Homeowner Insurance Claims: Six Things You Need to Know

Homeowner Insurance Claims: Six Things You Need to Know
You’ve notified your insurance company, what’s next?

Mark Wolfe, Attorney

“Many homeowner and commercial property insurance policies have a dispute resolution provision for valuation disputes. However, these provisions vary from policy to policy and often have legally binding requirements that must be complied with in order to resolve the dispute.”

As thousands of us along the Alabama and Florida Gulf Coast begin the recovery process after Hurricane Sally, many of us will be having to make insurance claims for damage to our homes and property. Here are some important things you need to know about your property damage and/or homeowner insurance claim. Keep in mind an insurance policy is a contract between you and your insurance company that details what each party must do related to a loss. Your failure to comply with these requirements can be grounds to void coverage! Also, when you are making an insurance claim it is your burden to prove the loss with proper documentation and credible evidence.

 

1. Notify Your Insurance Company Immediately. Most insurance policies require notification of a potential claim as soon as possible. A delay in notifying the insurance company of a potential claim could result in a denial of coverage.

2. Document & Mitigate Your Damages. There is no such thing as too many photographs or videos of your damage. Also, your policy requires you to undertake reasonable steps to help minimize the loss. This may mean putting a tarp over roof damage to prevent more damage or putting plywood over broken windows. Failure to mitigate your damages can result in the denial of benefits or reduced benefits. If you can not get to your property to assess and/or mitigate your damages because of government restrictions, make sure to print or screen shot the restriction.

3. Review Your Policy. There are several important things to know about your policy and the coverage it provides. While there is no “uniform” homeowner policy, most contain the following sections and parts. The starting point in your review is the Declarations Page. This tells you the amount of coverage available for the various losses and should document what real property is covered by the policy. It should also document the deductible for each claim. The Terms and Definition sections defines a “covered loss” and any exclusions as well as all the other relevant terms used in the policy. The Property Damage section of your policy outlines the what real property and personal property will be covered under the policy and it usually explains the loss of use coverage. The Personal Liability portion of the policy explains the personal protection afforded to you for liability claims made against you or a member of your household for negligence or careless actions. The Additional Terms & Conditions section of the policy may contain legal provisions such as assignment of benefits, subrogation and dispute resolution procedures.

4. Be Careful in Your Conversation with the Insurance Company. Always be truthful but only provide facts you know to be true. After a storm, insurance adjusters are working hard and moving quickly. Often when reporting your damage the insurance company will ask about other damage. If you assume you have no other reportable or claimable damages and say you have no other damage then the adjuster may not give your house a full inspection when he or she comes to adjust your loss and write an estimate. Always ask that the adjuster give your home or property a full and complete inspection. They are trained to identify damage and they may see storm damage that you did not realize.

5. What to do if  You and the Insurance Company Don’t Agree. Generally, there will be two potential areas for disagreement: coverage and valuation of the loss. If your insurance company is denying coverage for the damage then you have a right to have the denial in writing. Generally, you should ask for a written explanation of the denial and ask for a specific reference to the policy provision that supports the denial. E.g., A policy may exclude flood or rising water damage. Have the written denial letter and the policy reviewed by an experienced insurance claims attorney as soon as possible. If you disagree on the valuation of the loss, e.g., repair vs. replace, then you may want to consult with an experienced insurance attorney. Many homeowner and commercial property insurance policies have a dispute resolution provision for valuation disputes. This allows for a resolution without having to file a lawsuit! However, these provisions vary from policy to policy and often have legally binding requirements that must be complied with in order to resolve the dispute. Some States even allow for the recovery of attorney fees if you are successful

6. Consultations are Free! Almost all lawyers who represent people who have a dispute or disagreement with an insurance company provide free consultations. Many of these lawyers will represent a claimant under a contingency fee contract; that is, no money recovered for you, no fee owed. However, the percentage charged can vary greatly from law firm to law firm. Some may charge 15% of the total recovery while others may charge 25% of the amount in dispute. Also, some lawyers may advance the expenses related to the matter while others may require you to pay those expenses directly and as incurred. If you hire an attorney to assist you with your claim, you should know exactly how the fee will be calculated and how expenses will be handled. You should always get a copy of the representation agreement. If you don’t get a copy of the agreement at least send a written confirmation of your understanding as to how fees and expenses will be handled.

