Many claims result in an insurance claim dispute. For many claims the Appraisal Umpire may be the policyholders only real chance for a fair claims settlement. Unfortunately, insurance claim disputes occur every day of the year. What causes such disputes? The first and most obvious reason is that almost all policyholders believe that they are entitled to a larger settlement than what their adjuster has provided. Others occur because many insurer’s goals are to pay as little as possible on claims. Another common reason is that claims that should be covered are often denied by insurance companies. Many other reasons as well can result in a dispute.
There are many ways one can deal with an insurance claim dispute. Most would want to engage in the aggressive approach. It can be hard to keep your cool sometimes, however, it’s never encourage to use aggression. Overpowering aggression will surely cause a further delay on the settlement. In most instances the disagreements and disputes associated with an insurance claim can be settled quicker using a civilized manner. Don’t take it personal, the two parties are allowed to disagree. Insurance damages shouldn’t cause a brawl. There are several options that are more productive. The approach a policyholder uses will depend largely on the level of the damages associated with the claim.
For claims where the two sides are an impasse, it’s advised to first obtain the name and phone number of the adjuster’s supervisor. This can be done by calling the company directly or simply asking the adjuster for the information. Call the adjuster’s supervisor and/or the complaint department and advise them of your problem. They may be able to help you right away and agree with your side of the story. The policyholder can also request a “reinspection” of the damages by another adjuster. It’s a good idea to request that a “General Adjuster” be the one to reinspect the claim. A General Adjuster usually has 15+ years experience. It is also important to obtain the name and extension of the person who you spoke with in the complaint department as well.
If you have a dispute about repairing a structure that has suffered a large loss, you can hire an engineer to provide an analysis report of the damages. If the result still has not satisfied you there you should file a complaint at Department Of Insurance in the state you live in.
Unfortunately, you may find yourself in a position where you still cannot ascertain a fair settlement for your claim, even after all this. It can be very frustrating, however, you still have options. Options that are located directly in your policy that protect you. For more information and to have all your questions answered, call (919) 669-9111. The consumer information hotline can answer all your questions for claims and disputes related to flood, water, fire, smoke, tornado, wind, hail, even hurricanes and theft. The trained personnel are available to assist you with all the available options you are entitled to under the policy.
In conclusion, if you are still under the impression that you have not been treated fairly, after you have applied all the above-mentioned options, you can always turn to the clause buried deep in your policy called APPRAISAL. The Insurance Appraisal Clause allows each party of the dispute to settle their differences without litigation. It’s similar to an arbitration. (For a complete explanation of the Insurance Appraisal Clause and process visit http://www.insuranceappraisalprocess.com ).
This appraisal clause calls for an impartial, competent, and unbiased Appraisal Umpire that works with two independent appraisers. The three get together to review and settle the differences between the estimates and damages. The Appraisal Umpire is the tie-breaker that allows policyholders to obtain a fair claim settlement. Being that the Appraisal Umpire has absolutely no interest in the outcome of the dispute, it concludes with a decision based solely on the facts presented to them.
(C) Joseph Brennan is President and owner/operator of Insurance Claims Group, Inc., a national independent adjusting, appraisal, and umpiring firm. We will answer your claim questions FREE – Ph: 919-669-9111 . Get Appraisal Umpire Help, by visiting http://www.insuranceclaimsgroup.com or http://www.insuranceappraisalumpire.com
Independent Appraiser and Insurance Appraisal Protects Policyholders
Almost all insurance policies have an appraisal clause that allows the parties of the insurance contract to resolve disputes that may arise during a claim. Appraisal is for the “amount of loss,” only. This is the amount of monies it will cost to fully complete the repairs caused by the claim damages. For instance; policyholders could be forced to use an independent appraiser to settle their differences with the insurance company, using the appraisal process to protect their interests.
In a recent Texas case, JM Walker, LLC v. Acadia Insurance Company, reveals how an independent appraiser and the appraisal process protected a policyholder from mistakes made by the insurance company. Mistakes that could have cost the policyholder “hundreds of thousands of dollars!” Each situation can be a bit different simply by how the appraisal clause is worded in the policy, by the type of damage that occurred, and by all the facts pertaining to the loss.
The insured, JM Walker insured five buildings in North Richland Hills, Texas. A severe hailstorm damaged the roofs on all five buildings. As any insured would, Mr. Walker submitted the claim to Acadia, the insurance company who insured the buildings. The adjuster from Acadia denied payment on the claim at first. The adjuster determined that the roofs had minimal damage from the hail and did not require full replacement. This analysis resulted in non-payment because the adjuster’s estimate was under the $5,000 deductible.
It’s no surprises that Walker did not agree with the assessment of the adjuster. The two parties could not reach an agreement, so Acadia invoked the appraisal clause. Mr. Walker submitted the matter to a district court by filing a lawsuit. However, the Judge got both sides to continue with the appraisal process. It is not uncommon that courts will rule this way, as most insurance policies will require that all the policy provisions be exhausted before either party can litigate against the other.
The appraisal clause states that each party will hire an independent appraiser. The two appraisers will then choose an umpire. If the two independent appraisers cannot agree on the amount to repair the damages they will submit their differences to the umpire. The umpire in this appraisal agreed that the roofs required replacement and produced an award favoring Mr. Walker in the amount of $423,053.96. Appraisal awards are binding. In turn, Acadia had to pay the full amount of the award. (I should remind you that Acadia’s adjuster first determined the loss amount to be $0 because they believed the damages were below the $5,000 deductible.)
JM Walker filed an appeal in the United States Fifth Circuit. Walker believed he was entitled to more insurance proceeds for his damages, plus was seeking additional monies for which he believed was “bad faith” conduct by Acadia and their poor handling of the claim.
The Court stated that under Texas law, “appraisal awards made pursuant to the provisions of an insurance contract are binding and enforceable, and every reasonable presumption will be indulged to sustain an appraisal award.” The Court also stated that an otherwise binding appraisal may only be disregarded in three situations:
(1) when the award was made without authority; (2) when the award was made as a result of fraud, accident, or mistake; or (3) when the award was not in compliance with the requirements of the policy.”
Mr. Walker argued on all three points and was dismissed by the court on all three. This appraisal is a good resource of how the courts respect the conditions of the appraisal process in Texas. In my opinion, the Independent Appraiser and the insurance appraisal process protected the policyholder. The work by the Independent Appraiser and the Appraisal Process was responsible for Walker receiving $418,053.96 over what the insurance company was willing to pay on the claim.
In the event that you find yourself in an insurance claim dispute, you should highly consider calling an Independent Appraiser for assistance in the insurance appraisal process. Insurance Appraisal Services is all we do. Feel free to call Insurance Claims Group, Inc. at 919-669-9111 to have all your insurance appraisal questions answered.
(C) Joe Brennan is President and owner/operator of Insurance Claims Group, Inc., a national independent adjusting, appraisal, and umpiring firm. We will answer your claim questions FREE – Ph: 919-669-9111 . Get Independent Appraiser Help, by visiting http://www.insuranceclaimsgroup.com or http://www.fireinsuranceclaims.net
