FAQs
BEST INFORMATION ON THE INTERNET FOR INSURANCE CLAIMS.
(1) Why do Public Adjusters exist? They exist because in matters of insurance the policyholder is often grossly underpaid for his insurance claim by his insurance carrier when there is an unexpected loss. Insurance companies are in business to make money. Just like a casino, their profits are higher if their payouts are less. The mission is achieved when the carrier's adjuster pays out as little as possible on a claim.
Bloomberg, a reputable business magazine, says that state insurance departments and civil court cases in the United States show insurance carriers frequently pay up to 70% less than the cost of actually rebuilding a damaged building- even when those companies assure property owners that they are fully covered. There are thousands of documented complaints on record. “The 60 million U.S. Homeowners who pay more than $50 billion a year in insurance premiums are often disappointed when they discover insurers won't pay the full cost of rebuilding their damaged or destroyed property. The insurance companies routinely refuse to pay market prices for homes and replacement cost of contents, and they use computer programs to cut payouts. They change policy coverage with no clear explanation. They ignore or alter engineering reports and they sometimes ask their adjusters to lie to their customers, as interviews with former employees and state regulators show.” These are problems which cannot be simply dismissed.
Additionally there are other factors that explain why insurers frequently underpay their claims. Our own experience at AUDUBON has been that such carriers will often send out adjusters to a loss who are inadequately trained. These employees usually have received only a few hours in the classroom and they are incapable of making sound clear decisions about what needs to be done. They are inevitably hampered by their limited skills. The bottom line is that given this poor training they cannot accurately assess the damages that are covered nor can they properly determine which coverages may actually apply to the loss. Furthermore, they do not possess the experience to know the full range of cost involved in property damages. Therefore, they will leave out some of the cost and overlook others.
All of these facts mentioned above are legitimate reasons why insurance carriers are so very much distrusted. Based upon this information it is understandably reckless and irresponsible for a policyholder to take such a chance by relying solely on the opinion of an insurance carrier for his claim. There is too much at stake for him. He has a large investment that is definitely at risk. And the odds of him fully recuperating his loss, returning the property like it was, is not very good.
Like it or not, in this day and age, the policyholder needs to be an informed consumer. In order to do this he has to seek out help for himself. He needs to find someone to look out for him the same way that the insurance carrier has their guy looking out for them. The policyholder needs someone working on his behalf who can level the playing field and aid him to recover all that he is entitled to for his loss- somebody who can make sure that the terms of his policy are fulfilled. The policyholder needs a professional, a person with the expertise in these types of matters. That person must know both insurance and construction, and also be an expert with negotiating skills. Most importantly, he must be effective. This kind of a professional is called a Public Adjuster.
(2) What does a Public Adjuster, a PA, typically do? A PA is a professional whom is contracted by a policyholder to negotiate the best settlement for him on an insurance claim. The policyholder pays nothing to the PA until such time as there is an actual settlement. Meanwhile, the PA works closely with the policyholder to make sure the claim is done fairly and promptly. The PA reviews all insurance coverage, inspects the loss, analyzes the damage, and assembles all of the claim data support for the policyholder's insurance claim. Thereafter, he will then proceed to represent the client with the most effective approach for his claim. At AUDUBON, we have SUCCESSFULLY COLLECTED AS MUCH AS 1000% MORE THAN THE AMOUNT OFFERED BY THE INSURANCE CARRIER.
(3) What kind of services are offered by a PA? AUDUBON is a turn key operation. We handle Full Adjustments, Damage Appraisals, FEMA Public Assistance Counseling, and that of Referral Counseling. Full Adjustments can either be a New Claim handled for the client in it’s entirety from the beginning to the end, or a Reopened Claim handled for the client who first tried to obtain a fair settlement but was unable to do so (a frequent occurrence). A Damage Appraisal is an estimate of property damage prepared for a client’s own personal use. Such personal use may include a variety of purposes like Insurance Claims, Legal Matters, Real Estate, Mortgage Obligations, Income Tax, Property Tax, or in a disaster situation FEMA Requirements (Federal Emergency Management Agency) for a loan or grant on property damage exceeding the limits of an insurance policy. As a FEMA Public Assistance Consultant we offer advice and guide a FEMA grantee sub-grantee through the complicated grant application process after a disaster. This service can be provided for an extra fee so that one can get additional assistance for his loss. Money obtained from FEMA is in the form of a grant or a loan for the amount of property damage not paid by the insurance company. Referral Counseling helps one to find alternate qualified PAs within a particular location.