If you are an Alabama or Florida Gulf Coast resident and you have a question about your insurance claim, please contact Boteler Richardson Wolfe – Attorneys at 251 433-7766. We’ve been helping Gulf Coast residents with insurance claims since 1987. Offices in Mobile, AL  and Foley, AL

 

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

 

The insurance adjuster wants to take a recorded statement from me. What do I need to know?

5 Things you Need to Know BEFORE Giving a Recorded Statement to the Insurance Company.

by Mark Wolfe

NUMBER ONE: Set up the recorded statement for a time and date that is convenient for your schedule and get a transcript or copy of your statement. As you will see below you will need to do some basic preparation before your give your recorded statement so make sure you schedule the statement in advance so you can prepare. Also, make sure you have enough time for the statement so you are not rushed or hurried. Most recorded statements do no last more than fifteen to thirty minutes, but you may want to allow up to an hour just in case it runs longer. Ask if you will be given a chance to review the statement or at least be given a transcript or copy of the statement. [Most legitimate insurance companies will provide a copy but you must ask for it.] If the adjuster wants to know why you want a copy you can explain it is simply to make sure the transcript is accurate and that you would like to have a chance to correct any misstatements, inaccurate responses or mistakes you may have made. If the company agrees to give you a transcript or copy, verify this in a written communication. Some companies such as Omni Insurance Company now require the claimant to pay $15.00 for a transcript of the recorded statement. Even if you have to pay for the copy or transcript, it’s worth it to make sure it is correct.

NUMBER TWO: Prepare for the recorded statement: 1) Review the accident report before giving the statement. If you do not have the accident report, get a copy or ask the adjuster to furnish you with a copy before scheduling the statement. [Again, most legitimate insurance companies will mail, fax or e-mail you a copy of the accident report but just as with getting a transcript of your statement, you have to ask for it.] 2) Make sure you know your direction of travel and the name of the road you were on. You will also need to be able to identify the direction of travel for the other driver and what road he or she was on. 3) Make sure you know the time of the collision. 4) Review in your mind your route of travel and be able to tell the adjuster where you were going and the purpose of your trip. 5) Know the names of all passengers and if possible their contact information, especially if you believe they can help validate your account of how the collision occurred. 6) You will need to know the weather conditions and if safety belts and/or child restraints were being used by you and your passengers. 7) You will need to be prepared to describe the property damage to your vehicle and the other involved vehicles as well as describe the post-collision position of the vehicles. 8) You will need to have the contact information for any witnesses known to you. 9) You will probably be asked for information about your employment such as how long you have been employed, the type of work you do and your job’s physical requirements, your pay rate and the name and telephone number of your immediate supervisor. NOTE: If you are making a lost wage claim or loss of revenue claim, you can anticipate a more detailed inquiry into these areas. 10) If you were injured, even slightly, you need to be prepared to describe your injuries with specificity and in detail. Your description of your injuries should always be honest and never exaggerated but you need to make sure all injuries are mentioned. Bruises and small contusions from seat belts are often forgotten or not mentioned as are small cuts or abrasions. If you have received medical attention, or are still receiving medical care for injuries from the collision, be sure you have the healthcare providers name, address and telephone number available and be prepared to tell the adjuster about the number of visits and what you have been told about your injuries. Also, if you were injured in the collision and making a bodily injury claim for medical bills and related damages, be prepared to answer questions about your past medical history, i.e., other similar injuries, other prior accidents or incidents, etc.

