The Housing Scene

As too many homeowners have learned after a major loss, obtaining a full and fair settlement from their insurance companies isn’t a given.

Too many insurers tend to lowball their damage estimates, hoping the insured will accept their offers and go away. The job of their adjusters is to pay out as little as possible; after all, these are money-making businesses, and the less they pay, the more profitable they are.

Consequently, you must take every precaution to protect yourself and make sure you receive what you deserve. “Be vigilant,” says J. Robert Hunter, director of insurance at the Consumer Federation of America (CFA) and a former federal insurance administrator who ran the National Flood Insurance Program. “You paid your premiums and you are entitled to coverage.”

Hunter admits not all insurance companies handle claims poorly, so “go into the claims process with an open mind. (But) be ready to stand up for yourself and your family, or you run the risk of being shortchanged.”

Every time there’s a national disaster, such as hurricanes Harvey and Irma, the CFA sends out a bulletin outlining the steps consumers should take to ensure they obtain fair payment for their losses. You can go to the CFA website (consumerfed.org) to obtain the latest one, dated September 2017.

Here’s a synopsis of the latest tips:

-- File your claim promptly. Insurers tend to handle them on a first-come, first-served basis.

-- Obtain and save your claim number. The quickest way for claims departments to find your file is with this all-important number.

-- When an adjuster arrives to survey your damages, find out if he’s an employee of your insurer. If he’s not, he’s an independent adjuster hired as a contractor by your insurer. So find out if he’s authorized to make claim decisions and payments on behalf of your insurer. Also ask for the name of the in-house company adjuster to whom he is sending your information.

-- Many insurance companies have repair programs in which they offer to send out one of their approved contractors to estimate your damage and repair it. Nothing wrong there, but you are under no obligation to use them. You are free to obtain your own estimates, perhaps from contractors you have used in the past and are satisfied with.

-- Keep good records, including the date, time, name and a brief description of every exchange you have with your insurer. If an adjuster misses an appointment, make a note. If possible, take your own photos of your damage. And keep receipts when you pay out-of-pocket for emergency repairs -- and alternate living arrangements, if the house is uninhabitable.

-- If your claim is denied, demand that the company identify the language in your policy that serves as the basis for its decision for offering you so little, CFA’s Hunter advises. “This approach has several benefits,” he says. The insurer may be right and you may not know it, so by pinpointing the appropriate language, you can make your own determination.

-- The company may have slipped new limitations into your policy without adequately notifying you. For example, many insurers have added percentage deductibles, which shift a greater share of the loss onto you, but some have not have given customers the option to select the level of coverage. If that’s your situation, it’s time to consult an attorney.

-- Be aware of other new limits that may have been added recently. One such limit is a ceiling on replacement-cost payments that says insurers no longer cover the additional costs involved in bringing a damaged house up to current building codes.

-- Once an insurer gives you the reasons for its actions, it cannot produce new reasons later. “You have them locked in, which is an important protection,” says Hunter.

-- If you review your policy and find that, under a reasonable reading, you think you’re entitled to the full amount of your claim, “you will likely win if you go to court,” says Hunter. “Courts consistently rule that if an insurance policy is ambiguous, the reasonable expectation of the insured party will prevail since the consumer played no part in writing the language.”

If you believe the insurer’s offer is too low, complain to more senior staff. Hunter suggests going to the executive in charge of consumer affairs, who is paid to keep policy-holders happy. Refer to the records you’ve kept since the claims process began.

“The more serious the insurance company sees that you are in documenting how you were treated, the more likely they will make a more reasonable offer,” says Hunter.

Also, complain to your state insurance department. Every state will seek a response to your beef from your carrier. And some states will actually intervene on your behalf.

According to Hunter, “if your treatment by your insurer was particularly bad, courts in many states will allow additional compensation if the company acted in bad faith.”

Other choices: Contact a lawyer or a public adjuster (PA), an adjuster who works on behalf of consumers, as opposed to insurers. Many PAs once worked for insurers, and know the world of policies and coverage inside and out.

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