(4) Why shouldn't I handle my insurance claim myself? Why a PA? First, a PA works for the policyholder not the insurance carrier. This means that the PA looks out after the policyholder's interest exclusively. Secondly, a PA usually can obtain a much larger settlement on an insurance claim than one can by doing it own his own. According to the Program Policy Analysis & Government Accountability (OPPAGA- of the Florida Legislature, Report No. 10-06 January 2010) PAs often get more money. In Catastrophe situations of recent years those policyholders represented by a Public Adjuster received payments of 747% higher than those policyholders who did not use a Public Adjuster. For non catastrophe claims, policyholders who used Public Adjusters received payments that were 574% more than policyholder's who didn't use a Public adjuster. Thirdly, a PA is the most cost effective way to acquire representation for a claim. He is a professional who deals with construction and insurance policies on a daily basis. No one else is more qualified with both fields of endeavor as a unified application. Fourth, a PA can help one to get a settlement more quickly than he could if he handled his claim on his own. The period following a loss can be very stressful. A typical insurance policy contains hundreds of provisions and stipulations to be navigated. Plus, there are inventory appraisals and real estate evaluations required to put forth a claim. PAs know their business and are familiar with procedures that will enable one to move towards an acceptable end avoiding the unnecessary diversions- they cut through the red tape. Simply put that means you get paid much faster.
(5) What kind of a client does a PA service? We provide help with property matters for homeowners, businesses, and government entities- all policyholders having an insurable interest. This would include the insured with rental properties which are residential and commercial buildings, apartment complex proprietors, condominium owners, local-state-federal government bodies for their buildings with contents and related equipment, etc.
(6) With what kind of a loss may a PA be of help? We handle damage claims for Fire, Lightning, Hail, Collapse, or Landslide, Hurricane/Tornado/Wind, Mold, Smoke Damage, Vandalism, Earthquake, Explosion, Theft, Frozen Pipes, Sonic Boom, Glass Breakage, Mysterious Disappearance, Falling Objects; Aircraft & Trees, Power Surge To Electrical Appliances, Mechanical and Electrical Breakdown, Bursting Of Hot Water Appliances, Accidental Discharge/Sudden Leaks From Pipes, Riot Or Civil Commotion, Consequential/Spoilage, Weight Of Ice & Snow, Builder’s Risk Loss, Interruption Of Business Income, Leasehold Interest, Extra Expense & Expediting.
(7) What should I do in the event of a property damage loss? Contact AUDUBON ADJUSTMENT and we will get in touch with your insurance carrier to get the process started for you? We will then help you to put together the information needed that justifies your claim. Finally, we will negotiate a settlement with your insurance carrier that is in your best interest. In the meantime, you should take photographs of the loss as a precaution to build evidence for the damage. Furthermore, you are required by your policy to take all necessary steps that will prevent further damage. You must do whatever you can to limit the extent of your loss.
(8) How long does it take for a PA to handle a claim? Some claims can settle in a few days. And others may go on much longer depending on the circumstances. Overall, we at AUDUBON are known for our ability to settle claims quickly.
(9) How does a PA get paid? A PA gets paid a small percentage of the gross amount of the settlement when he conducts a Full Adjustment. And he gets paid a smaller percentage of the gross estimate when he does only the Damage Appraisal.
(10) What do I have to do to engage a PA's services? With AUDUBON you get a FREE INITIAL CONSULTATION. Then, for a Full Adjustment, you sign a Retainer that contracts our adjuster to start to work on your claim. For a Damage Appraisal you would simply have to sign a Damage Appraisal Agreement.
(11) What is the process after I have signed the Retainer for a Full Adjustment? First, you would cooperate with the PA while he is preparing the necessary information that will be used to satisfy your burden of proof. After meeting that obligation, the PA will present the compiled information to your insurance carrier. Thirdly, the PA will enter into negotiations to help settle the claim on your best behalf. Subsequently, a check for your loss will be sent directly to the PA. He, in turn, will provide this check to you in exchange for the payment of his services.
(12) What is the process after I have signed a Damage Appraisal Agreement? The DAMAGE APPRAISAL itself will be completed and provided to you in return for the payment of the PA’s services. Such payment is due upon the presentation of the APPRAISAL.
(13) What if I handled my claim on my own and then was dissatisfied with the insurance carrier’s offer/settlement, could I still hire a PA? Yes, most definitely you could if you have not already signed a Release. We will be very glad to help you with that. AUDUBON, to it’s credit, has a 100% SUCCESS RATE WITH REOPENED CLAIMS. Our PA’s are very skilled at determining what needs to be done to resolve these matters. However, the fee for a Reopened Claim is the same as a New Claim. There is no cost advantage. The reason for this is that a Reopened Claim will have to be reworked in it’s entirety for the PA to discover exactly what has gone wrong with it. Such a job will require the same amount of time and labor as a New Claim- sometimes even a little bit more wherever there are complications. Bottom line, it is really more in one's favor to hire a PA for the Full Adjustment in the beginning whenever he first learns that he has damage.