NUMBER THREE: What to do when giving the statement: 1) Relax and try not to be nervous. 2) Be polite and use yes or no instead on unghn-hughn or ungh-ungh’s. The later responses can be very difficult to discern and transcribe and are easily transcribed incorrectly. Also, remember this may be your only chance to interact directly with the insurance company. For the remainder of the claim process, you are primarily just another claim number to the insurance company. You want to make a good impression. See Claimant Profiling information in Suggestion Five. 3) Answer the question. Many times people go into a long narrative in response to a simple question. Try to be concise and accurate in your response. 4) Confirm on the record that you will be getting a transcript or copy of the statement. Many companies will now send you a digital sound document of your statement by e-mail. 5) If you were injured in the collision and anticipate making a bodily injury claim, ask the adjuster on the record and at the end of the statement if he or she has a preferred healthcare provider or doctor you need to go see to verify or validate your injury. Most of the time at the end of the statement the adjuster will give you an opportunity to say or add anything to the statement and this is the perfect time to ask the adjuster about a preferred healthcare provider. WHY THIS IS IMPORTANT. Most companies do not have preferred healthcare providers for you to see and most will not ask you to see a doctor of their choice to validate the claim, but by offering to do so, you are telling the adjuster early on that your injury claim is legitimate and meritorious because you are willing to allow them to “independently verify” the truthfulness of your injury claim. Obviously in catastrophic injury situations or broken bone claims, this offer is not as important, but if you have a soft-tissue injury such an offer can help establish in the adjuster’s mind that your claim is legitimate and you are not trying to present a fraudulent or exaggerated claim.
NUMBER FOUR: What not to do when giving the recorded statement: 1) Do not exaggerate or overstate any aspect of the collision or your injuries. Be honest and candid in your account of the collision and your injuries. 2) Do not speculate. If you do not know an answer it is OK to say you do not know; however, try to give an estimate if at all possible. NOTE: Excessive use of “I don’t know” is often considered by adjusters as being deceitful or not completely honest or candid. 3) Do not give out personal information such as your date of birth and your social security number during the statement. You can confirm the last four digits of your social security number but in this day and age of identity theft it’s better not put your personal information into a statement that will be transcribed by someone you do not know. Understand the adjuster will need this information to process your claim. We are not advocating that you not provide said information, we just do not believe the recorded statement is the appropriate place to disclose said information. Often times this information can be confirmed with the adjuster after the statement is over and the recorder turned off. 4) Do not agree with any commentary or suppositions asserted by the adjuster about your actions or details of the collision. In other words, do not let the adjuster “put words in your mouth.” NOTE: Most legitimate insurance companies do not allow adjusters to do this, but some companies encourage, or do not strongly discourage, this type of gamesmanship by their adjusters. Some examples: “So you’re saying you’re really not hurt that bad and aren’t going to need medical care.” – “OK, if I understand what you’ve said, you’re not really really 100% certain the accident was our insured’s fault.” – “Based on what you’ve told me so far, wouldn’t you agree that you could have avoided this collision if you would’ve swerved just a split second sooner?” – “So based upon what you’ve told me about your work requirements, wouldn’t you agree you could probably be working even though your doctor told you to stay off work for two to three weeks.” If you find yourself confronted with this situation, you can simply tell the adjuster you are not going to agree or disagree with any of his or her characterizations. Also, if you do not believe the adjuster is being fair to you because of these type of forced questions, stop the statement. Giving a recorded statement is a courtesy and if the adjuster is going to abuse that courtesy then you have a right to stop or cancel the statement. NOTE: If you stop or cancel the recorded statement for whatever reason, send a written communication to the adjuster documenting why you felt it necessary to cancel or adjourn the statement. If you do not believe the adjuster was being fair or if he or she was rude and/or ugly, describe the adjuster’s behavior in detail.

NUMBER FIVE: A few last things to consider. 1) While the adjuster’s main job in a recorded statement is to gather information related to the claim, he or she will also be gleaning notes for your “Claimant Profile.” Most major insurance companies now use some sort of “claimant profile” in the claims process. A claimant profile can be very detailed and complex or it can be something very simple but the main idea is to bring into the claims process some sort of general assessment about the personality and background of the claimant. We live in the information age and information is power. The more information about you an insurance company can gather the more accurate their profile of you will be. This profiling can be very complex and include personality traits, such as “likelihood to consult an attorney,” “easily discouraged,” “financially distressed, “ ”very anxious and impatient for claim resolution,”etc. The company will have also reviewed your past insurance claims history and may bring that into your claimant profile: “Past bodily injury litigant.” Your driving history will also be pulled in to your claimant profile. How you handle yourself during the recorded statement may also find it’s way into your claimant profile: “Claimant was polite and well spoken during statement. High credibility assigned.” So remember to be polite and courteous during the recorded statement. 2) Try to be understanding of the adjusters job and position. While most adjusters handle themselves in a professional and civil manner please remember because of continued cut-backs by insurance companies, most adjusters are overworked, underpaid and mostly unappreciated by their company. Sometimes the stress of their job is reflected in the way they communicate with claimants. So even if the adjuster is having a bad day, try not to react in-kind. Stay calm and polite. Finally, 3) if the insurance company sends you a transcript or digital recording of your statement, take time to review it as soon as possible. Send a written communication to the adjuster with any corrections. Also, if you think one of your responses may need further explanation or more details, make the additions in the written communication.

If you would like a free consultation with Mark (or any of our attorneys) about your insurance claim, please email him at mark@brwlawyers.com or send a text to 251 533-9548 (cell). You can also call Mark directly at 251 410-7761.

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.