(14) Can I hire an attorney to represent me if the PA was unable to settle the claim? Yes, you can. Most of our clients hire a PA first because the fee is cheaper than an attorney. Then should the claim become a legal matter they can obtain legal services. This arrangement can be a plus. In fact a PA can work with one’s attorney to help supply related evidence already compiled on the matter in question. Also, he can appear as a material witness in the litigation. We, at AUDUBON, work closely with attorneys everyday helping them to prove their case. They like our files because they know the information will stand up in court. The work is strong. And it get results.
(15) Is it possible to get an advance from my insurance carrier while my claim is being settled? Yes, depending on the circumstances of your loss. Give us a call about your particular situation. We will be happy to discuss it with you in confidence.
(16) What is subrogation? That is when one has received damage to his property and another party is responsible/liable for the damage. The cost of the damage would then be paid by one’s insurance carrier. And they, in turn, would retain the right to recover such costs from the party who is responsible/liable.
(17) What is a forced placed policy? A forced placed policy is when a property owner with a mortgage has defaulted on his insurance and the mortgage company takes out a policy to insure the unpaid portion of the mortgage. At that point the mortgagee is the only party who retains an insurable interest in the property. The homeowner therefore is no longer eligible to make a claim for any given loss when only the mortgage company's interest is insured.
(18) Can one ever receive more money in an insurance settlement than the amount that is shown on the face of his policy? Yes he can. IT IS ACTUALLY POSSIBLE IN SOME CASES TO GET AS MUCH AS 125% OF THE POLICY LIMITS. This type of recovery can take place wherever certain provisions of an insurance contract have been set in motion by the extent of the loss. Each claim must qualify in order for it to receive the extra money. AUDUBON can check on yours for you.
(19) If an insured has multiple policies whereas a building is destroyed by a covered peril from each policy, is there a way to sort out the damage for each one of them? The answer is yes. We saw a lot of instances with this issue after Hurricane Katrina. The question was to what extent was there wind damage or water damage to coastal buildings that were damaged by both. Plenty of the claims were resolved by Public Adjusters but precedent cases were determined in the courts as well when the issue became a legal matter for certain groups of homeowners. Often forensic science was the tool that PA's used to sort out this kind of a problem. But PA's have other methods as well.
In some cases the insurance company for the wind would claim a building was damaged by flood and that the wind insurers owed nothing when in fact it was later proven that the building was destroyed by wind that came prior to the flooding. The wind carrier was then found to owe for all damages as the wind was the main cause for damage. To the contrary, in other cases the damage had to be apportioned to both the wind and the flood coverage. Each one individually had some cause in the loss. The degree would vary. And in a third situation the flooding was found responsible for all of the damage by itself. Every case depended on its own conditions and required a skilled professional to determine the best way to analyze all of the circumstances. Multiple policy issues are much more complicated than those of a single policy concern. They have to be analyzed in more of a comprehensive manner so that the coverage questions can become fully apparent and properly addressed to the extent of their implications.
(20) Why would an insurance company only pay out a small amount of money for only one peril whereas there has been a large loss with multiple covered perils under a single policy? To be sure, we would have to see your damage and analyze it before we could make an accurate decision whether the carrier would actually owe more. When I think of this question I think of the case of windstorm issues whereas a building is damaged due to wind, water, and mold. The mold coverage could be limited to a smaller amount than is on the face of the policy. This is called a sub-limit. A situation like this is often misconstrued by an inexperienced company adjuster. He may be easily misled to believe that most of the damage is the result of one peril only, namely the mold. Accordingly the insurance company would only have to pay for a small portion of the total damages. Obviously that point of view is incorrect. Here the PA has to rely on the intent of the policy to put things into perspective for the company adjuster. Each case could be different depending on the situation but in general we at AUDUBON have found most carriers to be liable for all of the damage, not just a small portion. After careful examination of the situation we can usually show the company adjuster where he has made an error and an amicable agreement can be reached. Consequently, the full amount of the claim would necessarily be paid.
(21) Is it possible for a peril to be in effect a covered peril at certain times yet not to be a covered peril at other times? Yes. Believe it or not, it is true. Depending on the type of a policy one has there in fact may be certain conditions required to take place prior for a particular peril to become one that is recognized as being covered. An example of this would be the case of rain damage to the interior of a building or the theft of personal contents from one's home. Each one requires other events to accompany them in order for them to actually become a covered peril. A PA well versed in the conditions of a policy will be able to identify your policy and locate such conditions to let you know how they apply to your particular situation.
*** Feel free to contact us about other questions not covered by FAQs along with general questions such as “What is the best way to handle an insurance claim?”, “How to make an insurance claim for Fire Damage, Wind Damage, Flood Damage,etc.?” You can call us at (601) 433-7516 or send a completed Contact Form from our Contact page on this web site. Click on Contact atop of this page. Click Contact Form. Complete and click send. ***